This week’s guest columnist is Dr. Wesley Adams, a Family Practice resident at the University Hospital and Clinics here in Lafayette.
I saw my first seizure while at a family reunion. I was eating with teenage cousins when one of them suddenly stopped eating and said “I feel kinda weird.” Then her eyes rolled up to the back of her head, her arms began jerking, and she slid out her chair onto the floor. After a few seconds of shocked silence, we all began shouting at once, moving furniture away from her, and fumbling with phones to call 911. Her body stopped shaking after a few minutes, and then a few minutes after that she opened her eyes. “What’s going on?” she slurred, her head rolling around to see us all standing over her, “Whatchya all looking at?”
I didn’t know much about seizures then, but that was before medical school. When the brain functions normally, it’s cells communicate with each other using tiny electrical impulses. Our brain coordinate and controls these impulses to do things like think, talk, and walk. During a seizure the impulses go haywire, firing randomly and excessively. The patient goes unconscious, and muscles sometimes twitch from faulty nerve signals coming from the brain.
Seizures are scary, especially for parents of a seizing child. The good news is that the vast majority of seizures are benign. Patients typically recover from a seizure pretty quickly. Kids breathe adequately during a seizure, though this can be hard to perceive with all the shaking and foaming at the mouth. Kids don’t swallow their tongues- that’s a myth. The only real danger from seizures is if the child’s alone in a bathtub or pool, or a teenager seizes while driving.
Epilepsy is a diagnosis where a child has regular seizures. One common type is the Absence seizures, typically in elementary school-age kids. These are super-brief seizures, just a few seconds, where the child appears to be just staring and day-dreaming, but is actually unconscious. Then they come to before they have time to lose muscle control and fall out of their chairs. Other kids have full-blown “tonic-clonic” seizures, like my cousin above. Fortunately, anti-seizure medication controls most epilepsy.
Fast forward 10 years from that exciting family reunion. I was on my first shift in the Pediatric Emergency Department at Lafayette General. The paramedics brought in a teenager who had a seizure at school. The vice-principal who came with her reported that she had suddenly closed her eyes tightly, and her arms began shaking. The girl (we’ll call her Tina) remembered shaking, and classmates talking to her. However, despite her best efforts, she couldn’t open her eyes or get words out. The episode lasted about 2 minutes, and she felt fine immediately after.
This wasn’t Tina’s first seizure. She had already seen a neurologist. Her MRI showed normal brain structure, and her EEG showed normal brain electrical activity. The neurologist diagnosed Psychogenic Non-Epileptic Seizure, or PNES. Unlike epileptic seizures, with their haywire brain electricity we discussed above, these manifest from extreme psychological stress. Patients often aren’t unconscious because their brain cells aren’t misfiring. If they do go unconscious, it’s from passing out, not brain malfunction.
PNES starts with post-traumatic stress and developmental issues. Post-traumatic stress stems from disturbing things like bad car accidents or abuse incidents. These kids also have poor coping and communication skills. When faced with difficult memories or tense situations, their brains go into a kind of protective mode, walling off the unpleasant circumstances and directing the emotional intensity to physical symptoms like trembling and fainting.
PNES can be difficult to treat. It requires combinations of therapy and medications like anti-depressants or mood-stabilizers. It also requires lots of patience from parents, therapists, and schools. After all, these are teenagers! With thorny problems!
A final word about the most common seizure in the Pediatric ER- febrile seizures. These are brief seizures in infants and toddlers with fevers. Like epileptic seizures, these are scary for parents, but benign for the kids. Most toddlers have only one in their lives, and outgrow them by age 6. Like epileptic seizures, kids breathe adequately during the seizure and their brains aren’t injured, and aren’t being “cooked” by the fever. The majority of fevers are from viral infections that pass in a few days on their own.