A young girl had experienced frequent bouts of headaches, dizziness, and fatigue that many doctors had contributed to lingering concussion symptoms, but after she began to experience episodes of "strange shaking," there was "no doubt" what the true cause of her symptoms was, Lisa Sanders writes for the New York Times Magazine.

Could multiple concussions have caused the patient's symptoms?

For the past several years, a young girl had been "plagued by headaches, episodes of dizziness and odd bouts of profound fatigue," which several specialists had attributed to persistent post-concussive syndrome. Since the fourth grade, the patient had suffered at least one concussion every year while playing sports.

However, even after quitting sports, the patient continued to fall and hit her head, leading to symptoms that persisted long after her injuries. According to the specialists the patient and her mother visited, her condition would improve with time and patience.

"And yet her head pounded and she retreated to her darkened room several times a week," Sanders writes. Although the patient did everything her doctors recommended, including getting plenty of sleep and resting when she was tired, she still had headaches and often got dizzy.

Over time, the patient found it more and more difficult to pay attention, and her grades began to slip. Then, one day, the patient's high school called her mother saying she was sick and needed to go home.

According to one of the patient's friends, she seemed to have zoned out in class and started drooling. Her hand also began to shake. Although whatever happened only lasted for roughly a minute, the friend said it was strange.

Worried that her daughter had experienced a seizure, the patient's mother quickly looked for a specialist. However, the EEG the neurologist performed came back normal. "She may have had a seizure, the neurologist said, but these are often isolated events," Sanders writes.

A 'strange shaking' in the night

A few weeks later, the patient experienced a similar episode, this time in front of her pediatrician during an appointment. However, a few minutes later, when she asked if she could still go to homecoming that night, her doctor said she could.

That evening, the doctor called the patient's mother to explain what he believed happened during the appointment. "That wasn't a seizure your daughter had in my office," he said. "I think it was a panic attack."

Typically, patients who have a seizure will have severe fatigue and confusion, which did not occur with the woman's daughter. "No one who's had a seizure asks about going to homecoming," the doctor said.

Instead, the doctor believed the patient, who was breathing heavily before her episode in the office, had hyperventilated and had a panic attack. According to the doctor, panic attacks are common in teenage patients, and he recommended she see a psychiatrist.

However, the patient's mother "was certain he was wrong," Sanders writes.

That night, after the patient came home after only 20 minutes at the homecoming dance complaining of a headache, her mother saw her begin to shake in bed. "It was like the kind of shaking chills you might get from a fever, but more so," Sanders writes. "The episode lasted only a few seconds."

Worried about her daughter, the patient's mother stayed by her bed in case the "strange shaking" occurred again. A few hours later, the girl was shaking. The sharking only lasted a few seconds as the patient continued to sleep.

Although the patient's mother called the pediatrician's office, the doctor on the line only reminded her that her daughter had had a similar episode earlier that day and that it was believed to be a panic attack, not a seizure.

However, remembering the neurologist who had performed an EEG on her daughter before, the patient's mother got in touch for a second opinion. The doctor who called back was Cigdem Akman, a pediatric neurologist from NewYork-Presbyterian Morgan Stanley Children's Hospital.

The patient's mother described what happened at the pediatrician's office to Akman, adding that "[h]er doctor thought it was a panic attack, but my daughter has never been one to lose her head." She also told Akman about the shaking she had seen and felt that evening.

After hearing about the situation, Akman told the patient's mother that she had "no doubt that your daughter is having seizures" and that the patient would need to be evaluated. Akman ultimately arranged for the patient to be seen in a video EEG lab where a 48-hour study could help uncover what was happening.

Careful observation finally reveals the answer

Two days later, the patient and her mother traveled to the hospital's epilepsy monitoring unit. During the first 24 hours, the patient had eight seizures, one while she was awake and seven while she was asleep.

During the seizure when the patient was awake, she was able to walk and talk normally. However, she blinked rapidly several times before her chin lifted and her eyes rolled back. The episode only lasted a few seconds, but the EEG showed that an "absence seizure," a type of generalized seizure that is characterized by a lack of attention, had occurred.

The patient's unusual eye movements suggested that she had a rare absence seizure disorder called Jeavons syndrome, which was first described in 1977.

According to Sanders, Jeavons typically starts in childhood but is not diagnosed until adolescence, and girls are much more likely to be affected than boys. "Affected children have seizures that are very brief, lasting only a few seconds, but often occur many times a day," Sanders writes. "Untreated, these seizures can impact learning. And they can change from absence seizures to tonic-clonic or grand mal seizures, as this young woman's had."

It took a few months for Akman to find the most appropriate antiseizure medication for the patient, but since then, she has not had any seizures. With her seizures under control, the patient's symptoms, including headaches, dizziness, fatigue, and inattention, disappeared.

"On the antiseizure medication, the young woman's grades went up," Sanders writes. "She is now a junior in college, majoring in neuroscience." (Sanders, New York Times Magazine, 10/13)