Seizures on hearing the alarm clock

Abstract

In October, 2006, a 25-year-old trainee graphic designer was referred to us to establish whether her seizures were epileptic or dissociative. For 8 years, she had had seizures triggered by unexpected auditory stimuli, such as the ringing of her telephone or alarm clock. She would become startled and have a “turning feeling in her head”, palpitations, and anxiety. She would then hyperventilate, lose consciousness, and collapse, often with urinary incontinence. These episodes had occurred less frequently when she had avoided stress, not even attending school. However, she was now having seizures, with loss of consciousness, every day. Her electroencephalogram (EEG) and MRI of her head had been normal, as had several electrocardiograms (ECGs). She had no risk factors for epilepsy; she had never received a psychiatric assessment. Nonetheless, she had been diagnosed with complex partial and generalised epilepsy. Trials of antiepileptic drugs (valproic acid, carbamazepine, oxcarbazepine, topiramate, clobazam, and levetiracetam) had been unsuccessful.