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epilepsy and hypoxia

By Anonymous May 27, 2011 - 12:41pm
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My quesiton / situation is probably a bit unusual, but hopefully it makes sense after reading it. Once you read this you will understand why I am hesitant to identify myself.

When I was 14 or so I had 2 episodes of grand mall seizures. My first seizure happened on a commercial flight from Los Angeles to San Franciso, apparently just after take off as the plane was climbing. I lost recall of the few hours before the flight. When I regained consiousness I was confused and found myself belted in a seat (as normal) with a flight attendant and a couple passengers standing next to me. I was a 14 year old kid, so I think people were more worried than normal. The flight attendant asked me if I had epilepsy, which I had no idea what that was at that time. The FA told me that the paramedics had been notified and would be waiting for me upon arrival as they could not let me leave on my own because of my age. I recall the flight continuing on for what seemed like an eternity to me. The flight arrived on time or close to it, but due to the event I lost all concept of time and no longer wanted to be where I was. I suspect the reduced oxygen levels were also agitating my feelings. Upon landing, the passengers were forced to wait for the paramedics to board the plane for me (somewhat embarrassing). Then they treated me and others deplaned. I was escorted off and placed onto a guerney and wheeled to the awaiting ambulance and taken to a hospital. My mother and the police were waiting for me as I was admitted into the ER. Apparently the police were concerned that I may have taken some drug which caused this. No drugs had been taken and it was determined it was a medical issue.

I was examined and given the EEG tests. They were negative but I was prescribed dilantin (sp?) as a precaution.

A few months later, after receiving my motorcycle permit, a second grand mall seizure happened while I was riding. I was riding with my father, on seperate bikes, and he had apparently gotten a head of me. Again I lost memory for the hours just before the event happened so I can't remember where he was. As I was travelling at freeway speeds (yes, not legal with a permit), an an off duty fireman was behind me and noticed I started to lose control and appeared to be having some problem. Somehow I knew to pull over before I passed out. The fireman said I came to rest, got off the bike and went into a seizure and fell down on the side of the road. Apparently I could tell I needed to stop, but don't recall how I knew due to the memory failure. Paramedics came and transported me to the hospital.

Again I was treated and given some tests, but at this point the memory is vague.

Time passed and eventually I stopped taking the meds. I think it was typical teenage rebellion and not with advice of the doctor. I never had another seizure that I recall but have suspected a few times I may have had petite mall seizures a few times as I recall times where I blanked out, but no other evidence seemed to be obvious.

As I grew older I became a police officer and worked for 11 years. I left and purused my childhood dream of being an airline pilot. No one was aware of my childhood episodes and as far as I knew, per later doctor visits, I had no on going issues. Of course I never had another EEG, but since no seizures were reported, no one stopped me from pursuing these jobs.

During my tenure as a police officer I never really had any serious issues, but when I started as an airline pilot flying at higher altitudes my skill levels seemed to drop. I performed very well in similators and with every other aspect of flying. However, when I was on board the plane, in reduced atomosphere (8000 feet equivelant) I recall numerous issues. There were things I knew I needed to do, but it seemed that my response time was dangerously slow. I can recall numerous times when I would look at controls and know I had to do something very basic, but I could not recall what it was. Of course my training was a failure and I lost my first job. I worked for a while with another company flying at lower altitudes and did fine. Again I went back to another airline and had similar issues to the first one. It was as if my brain went into data lock, like a computer does when it's ram is overloaded. These problems did not surface in the similator which of course was operated at ground level with no reduced atomosphere.

I have since given up that dream, and now run a small security company. I hate my work now and wish I was back behind the controls of an airplane flying from city to city. My mother could not figure out why I had such issues being I had always been successful at other complicated endeavors and flew smaller airplanes without issue. I was a quite successful amature motorcycle racer as a kid, won numerous snow skiing competitions and have always done well in academics. Yet for some reason, in that reduced atmospher cockpit, my brain seemed to freeze up.

