Seizures (ER)

Two-year-old
Jerry Turner, Jr had a seizure today, and it’s not his first.

“When he was first born, as a baby he had a problem where
his blood sugars were very low,” Dr. Goo confirms with Jerry’s
mom, “And they found that his uh, pancreas had a tumor, so
it was making too much insulin…and because they took the
pancreas out, he became a diabetic.”

And as a diabetic, his brain wasn’t getting a steady supply
of glucose, which in turn triggered the seizures. “Your brain
needs a continuous supply of glucose or sugar to keep those brain
cells or neurons going,” explains Dr. Goo, “And if
you decrease the level of sugar or glucose that’s going to
the brain, you’ll have a seizure.”

Jerry began taking insulin for the diabetes and a medicine called
Keppra to help with the seizures, and yet “A few months ago
he had a seizure even though his blood sugars were doing very well.
And so there was a concern- why should he have seizures if his
blood sugars were normal,” says the doctor.

The diabetes and blood sugar is under control- it must be something
else. To help solve this mystery the doctor calls Jerry’s
neurologist. By the process of elimination, they come to a decision. “After
reviewing his previous workup, and checking his blood sugars and
the rest of his blood chemistries, we saw that those are normal,
and we’re left with that he has an underlying seizure disorder.”

In other words, there may be something wrong in his brain. Jerry
will visit a neurologist in a few weeks to find out more. In the
meantime Jerry will go home, but the doctor is optimistic, “He
looks like a very bright boy and if we can get the seizures under
control, he should do very well.”

Each year, anywhere from 25,000 to 40,000 children in the United
States experience an unprovoked seizure, defined as a seizure that it is
not caused by head trauma, an infection or other known causes. Researchers
from the National Institute of Neurological Disorders and Stroke (NINDS)
have found that a number of children who have unexplained seizures do not
go on to have an additional one. In fact, the American Academy of Family
Physicians reports that approximately 4 to 10 percent of children have an
unprovoked seizure without recurrence. And by not beginning anti-seizure
medication, these children can be spared from experiencing the side effects
of the anti-seizure medication, which often include rash, nausea and vomiting,
weight gain, irritability, a decline in mental ability, sleepiness, and even
liver or bone marrow damage in severe cases.

The American Academy of Pediatrics (AAP) says that
seizures are caused by abnormal electrochemical activity within the nerve
pathways in the brain. Stroke victims can be identified when their muscles
become stiff or rigid or when their muscle movement becomes jerky. These
occurrences are sometimes repetitive and can occasionally be violent. While
more than 20 different types of seizures exist, the AAP places them in
two categories – partial and generalized:

• Partial seizures – T hose that begin in a focal or discreet
  area of the brain.
• Generalized seizures – Those that involve larger areas
  of the brain (often both hemispheres, or sides) from the onset.

Most seizures are single, unique events in the lives of children.
So how can you tell if your child is having a seizure? The Centers
for Disease Control and Prevention cite the following signs indicating
that your child may be experiencing seizures:

• Suddenly falls for no reason
• Experiences a lack of response to noise or to spoken words for
  brief periods
• Exhibits dazed and confused behavior
• Is unusually sleepy and irritable when wakened in the morning
• Exhibits head nodding
• Rapidly blinks and stares
• Frequently complains that things look, sound, taste, smell or
  feel “funny”
• Experiences episodes of fear that have no observable cause
• Exhibits clusters of jack-knife movements, accompanied by crying
  or clusters of grabbing movements with both arms
• Experiences sudden stomach pain followed by confusion and sleepiness
• Has a blank stare followed by chewing, picking at clothes, making
  random movements and being unresponsive toward surroundings
• Experiences sudden muscle jerks

If you determine that your child is having a seizure, the Epilepsy
Foundation says that you should take the following steps to keep
him or her safe for the minute or two that the seizure usually lasts:

• First, clear everything out of the way.
• Don’t hold your child down or try to stop the jerking.
• Put something flat and soft under your child’s head.
• Make sure nothing tight that could interfere with breathing
  is wrapped around your child’s neck.
• Check your watch so you will know how long the seizure lasts.
• Turn your child gently onto one side so he or she doesn’t
  choke.
• Don’t try to open your child’s mouth.
• Don’t try to put anything in your child’s mouth.
• Don’t try to give your child anything to drink during
  the seizure.
• Comfort your child as he or she starts to wake up afterward.

Any child having a seizure requires prompt medical attention to
determine the cause. It is important to remember that just because
your child has a seizure doesn’t mean he or she has epilepsy.
Even if your child has more than two seizures and they are caused
by head trauma or meningitis (symptomatic seizures), it is not thought
of as being epilepsy. It is also not considered to be epilepsy if
two or more seizures occur on the same day.

As a parent, you should know that it is not uncommon for infants or
small children to experience a seizure or convulsion induced by a fever.
In fact, the NINDS reports that approximately one in every 25 children
will have at least one febrile seizure, and more than one-third of
these children will have additional febrile seizures before they outgrow
the tendency to have them. Most febrile seizures last a minute or two,
although some can be as brief as a few seconds while others last for
more than 15 minutes. Although they can be frightening, the vast majority
of febrile seizures are harmless.