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Childhood Seizures

The TVClubHouse: General Discussions ARCHIVES: 2005 Dec. ~ 2006 Feb.: Health Center: Childhood Seizures users admin

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Herckleperckle
Member

11-20-2003

Monday, August 22, 2005 - 1:25 am   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported June 14, 2004


Childhood Seizures
Full-Length Doctor's Interview


In this full-length doctor's interview, Colin Roberts, M.D., explains the incidence and various severities of seizures, as well as steps parents can take to protect their children during a seizure.

Ivanhoe Broadcast News Transcript with
Colin Roberts, M.D., Pediatric Neurologist,
Doernbecher Children's Hospital/Oregon Health & Science University, Portland, Oregon
TOPIC: Childhood Seizures




What should parents do if their child is having a seizure?

Dr. Roberts: It's obviously a very frightening situation, and it's important to think about what you might do even before it is a concern. The most important thing to worry about is children actually injuring themselves physically when they are having seizures. A seizure is a storm of electrical activity in the brain. The child is not in control of his body at that time. We worry about children bumping into things and injuring themselves. The most important thing to do when a child is having a seizure is to get him into a situation or setting where he is protected from hurting himself. That most commonly means getting the child down onto the floor away from anything he can bump into, like furniture or toys, and getting him onto his side. Often, children who are having seizures are not in control of their ability to swallow or breathe, and they may have saliva that pools in their mouth. They may also vomit. This is why it's important to get them onto their side, so that the vomit will not obstruct their ability to breathe.



With older children, you can lay them down and put them on their side, but would the procedure be any different with a baby?

Dr. Roberts: No. Position the children so that their airways are open and to make sure they are lying on their side so that whatever is in their mouth can come out. It's also very important that you not put anything in anybody's mouth who is having a seizure. People want to do this because a common fear is that people having a seizure could swallow their tongues. It is much more common that if you put something in somebody's mouth, such as a spoon, pencil or popsicle stick, they will actually bite it off. This could become lodged in their airway, which would be a much more dangerous situation. It's much safer to allow whatever is in the mouth to come out on its own and not to put anything in the mouth.



By not putting your fingers in the mouth you are, basically, keeping the airway open?

Dr. Roberts: Exactly. You are keeping the airway open, and you're preventing injury to yourself potentially. People who are having seizures may have movements of their jaw that they are not in control of. They could bite off your finger.



Would you treat a seizure victim similar to a choking victim?

Dr. Roberts: No. Seizure patients do not need the Heimlich maneuver or other things to clear the airway. They need the ability to have their secretions come out on their own.



To protect the child we should not put anything in their mouth?

Dr. Roberts: Right.



What other precautions should be taken?

Dr. Roberts: When people have seizures you worry most about them hurting themselves, as I mentioned, but you also worry about the electrical activity in the brain. However, brain injury only happens in very prolonged seizures. A state of continuous seizure is electrical activity in the brain for 15 minutes to 30 minutes or longer. It's a much longer seizure. The vast majority of seizures last one to two minutes and stop on their own. It is very important to know exactly how long someone has been having a seizure. It is a difficult time to think rationally and, oftentimes, seems like it has been lasting forever while your child is having a convulsion. But it is important that you do look at the clock and note exactly when seizure activity began so that you can pass that information on to your doctor.



When should you decide to call 911?

Dr. Roberts: If it's the first seizure, we certainly encourage you to seek whatever help you think is necessary, whether that is calling 911 or your doctor. I encourage you to do that as soon as you can after you've established the child is safe. If the seizure has stopped on its own, you do not need to immediately rush the child to the hospital, but it is important that you get medical staff involved.

If a seizure has been going on for two minutes and is not stopping at that point, we definitely encourage you to then seek medical attention. As the seizure becomes longer, certainly as it reaches five minutes or longer, the chance that it might then go on to be dangerous is high enough that the child may need medicine to stop the seizure. Basically, it's important that if a seizure goes on for more than two minutes to seek medical attention.

On the other hand, we follow many patients who have chronic recurrent seizures and are much more familiar with how to care for their child at the time of a seizure. These patients may not need to seek medical attention and may actually be able to intervene on their own.



When you say seek medical attention after two minutes, should parents call their doctor or 911?

Dr. Roberts: I think it depends upon the availability of their doctor's office. We certainly want you to get medical attention as soon as you can. I think that activating emergency services with 911 is probably the best intervention.

Also, remember that the medical attention may take a period of time to arrive. It's very important to make sure that the child is safe and is not going to be injured by the seizure before medical help can arrive.



What is the most common mistake that parents make when their child is having a seizure?

