Cyclical excessive sweating turned out to be Temporal lobe epilepsy- Case Study

A man's monthly episodes of excessive sweating were found to be triggered by temporal lobe seizures that were previously undiagnosed. The case has been reported by Mark K. Chelmowski and colleagues at Advocate Aurora Health Care, Milwaukee, Wisconsin (M.K.C.) and has been published in Annals of Internal Medicine.

Excessive sweating is common and frequent causes include obesity, anxiety, or hyperthyroidism, among many other common conditions. It can also be a sign of silent Myocardial Infarction. The reasons people typically sweat are because they are releasing body heat or experiencing certain emotions, two processes that are regulated by the brain. But cyclic sweating is different because it occurs in cycles that are regularly repeated.

According to history, a 60-year-old man from Wisconsin experienced profuse sweating episodes on a monthly basis for three years. Each month, the man would break into a heavy sweat for several minutes at a time over a 13-hour period. The patient had been seen by specialists at various hospitals and was told that he was suffering from "hyperhidrosis," which just means excessive sweatingClinicians from Advocate Aurora Health Care and Ascension Wisconsin carried out a series of tests to rule out common causes.

During an office visit, the patient had an episode of severe sweating observed directly by the clinicians. Altered responsiveness during the sweating event suggested a seizure, so the clinicians scheduled a 7-day ambulatory EEG to begin a few days before his next expected cluster of sweating episodes. The EEG showed left temporal lobe activity suggesting a seizure. In this man's case, the seizures in the temporal lobe of his brain were activating a pathway that leads to sweating. After treatment with anti-seizure medications, the patient has only had one episode of sweating in the last year and a half.

According to the authors, these findings suggest that seizures should be considered in the differential diagnosis of cyclic conditions with autonomic symptoms, such as sweating or nausea and vomiting. This is a fit case to alert clinicians to an uncommon cause of excessive sweating.

http://annals.org/aim/article/doi/10.7326/L18-0425