Additionally when I was about 24 years old, the doctor told me I was "borderline" hypoglycemic, but not severe enough to warrant treatment. I was just advised to not let myself go hungry for extended periods of time or I would risk problems with that.

Now in my mid 40s, I don't know what happened in the airplanes. It doesn't make sense based upon other things I succeeded at. Could I really be that mentally challenged? Is flying a modern day aircraft so sophisticated that successful pilots are just so much more gifted than I am? Am I really lacking what "they" have? I could understand it if we were talking about military fighter pilots, as that does require extreme abilities and many candidates wash out of the program and are re-assigned to less demanding aircraft. Most still end up pilots, but they just don't make it to the elite status of fighter pilot. Maybe I'm not the best pilot in the world, but I find it quite difficult to believe that I was not qualified to operate a 50 passenger regional jet. The airlines conduct a lengthy battery of tests before they even hire a pilot. Each pilot must complete intense training and prove their abilities in both study and operation of the similator before proceeding to the aircraft. I made it that far with no issues and the general consensus is that if you can fly a similator, you can certainly fly the airplane. The similators are designed to be more challenging than the aircraft. If someone is going to fail training it usually happens long before they ever reach an airplane. The airlines don't want to spend the money to train someone and give them a type rating ( specific license) and then send them on their way. I was the exception to the rule and was given that $10,000 license for free, but not kept on the job. I was even paid for earning it.

Do I still have some degree of epilepsy left over? Should I be concerned? Is it possible my "brain freezes" were a combination of some epileptic condition left over from childhood coupled with reduced oxygen and high demand? When I was starring at the controls unable to recall the most basic of aviator skills was I having a petite mall seizure? Certainly if I had a grand mall seizure in the cockpit that would have been quite embarrassing and likely a career ender, but the positive would have been my issues would have been obvious and I would at least have been eligible for disability benefits, even if only from social security or someone. As it ended up being, I left feeling like a failure, when I knew exactly what to do, but just could not do it. It never felt right to me and I still ponder to this day, how could this be. Why couldn't I just pull back and turn right? Why couldn't I do what I did in the similator which is just like the airplane?

If anyone has thoughts or ideas on this, please let me know. I know I should discuss this with a doctor, but I am scared to even bring up the thought of epilepsy and have someone tell me I can't drive now or have other issues. I don't have medical insurance so paying for medical treatment is not easy.



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EmpowHER Guest

Hello again Susan,

Yes I wondered about hypoxic hypoxia (what they say affect pilots) first but it's probably ulikely that alone could be the culprit as everyone else on board would have also suffered from it as well. It could be, and I am suspicious of, me being more sensitive to it. The reason why is where the question comes in. Maybe a borderline hypoglycemic combined with altitude is just enough to slow down brain function. It wasn't enough to reduce life functions, but enough to make performance an issue. Performance that was just fine doing the same thing at ground level, but not at altitude.

As far as not happening at altitude, remember I only had 2 seizures and they were as a kid. One was in flight as a passenger and one was while riding a motorcycle at altitude. The day on the motorcycle I had spent the day at a waterpark, with a barbeque and lots of sun exposure. I was rather exhausted and probably not in the best condition to be riding a motorcycle on the street (freeway) for 50 miles. What I have read about hypoglycemia also indicates that exhuastion can be an issue. Again, both of those incidents resulted in seizures, but those were the only times. This time, the issue just seems to be slow mental reflexes. Something that is akin to hypoxia, so I'm told. Once again that brings up the question why did I go hypoxic when the oxygen in the cabin would have only been 8000 feet (the equivelant level on board a pressurized aircraft). No one else was affected, why was I?

