When Seizures Attack!

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.

Febrile Seizure- Stay Calm?

This week’s guest columnist is Dr. Benjamin Fontenot, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

It was mango season on Saba island, Netherlands Antilles.  My wife and I were on the beach eating some, and we decided to give our 8 month-old daughter a taste.  She liked it, but then paradise turned scary- she became lethargic, turned blue around the lips, was twitching, and seemed to stop breathing.  We called 911 and the island police rushed her to the local ER.  By the time we arrived, she was awake, pink, and breathing fine.  And now had a 103 degree fever. This was our first “febrile seizure,” and it had nothing to do with the mango.  Our daughter had an ear infection, which caused the fever, which led to the seizure.

What is a febrile seizure?  Simply, it’s when a child has a seizure with a fever. The child suddenly goes unconscious, has rhythmic twitching of the face, arms or legs, and is unarousable.  The child’s breaths are so shallow that it’s hard to tell if they are breathing.  After a few minutes of seizing, the child relaxes and breathes normally, and though sleepy and confused-acting, can be aroused.  After 10 to 20 more minutes he becomes more awake.

Febrile seizures only happen to about 4% of kids, but they sure are memorable when they do!  It’s frightening to watch, but doesn’t cause lasting harm.  Intelligence and other aspects of brain development aren’t affected- these kids grow up fine.  And kids do breathe adequately during seizures, although it’s tough to tell.

More good news: most kids who have febrile seizures never have another.  About one third of these kids have more than one, but they all outgrow them by 6 years of age.

Febrile seizures happen between ages 6 months to 5 years.  How high the fever goes, or how fast it goes up, has nothing to do with having a seizure.  Thus if your child has a fever of 104, that does not mean they’re going to seize.  Some kids seem to get them, most don’t.  In fact, seizures usually happen before the onset of fever, so if your child is already hot, it’s less likely that they’ll have one.

During my second year of medical school, it happened again.  My daughter was 16 months at the time.  She was playing with the neighbor’s kids when she suddenly stopped, fell straight back on the floor, and began shaking.  The other mothers freaked out, but my wife assured them that it was “only a seizure.”  She sure got some strange looks!  Then the fever started, and it turned out to be another ear infection.

As we discussed above, febrile seizures are scary to watch, but are actually no reason to panic.  They don’t hurt child’s brain, kids breathe adequately during the seizure, and go on to grow up fine.  Easy to say, but what do I do if my child has one?

First, stay calm.  Roll the child onto his side, so if he won’t choke if vomiting. Don’t put things in the mouth.  Some people worry kids will “swallow their tongue” or bite their tongue, and think sticking something in will help- wrong!  Kids don’t choke during seizures, and shoving things in can hurt their teeth and mouth. Don’t try to stop the jerking either- you can’t, and again may hurt the child by trying.

Watch the time.  Seizures lasting past 5 minutes may require treatment. If the seizure is going that long, call 911.  Paramedics carry medication that can stop seizures.

Once the seizure is over, the child should see a doctor, to determine the source of the fever. Fevers are usually caused by viruses that go away by themselves, but sometimes kids have bacterial causes like ear infections, and need antibiotics.  Blood tests are mostly unnecessary after febrile seizures.

Can you prevent febrile seizures?  Regular dosing with acetaminophen (Tylenol) or ibuprofen don’t prevent them. Giving anti-seizure medication, like for kids with epilepsy, may help.  However, in most cases this is not recommended. Potential side effects of daily anti-seizure medications usually outweigh the benefits. Remember- febrile seizures are not harmful. The only danger is leaving kids in the bathtub unattended and they seize and drown.  But you shouldn’t leave kids alone in the tub anyway, seizures or not.

Febrile seizures are scary for parents.  Follow the plan above, recognize the signs and symptoms, and stay calm!

Seizures And Fevers: No Brain Frying Here!

This week’s guest columnist is Dr. Devan Szczepanski, a family practice resident at the University Hospital and Clinics here in Lafayette. 

Mrs. Breaux gets a phone call at work from Sue’s daycare.  Sue needs to be picked up because she has a fever.  When Mrs. Breaux arrives, the teacher explains that 15 minutes earlier Sue fell to the floor and began shaking all over.  The shaking lasted about one minute, then Sue relaxed and slept for about 10 minutes.  Now she is waking up and when Sue sees her mom she runs over with bright red cheeks and gives mom a hug.  The teacher is concerned and insists Mrs. Breaux bring Sue to the Emergency Room. However, Sue’s mom has seen this before and knows there is no need for panic. Marco, Sue’s older brother, also had febrile seizures.

Febrile seizures are much more common than people think!  Up to 4% of children will experience the “hot shakes” before 5 years old.  They sure make parents scared. Many parents are worried enough about fevers alone.  Imagine adding some seizure activity to the mix!  But the good news is that febrile seizures are perfectly safe and do not need a 9-1-1 call if the parent understands what to watch for.

By “febrile seizure” we mean, simply, a seizure that goes along with a fever.  The child will have a temperature of 100.4 or greater, pass out, have rhythmic jerking of arms, face, or legs for a few minutes, and then be confused and sleepy afterward.  The sleepy period, which we call the “post-ictal state,” lasts about 10 to 20 minutes and is followed by full awakening.  Often the seizure happens first and then later the fever is noticed.  Febrile seizures follow the rule of “S“: occur between Six months to Six years of age, are Short in duration, occur Soon after illness begins, and are more common among Siblings.

There is a lot of good news about febrile seizures.  Seizures don’t hurt babies’ brains. Kiddos grow out of them.  Only very few go on to have epilepsy (life-long seizures). Higher fevers do not increase a child’s chance of having a seizure.  Just because a child has a temperature of 104 doesn’t mean he is going to seize.  Some seize at 100.5, some 105, and the vast majority of kids with fevers of any height don’t have seizures.  Most kids who have a febrile seizure never have another.

So what to do if my child has a seizure?  The safest thing is to “hurry up and wait!” Meaning, don’t try to stop the jerking by restraining the child, don’t start CPR, don’t force things into the mouth.  Your only job is to make sure the child can’t hurt themselves by bumping into furniture or slipping under water in the tub (another reason to never leave your child alone in a tub!).  Please keep track of the length of time the seizure lasts.  This is important because the decision for further tests or treatment is often based on how long the seizure lasted.

When to worry?  If the seizure lasts longer than 5 minutes, call an ambulance. Paramedics carry medicine that can stop a seizure that lasts too long.  If the child does not wake up soon enough after a seizure (again, about 10 to 20 minutes), this may mean the child is more sick than from a regular virus. Get her seen.

So if the fever is not frying my baby’s brain, then why is she having a seizure?  GREAT QUESTION!  All the “wise ones” of science have tried time and again to answer this question.  Ultimately, it appears that it is mostly genetic.  Your child has inherited a brain that is wired to occasionally seize when she has a fever.  And then she outgrows that.

While it is important that your child see a doctor soon after the episode to be sure everything is okay, the main thing to remember is that while febrile seizures can be scary to watch, the seizure does not cause lasting harm.  In the words of Dr. Hamilton, the fever will not “fry your baby’s brain.”  Only YOUR nerves!