When a seemingly healthy 58-year-old man started experiencing "intense episodes of drenching sweats and strange distraction" every three to five weeks, his doctors were stumped — until a neurologist specializing in seizure disorders determined the cause of his episodes, Lisa Sanders writes for the New York Times Magazine.

'Intense episodes of drenching sweats and strange distraction'

One day, the 58-year-old man was driving to the gym when he suddenly "felt intensely hot," Sanders writes. "A vague prickling sensation spread down his face and neck to his chest and back. His heart seemed to speed up and then — pow — he was drenched in sweat," Sanders adds.

For five months, the man had been working with his doctor, Mark Chelmowski, to figure out the cause of these  episodes, which occurred every three to five weeks.

Then, the patient experienced an episode during an appointment with Chelmowski. He began sweating profusely and seemed to lose cognizance. However, his vital signs were normal, he didn't have a fever, and his blood pressure and heart rate were normal. A few minutes later, the episode stopped just as quickly as it began.

Following a fourth episode, the man's partner took him to the ED, where he had another episode. Worried the man was having a heart attack, the ED doctor immediately admitted him to the hospital.

After ruling out a heart attack, the patient was discharged and instructed to follow up with his primary care doctor.

Every three to five weeks, the patient was still experiencing "intense episodes of drenching sweats and strange distraction, one after the other, each lasting only a few minutes," Sanders writes.

"The pattern made the strange symptom seem even stranger," she notes. "The patient was in good shape. He ate a healthy diet and exercised regularly. The only medication he took was an acid reducer for his heartburn. He was almost never sick."

'Have you ever heard of seizures characterized by profuse sweating?'

To determine the cause of the man's symptoms, Chelmowski tested him for a myriad of conditions, including malaria, HIV, tumors, hormonal disorders, infections, abnormal heart rhythms, and cancer — but everything came back negative.

Then, Chelmowski referred the man to the  Mayo Clinic. He spent two full days answering questions and undergoing tests.

"Finally, they came up with an answer," Sanders writes. "Although his testosterone level was in the normal range, perhaps it was less than he was used to. Maybe this was a relative hormonal deficiency akin to a woman's menopause, a reaction to the natural reduction of sex hormones because of aging." To treat his symptoms, the doctors recommended testosterone-replacement therapy.

While the man was skeptical, he used the therapy as prescribed for months. However, the therapy did not help.

With no explanation for the man's episodes, Chelmowski started to worry that he was never going to find a diagnosis.

One morning, he spoke to an old friend at his usual spin class. He asked George Morris, a neurologist specializing in seizure disorders, if the man's episodes could be seizures.

"Have you ever heard of seizures characterized by profuse sweating?" Chelmowski asked. Morris confirmed that he had several patients who experienced similar episodes and urged Chelmowski to send the patient to his clinic for testing.

A few weeks later, the patient went to the epilepsy center at  Aurora St. Luke's Medical Center. Morris told the man that if these were seizures, they would likely only show up on an EEG when he was having one. They arranged for the patient to undergo testing during his next episode.

A few days after the test, the man received a call that confirmed the cause of his episodes: seizures.  

"They originated on the left side of his brain, just behind the ear, in what is known as the temporal lobe," Sanders writes.

Seizure-free for almost 5 years

No one understands why the seemingly healthy man started having seizures at 58-years-old. "It took a while for the patient to get on the right medications at the right dose, but once on it, his seizures stopped," Sanders writes. "He hasn't had one in nearly five years."

Still, the patient wonders whether his seizures are linked to a car accident he was in when at age 10 or 11. At the time, the man was riding in the front seat with no seatbelt and hit his head on the steering wheel.

"That kind of injury can cause seizures many years later," Sanders writes. "The injured neurons cause abnormalities in surrounding brain cells, which may, eventually, trigger the abnormal activity that results in a seizure."

However, epilepsy often starts in late middle age. Morris attributes it to cerebrovascular disease, or ministrokes.

Still, the patient said he isn't buying it. "He still traces it all back to a head-on collision resulting in a close encounter with a hard plastic steering wheel," Sanders writes. (Sanders, New York Times Magazine, 3/9)