I understand the thought of heart and especially lung problems, but no, I have had lung tests done and I seem to function rather well in that aspect. I have no history of heart problems and no one in my family has them either. I have had a couple oxygen tests with that thing they clip on the finger and my levels are very strong I'm told. The only medical problem I have had was a rupturing galbladder. I was admitted and had that removed in 1999. I know the liver has an affect on blood sugar and the galbladder is somehow tied to the liver but I havn't heart it would cause any issues with the blood sugar, just the ability to digest certain foods. If it can cause blood sugar problems, it's certainly worth investigating as well. I had a very difficult time digesting most foods for a few years after the surgery, but that seems to have passed. Now most foods are easy to digest, with few exceptions.

One thing I didn't mention before was as a child I took ritilan for what is now called ADHD. I took that for quite a number of years. I have heard many negative reports about that treatment and now wonder if that could have affected me in adulthood. I did take a test for Adult ADHD at the suggestion of my mother years back, but they said I didn't have it. Of course, as a kid I grew up eating sugary cerials, pop tarts and at the experienced the dawn of fast food. Now they are saying that is often the cause of ADHD and medicine is not always required. My parents didn't feed us fast food that often, but we certainly had the sugary breakfasts. My Mom told me, she wanted us to eat better breakfasts, but we insisted on that lousy food and she gave up trying. She said that may have had more affect than she realized at the time. She told me, now days they point out all the things that cause kids problems, but when she was raising her kids, it was either you are healthy or they shove a pill down your throat.

My mom passed away a few years ago, but my dad is still alive. He isn't sure what they had said anymore, but he does know I was not positive for epilepsy. He said he was quite concerned about that because of the issues it would have caused me and was relieved to know it wasn't epilepsy. There was something with my Mom and the possibility of diabetes, but I believe it turned out she was not diabetic, but told to monitor her diet as she came close to it. I will have to ask my sister who I believe would know that better than me. My Grandfather (her father) did have diabetes since mid adulthood and he took pills and controlled diet for it. My father has no medical issues at 69 years old, but he eats quite healthy, especially as his age as gotten up there.

You asked about feelings before the seizures. I don't have any memory of it, as it seems mostly to be like amnesia. I do recall some information about how I acted right before and I believe it was the passenger next to me who passed that information on to the paramedics who gave that to the hospital. As I recall the story, I was holding my stomach and said I am not feeling well. The passenger thought I was going to vomit and handed me a "bag". I refused it and lied back in the seat and turned pale white and was sweating just before I passed out. I do recall being quite wet when I woke up. I think he had called to the flight attendant (we were in the front row right behind the flight attendants) and im told the flight attendant was there as I passed out. I think she witnessed me loosing consiousness and having the seizure. Something makes me recall a feeling of almost being out of my body. I'm not sure how I recall that, but that sounds familiar. Perhaps I said something and it was reported back to me by the doctor. Maybe I vaguely remember that part. I am not sure.

The other seizure was also witnessed, by the fireman. He said I grabbed my stomach, exited the bike and keeled over in pain and wondered around the shoulder. He was concerned I was going to walk out in front of freeway traffic in the dark (scary). Before he could get to me I had gone to the ground and began the seizure. That time I did not regain consiousness until I was in the hospital. I had the seizure, was put into an ambulance and transported to the ER, undressed and put into a bed while unconsious. That seems like a long time, but perhaps I wasn't unconsious, but I have no memory of it like I did on the flight. Then again, when I came to, the nurse was there re-assuring me I was ok. My father came in just about that time and told me where we were as I had no idea. On the flight, I recall waking up and it had not been that long. Also, on the flight, I had vomited on myself. Not sure if that means anything, but I recall that and cleaning myself up with towels the flight attendant gave me.

I did read Susan's article. Unlike her though, I can't recall what the feelings were before the seizure. I seem to have lost memory when they happened. I did not know what I was doing on an airplane when I woke up the first time. I didn't remember boarding or even being at the airport. I thought I should have still been in Los Angeles. It was almost like someone drugged me and put me on the plane and I woke up enroute questioning where I was. I'm certainly not saying that happened, I'm just explaining the feeling.