Dr. Roberts: What we worry about the most is leaving the children in a position where they could hurt themselves. Think for instance, if a child was up on a chair, he could easily fall off. Remember they are not in control of their body. Also, we worry about the patients who perhaps are lying on their back and then choke on whatever is in their mouth because of that positioning. That could lead to a very different outcome from the seizure.



Can you hold your child during a seizure, or is that dangerous?

Dr. Roberts: There is no problem with holding your child. I'm certainly not going to tell parents not to hold their children when they're having seizures. However, it is important to know about what could injure the children when they have seizures, and it is important that you not interfere with them being safe. If you are able to hold your child comfortably and keep them in a good position, that is entirely fine.



Are children more likely to hurt themselves physically than the actual seizure hurting them?

Dr. Roberts: Exactly. We don't worry about the electrical activity actually injuring the brain unless that activity is continuous for 30 minutes or more. After 30 minutes, that electrical activity requires a lot of energy. You start to use up your energy stores in your brain, and that can actually injure your brain. Because most seizures are brief, that electrical activity never gets to the point where it is using up your brain's energy stores. Rather, we worry much more about children injuring themselves physically, which is much more common.



How common is it for children to have seizures?

Dr. Roberts: It's much more common that you might think. Single isolated seizures are actually quite common, and most of them happen for reasons that are not dangerous. Epilepsy, which is a condition of recurrent seizures over time, is a very different diagnosis. Epilepsy is not a diagnosis that is made after a single seizure in most cases. About 125,000 new cases of epilepsy are diagnosed in the United States every year. About 30 percent of those cases are currently kids under 18 years of age, and most of those diagnoses are made under age 2.



Is it more common to have a seizure that is not associated with epilepsy?

Dr. Roberts: Yes. Most patients in pediatrics who have a single seizure do not, in fact, have a condition that will lead to epilepsy. Rather, the most common reason to have seizures in childhood is actually a condition called simple febrile seizures, which is a different phenomenon from a chronic disease like epilepsy.




What are simple febrile seizures?

Dr. Roberts: Febrile seizures are a very interesting phenomenon, which are really quite common in childhood. These are seizures that occurred exclusively in the setting of a fever. These children are otherwise normal healthy children who have had normal development. They have no other major health problems, but are pre-disposed to febrile seizures. An illness with a fever can bring a seizure at that time. There seems to be a brief development or window when this most commonly happens, which is between the ages of 6 months and 5 years of age.




Do you have any idea how many kids are going to have these seizures?

Dr. Roberts: The statistics are difficult to pin down. Historically, we think that between 2 percent and 5 percent of children worldwide will have at least one febrile seizure. Maybe 30 percent of those children will go on to have a second or third. This translates to a large number worldwide. There are some countries like Japan, Guam, and others where the incidence is much higher.



Why do some countries have higher incidence of simple febrile seizures?

Dr. Roberts: We believe it's a genetic predisposition to the condition. In certain populations there is a much higher incidence of the underlying genetic defect which leads to the condition.



If a kid has a fever and then has a seizure, should it cause less concern than a seizure occurring without the fever?

Dr. Roberts: Potentially. I think the diagnosis of febrile seizures or of a different condition leading to seizures is something that a parent needs to make after a consultation with their doctor or neurologist. The diagnosis of febrile seizures is something that is made really after review of the risk factors and the underlying reasons that might have led to a seizure. Just because a seizure happens with a fever doesn't mean that it is in fact a febrile seizure.



So regardless if the kid has a fever when seizing, a parent needs to follow the same steps?

Dr. Roberts: Exactly. Even if it is a simple febrile seizure, it is very important to treat the child the same way to prevent injury.



Does the parent still need to get medical attention if it is a febrile seizure?

Dr. Roberts: No, not necessarily. Certainly with the first seizure I think it is important that you seek medical attention. Have the child evaluated if only for understanding of why they have a fever at that point, which might be very important. We have families who have children with recurrent febrile seizures, and these families are much more comfortable caring for those kids at home. They like to evaluate them when they are having a seizure and then make the decision about whether they need medical attention. We often train families who have seen many seizures, and certainly in children that have a risk of prolonged seizures, to actually get a treatment at home that could stop the seizure quickly without even needing to seek medical attention.



What is that treatment?

Dr. Roberts: The medication we most commonly use now is called Valium or diazepam. It is administered rectally in a gel form and is absorbed almost as quickly as if the injection were given intravenously. It can rapidly stop a seizure. We don't use medications by mouth when a child is having a seizure. As I mentioned, it is very important that nothing be in the mouth if somebody is having a seizure. To absorb the medicine by mouth would be very difficult and potentially dangerous. The time it would take for that medicine to reach the brain and have an action would be much longer than a medicine administered rectally.



