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Tuesday, July 29, 2014
Mini Seizures in Children?
I have an 8 year old boy who was born pre-term at 27 weeks. He suffered complications shortly after his birth and was on the ventelator for a short while. He also had a brain hemorrhage with bleeding to one side of the brain, consequently he has right sided hemiplegia but apart from these early problems he has made good progress, i would have described his health as being fair. Last week whilst on a family outing he had an episode of rapid eye blinking which lasted for about 10-15 seconds, apart from the blinking his posture remains steady, and later on in the same day he had the same episode. Now a week later whilst at school the same problem occured again with the same symptoms - the school described his epsiode as a fit. After bringing him home I rang the doctor and arranged an appointment, he says these symptoms are most likely of a mini seizure and told me if the episode lasted longer than a minute then i should take him to the hospital. Throughout the day he suffered a further 3 episodes which lasted approximatley 25-30 seconds with the same symptom of eye blinking with the last of these episodes also including a new symptom of his whole head also started to tremble/shake, this time i noticed that after the rapid blinking stopped he stared for a few seconds. He tells me that when the episode is about to occur he feels as though there is something wrong and during the episode he says everything goes dark.
How concerning this must be for you! I am not sure what your question is, but I find myself agreeing with his doctor that your son is likely having seizures. This is very common in children with cerebral palsy from intraventricular hemorrhage (IVH) or pre-birth damage for which there is no known cause. IVH certainly will worsen any damage that may have occurred before his birth.
Your son is actually describing seizure with aura very perfectly. He is right that things go dark because the brain is so overwhelmed with electrical signals that normal functions cease for a time, including vision. If he is standing, walking or playing actively when he has the sense that something is wrong, it is a good idea to recommend that he sit down in a safe place immediately so that he is less likely to injure himself.
Definitely seeing a pediatric neurologist who specializes in treating seizures would be an excellent idea. With the seizures seeming to become more frequent and the effects more visible, it is time to identify the type of seizures he is having and to begin medication to control them. It would also be a good idea to rule out other causes for the onset of seizures on the chance that addressing an infection or metabolic disorder not yet diagnosed is the key to preventing more seizures.
As your son's doctor may have mentioned, just doing an EEG randomly may well miss a true seizure problem if a seizure is not happening at the time of the test. Usually, a child will be hospitalized for a full day and have all of the EEG electrodes in place on the scalp, face, and chest to guarantee catching the seizure on EEG when it occurs. The time period is videotaped to identify behavior changes occurring before, during, and after the seizure. This helps to correctly identify the type of seizure. Knowing the type of seizure assists the doctor in choosing the medication most likely to stop the seizure.
Taking an anticonvulsant regularly will be an important step in effective treatment. Be sure to ask about side effects of the medication, when you should expect to see improvement of seizures, and what to do if he is ill and vomits the medication dose. Your son will need periodic re-evaluations to adjust his medication dose as he grows and, after good control has been a chieved for a period of time, to see if he can come off of his medication in time.
If seizures are confirmed, you will also want to obtain a medical alert bracelet for him to help identify the problem and assure that he gets the best help right away. It is also critical that he NEVER swim alone because the risk of drowning is large when a seizure occurs and he is unable to care for himself. Extra caution is also needed when operating recreational vehicles, etc.
Seizures can be very scary for parents. There are many wonderful websites to provide information and on-line support groups for parents. Both the American Epilepsy Society and the Epilepsy Foundation offer high quality parent parent information and support. In addition, most children's medical centers also sponsor local parent support groups.
I hope this information proves helpful and that your son is quickly seen by a pediatric neurologist. Delay beyond a week or two is unacceptable. I would try a different pediatric neurologist or have your son's doctor intercede for a sooner appointment. You are right on top of this problem. Great job!
Legido, A., & Piatt, J.H. (2090). Clinical pediatric neurosciences for primary care. Elk Grove Village, IL: American Academy of Pediatrics.
McInerny, et al. (Eds.) (2008). Textbook of pediatric care. Elk Grove Village, IL: American Academy of Pediatrics.
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University