I will look into the link you gave me and see about free or reduced medical care. This is something that I would like addressed. It would be nice to know what I can do about it and hopefully there is a solution to the problem. It was really quite frustrating to know I could do something, but even when I knew what I needed to do, I couldn't do it. Whether or not I go back to that line of work remains to be seen. I certainly am not happy with what I do now, but it does pay the bills.

Thanks again

May 29, 2011 - 2:32am
HERWriter Guide

Hi again Greg and thank you for your response.

I've been reading as much as I can about what may be going on, aside from a simple "Hypoxia" answer. It many not even be an answer since you didn't always get the seizures in high altitudes and since you were a pilot, you were in the skies a lot. It may all be a coincidence.

Have you ever had heart or lung problems? Your symptoms may be indicating that cardiac or respitory issues may actually be the root cause of your condition, rather than high altitudes. I'm just putting that possibility out there.

Are your parents still alive? Can you ask them about your medical history as a child and teen - what the doctors told them about your seizures?

Since grand mal seizures can be caused by low blood sugar alone, the root cause could be hypogycemia. As you metioned before, we can assume diabetes is not an issue? Is so, I agree that this all could be as "simple" as your hypoglycemia.
The condition known as "Reactive Hypoglycemia" may be what you are dealing with since it is not connected to being a diabetic.

For causes and treatments of hypglycemia:

Medication for diabetes is the most common cause particularly when combined with the following factors:

* Taking too much blood sugar-lowering medication
* Delaying or missing meals, or eating too little at meals
* Too much or too strenuous exercise

Reactive hypoglycemia may also occur in people without diabetes. It is now thought to be quite rare.

Other causes of hypoglycemia include:

* Drinking too much alcohol (especially binge drinking coupled with not eating)
* Prolonged fasting
* Early pregnancy
* Long periods of strenuous exercise
* Certain medications may increase the risk of hypoglycemia (people on beta blockers who exercise, aspirin in children)
* Certain pituitary or adrenal gland conditions
* Certain liver conditions
* Certain types of stomach surgery
* Certain autoimmune conditions
* Hereditary enzyme or hormone deficiencies
* A reaction to certain foods (rarely, eating unripe ackee fruit from Jamaica)
* Pancreatic tumors
* Tumors that produce an insulin-like hormone
* Any severe or protracted illness, such as:
o Heart or kidney failure
o Metastatic cancer
o Malnutrition
o Severe infection

Risk Factors

Factors that can increase your risk for hypoglycemia include:

* Diabetes
* Drinking too much alcohol
* Fasting, particularly in combination with strenuous exercise
* Family history of hypoglycemia

Symptoms may come on slowly or suddenly.
Symptoms include:

* Sweating
* Nervousness
* Feeling faint
* Heart palpitations
* Hunger
* Headache

As hypoglycemia worsens symptoms may include:

* Fatigue
* Dizziness
* Weakness
* Inappropriate behavior or severe confusion
* Loss of consciousness


The doctor will ask about your symptoms and medical history. A physical exam will be done.

If hypoglycemia is suspected, your doctor will try to document your low blood sugar. Your blood glucose levels will be measured while you are having symptoms.

If this is not possible, you may have a glucose tolerance test. This is a series of blood tests after taking glucose by mouth.

Other, less routine tests include:

* Laboratory tests for antibodies to insulin
* Imaging tests to check for a tumor, such as:
o MRI scan —a test that uses radio waves and magnetic fields to make pictures of structures inside the body
o CT scan—a type of x-ray that uses a computer to make pictures of structures inside the body
o Ultrasound—a test that uses sound waves to make pictures of structures inside the body

Treatments include:

Symptoms of low blood sugar can be relieved quickly by:

* Eating sugar in a rapidly absorbable form, such as:
o Fruit
o Fruit juice
o Sugared soft drink
o Table sugar in water
o Candy
* Taking glucose tablets
* IV glucose (in severe cases)

Some people who have prolonged or severe hypoglycemia take glucagon. Glucagon is an injectable hormone. It raises blood sugar levels.