What percentage of kids who have these seizures are going to go on to have severe epilepsy?

Dr. Roberts: It is a complicated answer to that question. I should say that the minority of children who have simple febrile seizures will go on to have epilepsy. It's a very different diagnosis.



And, it's even a smaller amount of epileptic kids who can't control the seizures with medication. Right?

Dr. Roberts: Yes. Now there is a sub-set of children who have epilepsy and are not responding to anti-convulsive medications. We also have many anti-convulsive medications we use for epilepsy. However, we've learned that, statistically speaking, after a few failed trials of anti-convulsive medication, the chance of responding to subsequent trials becomes less and less. In those children, we might be able to establish that they, in fact, have a very small chance of responding to seizure medications with time, and that we might consider a different kind of intervention for their epilepsy. We have several other kinds of interventions that we can use besides anti-convulsive medications. This includes something called the ketogenic diet. We have an implanted device called the Vagus Nerve Stimulator, which can significantly decrease seizures. We also perform a variety of different surgeries on the brain to remove the focus of epilepsy in the brain.



What is the percentage of kids who actually have epilepsy that are not able to respond to medicine?

Dr. Roberts: It can be as high as 25 percent of children who will never respond to any medicine, even from the first time they try a medicine for their epilepsy. Some may respond initially, but gradually stop having a meaningful response to their epilepsy medications. Those patients are having persistent seizures which are significantly debilitating to them. Then, we choose to move on to other kinds of therapy for their seizures.


END OF INTERVIEW



If you would like more information, please contact:

Christine Pashley
Media Relations Coordinator
Oregon Health & Science University
pashleyc@ohsu.edu

Herckleperckle
Member

11-20-2003

Monday, August 22, 2005 - 1:37 am   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported June 10, 2005


Delaying Medication Best
for Infrequent Seizures



(Ivanhoe Newswire) -- Epilepsy patients who don’t have seizures very often may not benefit from immediate treatment. New research from the United Kingdom shows taking anti-epileptic drugs right away does not reduce the risk of future seizures.

Researchers also found delaying medication does not increase the risk of chronic epilepsy in patients with infrequent seizures.

In the study, half the patients with single or infrequent seizures were given anti-epileptic drugs immediately after an incident; the other half did not get any medication until they and their clinician agreed it was necessary.

Researchers found immediate treatment reduced short-term recurrence of seizures but had no effect on long-term outcomes.

"We have shown that a policy of immediate treatment with anti-epileptic drugs, mainly with carbamazepine or valproate, reduces the occurrence of seizures in the next one to three years, but does not modify rates of long-term remission after a first or after several seizures," says Professor David Chadwick from the University of Liverpool in the United Kingdom. "At two years, the benefits of improved seizure control with immediate treatment seem to be balanced by the unwanted effects of drug treatment, and there is no improvement in measures of quality of life."

Researchers conclude delaying medication for infrequent seizures may be the best option.


SOURCE: The Lancet, 2005;365:1985-2012

Cher
Member

08-18-2004

Monday, August 22, 2005 - 10:16 am   Edit Post Move Post Delete Post View Post Send Cher a private message Print Post    
Thanks so much for posting this Herc! As you know it is information that I am always interested in with Justin. He has been on carbamazepine (tegretol) now since 2nd or 3rd grade and had his last seizure in 4th grade. He has now been seizure free since 4th grade and is now entering 9th grade. The last EEG showed less activity and in March he will have a sleep deprived EEG to see if it is improving.

thanks again!

Snee
Member

06-26-2001

Monday, August 22, 2005 - 9:03 pm   Edit Post Move Post Delete Post View Post Send Snee a private message Print Post    
thanks for this, herckle. it is very informative and reassuring. i saw my doc today and she said a lot of the same stuff. snickle's EEG is this thursday and then at some point she'll have a neurologist visit.

Cher, it sounds like we have something in common!

Herckleperckle
Member

11-20-2003

Tuesday, August 23, 2005 - 4:40 am   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Yw, you two! (I found it reassuring, too. Didn't know that about short vs longer seizures.)

Cher, since Justin is (15?) older and Snickle is a baby, I'll bet you could be a huge help to her, if, indeed, Snee finds out it is epilepsy. (Pray it is the febrile ones, Snee, but if not, like Justin's, I am sure the meds will make them essentially disappear.)

Cher
Member

08-18-2004

Tuesday, August 23, 2005 - 8:39 am   Edit Post Move Post Delete Post View Post Send Cher a private message Print Post    
Snee - I left a message for you in your folder.

Hi Herc!!!