Idiopathic generalized tonic-clonic seizures limited to exercise in a young adult

Loss of consciousness limited to exercise should suggest a cardiovascular etiology even when clonic activity is reported. Infrequently, epilepsy patients report a preponderance of their seizures related to exertion. In these patients, seizures also occur independent of exercise. This is a report of a normal young adult woman with episodes of loss of consciousness limited to exercise. During cardiac stress testing with simultaneous electroencephalography, she developed generalized paroxysms of epileptiform discharges preceding a generalized tonic-clonic seizure. This case demonstrates the utility of simultaneous cardiac stress testing with electroencephalography in confirming exercise-related seizures and distinguishing epilepsy from syncope.