Read more: http://www.empowher.com/media/reference/hypoglycemia

Also, take a look at this article here about living with Hypoglycemia: http://www.empowher.com/headache/content/living-hypoglycemia-low-blood-sugar

Do you see a corrolation between Susan's (not me) story and yours?

Also, you can look for free healthcare; it's available and you can hopefully get to the bottom of this without it costing you an arm or a leg. You can by trying here: http://findahealthcenter.hrsa.gov/Search_HCC.aspx

Again, I do hope to hear from others and I will contact Susan Schade myself to see if she can give you some input.

Take care,

May 28, 2011 - 10:27am
EmpowHER Guest

Hello Susan and thank you for the reply.
First off let me say the issue of safety wasn't neglected or not important, It's just that at this point it's past history and not a pressing matter. Of course if I was working and feared the worst, that would be of primary importance. At this point I'm still trying to figure out what actually happened and why my abilities seemed to drop when at altitude.

The embarrassment part comes from vivid memories of that very long 1 hour flight as a child. Of course that should not be an issue, but it's hard to ignore feelings that strong, even though I do believe that everyone involved on that flight did care about my health and no one was intentionally trying to make me feel bad. Most people had said they hoped I feel better as they exited the plane. I know they meant well, but at 14 that was a bit uncomfortable to be the talk of the flight no matter what reason.

At this point we don't know what it is. My reason for posting was to hear some feedback to see if anyone had similar issues since I was in an unusual situation where most people don't generally operate. As I had said before, I was also told that I seem to sit right at the borderline of hypoglycemia as well. At this point, I am trying to figure out if the difficulties were the result of one or the other. Being that I don't believe I have had a seizure in over 25 years, my first instinct would be to say it's not epilepsy, but being I didn't pursue medicine studies, I can't say for sure. I do know that when I miss meals or eat poorly I will find myself weak and quickly develop really bad headaches and quite miserable nausea until I eat again. Once I eat, it is amazing how quickly my discomfort disappears.

So as you can see the whole thing is odd for me. To be honest, if it is one of those issues, I would pray it was hypoglycemia and not epilepsy. From what I am told, hypoglycemia is easier to combat and not as likely to require a major lifestyle change. My diabetic friends joke that life is easy for a hypoglycemic, all they have to do is eat a snickers bar if they drop too low. Of course that's surely not all there is to it, but I imagine from a diabetics point of view it seems much easier to deal with.

It is interesting some of the things to avoid you mention. Pilots are instructed to turn off the strobe lights in clouds because the flash can cause seizures for any pilot. 8 hours of sleep sounds good, but when changing several time zones in a day, it's hard to truly get a full 8 hours since your body doesn't adjust as fast the airplane travels through them. As far as eating right, it's impossible to eat yoru own meals and we are forced to eat in restaurants. Even though sometimes we were able to get to a store and buy items to cook, we were in a hotel room and obviously unable to heat anything. The more I think about it, the more I'm thinking this sounds more like an issue of low blood sugar than neurological malfunction. If I had not had the 2 childhood seizures, I would not even ponder the idea of possible epileptic issues.

Out of curiosity, I had checked my blood sugar at a friends home with his glucose meter. It read 82, which at first he said was too low. As we researched information on the internet, it seems that for a diabetic, medically controlling his blood sugar, that would be too low but for a natural occurrence it is ideal. I am assuming you are in the US, so you know those numbers. Apparently other places use the metric system and the numbers are different.

Like I had said before, it's just an odd set of circumstances to me. I worked as a police officer before and had no problems completing training or operating daily in high stress life threatening situations, but of course I was at ground level breathing full pressure oxygen. I also did many high risk, mentally and physically demanding activities as well, all at ground level without issue. It wasn't until I tried similar activities in reduced atmosphere that I found I could not perform as I should. If my blood sugar dropped too low, is it feasible that by adding oxygen deficiency to the problem, I would lose cognitive skills?

