At an earlier stage, her family described convulsions occurring only during sleep, sometimes two or three times a night. Many medications have been used over the years, with different periods of response and loss of control. A physician report reviewing the history through July 2026—whose available copy shows no report date or signature—describes drug-resistant generalized epilepsy. Earlier records are not fully concordant: the exome requisition described focal-versus-generalized onset as undetermined, and the February 2025 report recorded ICD-10 code G40.2. A definitive electroclinical classification therefore remains uncertain, and not every current event has been shown to be epileptic.
The records and family accounts use different terms for the episodes, and those terms are not necessarily equivalent:
Absence seizures began in childhood.
Generalized tonic-clonic seizures were described after valproate was introduced and recurred during later periods of destabilization.
Atonic seizures or drop attacks were described by clinicians as sudden loss of tone causing a fall.
Syncope, fainting, or blackout are the family’s terms for many of the recurrent episodes, sometimes accompanied by urinary loss.
These labels may represent more than one event type. The available material does not include a typical episode captured simultaneously with EEG, electrocardiography, and blood pressure monitoring to determine the mechanism of each seizure or fall. An EEG was described as normal in a physician report, but the complete report is unavailable, and a normal interictal EEG does not exclude epilepsy. A July 2024 brain MRI was described as normal; two head CT scans in 2024 also showed no acute abnormality.
In February 2022, after two CoronaVac doses that were reportedly tolerated, her family noticed the beginning of a persistent pattern of fainting or falls and new convulsions after a Pfizer COVID-19 vaccination. The family recalls an interval of about 15 days; the retrospective physician report gives about 30 days. Her earlier COVID-19 infection had been almost asymptomatic. This timing is part of the history, but it does not establish that the vaccine caused the events. No specific vaccine-related mechanism has been documented.
Beginning in 2023, seizure frequency and intensity increased again after a longer period of control. At her first visit with the current neurology service in August 2024, the family reported multiple atonic events each day, about five convulsions a day, and frequent syncopal events. A separate February 2025 report described about five convulsions a month in addition to drop attacks. These frequencies likely describe different time points and should not be treated as one stable count.
During 2025, there were stretches without new tonic-clonic seizures while fall- or syncope-labeled events continued. Her family records tonic-clonic seizures in December 2025 and January 2026. The physician report reviewing the history through July 2026 describes two tonic-clonic seizures in one night in January, after a gradual levetiracetam reduction because of concern about irritability, followed by repeated syncopal events without full recovery and emergency evaluation. The family's chronology and the physician's retrospective account do not agree in every detail. The medication reduction preceded the recurrence, but that sequence alone does not prove causation.
In subsequent months, that report recorded syncope-labeled events reaching about 20 per day; the family had reported approximately 15 to 30 per day in April 2026. An April 6 gynecology referral still described multiple daily events, including drop attacks and tonic-clonic seizures, despite phenytoin, levetiracetam, and clobazam. By July 28, however, the family described convulsions as controlled and aggression as much improved, with some days free of syncope and other days with many events. These differences may reflect different dates, labels, and event types and do not form one stable count. “Convulsions controlled” also does not mean that every fall, loss-of-tone event, or loss of consciousness has resolved.