It's all a big "what happened" at this point in my life. Unfortunately along with losing my dream job, I also lost my medical insurance so visiting with a doctor is not as easy as just calling one up and going for a check up. I do get physicals every year for my pilots license and they check for diabetes, but they don't do EEG's or blood work. Apparently they can see diabetic issues via urine tests.

Thanks again for the response. If you or anyone else has any input I am more than appreciative. Hopefully I can afford to be fully tested and discover any issues I am not aware of. I know they have altitude chambers to see how certain people react, but I have no idea how much that costs or if doctors even perform tests in that environment.


May 28, 2011 - 4:40am
HERWriter Guide

Hi Greg and thanks for your post!

I'm sorry you've been dealing with these episodes since childhood. You do need to see a neurologist to have your brain fully examined and get a proper diagnosis.

I'm concerned that you seem more concerned about being embarrassed if you had a seizure in the cockpit than your health (or the safety of your passengers)! These seizues can be dangeous. Obviously, for your own health and the health and safety of others around you, you need to put the dream of being a pilot away, at least for now.

Ther is no "cure" as yet, for epilespy but the treatments are vast:

The goals of treatment are to:

* Treat the underlying cause (if know)
* Prevent seizures—may be done through medication, surgery, or special therapies
* Avoid factors that stimulate seizure activity

Anti-epileptic Medications

There are a wide variety of medications that may be used. Some of these include:

* Phenytoin
* Diazepam
* Lorazepam
* Carbamazepine
o Certain patients of Asian ancestry may be at risk for dangerous or even fatal skin reactions with this drug. If you are of Asian descent, the FDA recommends that you get tested before taking this drug. If you have been taking it for a few months with no skin reactions, then you are at low risk. Talk to your doctor before stopping this medication. *
* Valproic acid
* Divalproex
* Levetiracetam
* Gabapentin
* Phenobarbital
* Ethosuximide
* Clonazepam
* Primidone
* Oxcarbazepine
* Lamotrigine
* Topiramate
* Felbamate
* Tiagabine
* Zonisamide

These drugs may be given alone or in combination.

If medicine does not work or the side effects are too severe, surgery may be advised. Surgery involves the removal of the seizure focus. This is the area of the brain that has been identified as starting the seizure. Surgery is only an option for individuals who have very localized areas of the brain involved.
Vagus Nerve Stimulation (VNS)

A device is implanted in the chest. It will provide intermittent electrical stimulation to the vagus nerve. It is not clear how this works. Somehow it prevents or decreases the frequency of seizures. You may still require medications. The dosage may be less.
Ketogenic Diet

This is a very strict diet. It is high in fat and low in carbohydrates and proteins. This diet keeps the body’s chemical balance in ketosis. Ketosis decreases the frequency of seizures. The reason is unknown. Following a ketogenic diet is most successful in children. It is less successful in adults.
Modification of Activity

If you have a seizure disorder, you can take the following steps to try to decrease the chance of a seizure:

* Get enough sleep.
* Avoid hyperventilating.
* Avoid places where flashing or strobe lights are in use.
* Wear a medical alert bracelet. That way, if you have a seizure, people around you will understand what is happening. They will be able to take appropriate steps to be helpful.
* Consider keeping a seizure log. Record things that were happening around the time of a seizure. This will help to identify a seizure trigger.
* Take your seizure medications according to the prescription.

For more, click on our epilepsy page here: http://www.empowher.com/condition/epilepsy

You are not a failure because you couldn't pilot a plane. That's like thinking a blind person is a failure because he or she can't fly a plane. You have to work with what you've got! I'm sure there are dozens of careers out there that you're perfect for.

You can talk to a doctor and see if you are eligible for benefits because of your condition but you will have to see a doctor first.

Contact the Epilepsy Foundation to see how they can help, here: http://www.epilepsyfoundation.org/

Also consider seeing a career coach to see what kind of ful-filling work is for you.

I hope this helps and if other reades with epilepsy read this thread -please contribute!


May 27, 2011 - 2:00pm
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