A baby or child appears to have had a seizure, it will be important for the physician to know as accurately as possible what actually took place, determine whether an underlying problem(s) provoked the episode, and episode and whether further studies should be done and/or medications given. Some important elements of the evaluation will include the following:
- The history. What actually happened? Did the episode begin gradually or suddenly? Was the whole body or only a limited area (such as a twitching arm or leg) involved? Hose long did it last? (Keep track of the time because seizures always sects to last longer than their true duration.) Did the child lose consciousness? If so, how quickly did he return to normal? If he is old enough to describe what happened, did he notice anything before the episode? Was he incontinent of urine or stool? Did he bite his tongue or sustain any other injury? Was he ill at the time, or was
- there any injury (such as a blow to the head) prior to the episode?
- It may be difficult to keep track of such details during an event as terrifying as a seizure, but all of this information is extremely important for the physician who is evaluating the problem. It will be necessary to decide whether a seizure has actually taken place.
- •Physical examination. This may not be terribly revealing if the episode in question happened last week. But immediately after a lapse in consciousness or in an infant who has just had a febrile convulsion, the physical exam might offer important clues to the diagnosis.
- Laboratory tests. The physician may request that certain blood tests be performed to rule out a metabolic cause for the seizure or to help evaluate any infection that might be in progress.
- A lumbar puncture (spinal tap). This may be recommended if there is any question that a seizure might involve an infection in the central nervous system, most commonly meningitis. It is more likely to be requested in infants and young children (under two years of age) who have had their first febrile seizure, especially when they are younger than three months of age. In this age-group a fever and a seizure may be the only indications that meningitis is present. While it might sound frightening and dangerous, a lumbar puncture is not a highly risky procedure, even in an infant.
- An electroencephalogram (EEG). This study of electrical activity in the brain is a very helpful tool in the investigation of a seizure disorder. It can be particularly useful in distinguishing certain behavioral or physical abnormalities (such as those mentioned below under the SPECIAL NOTE) from true convulsions. Unfortunately, at times the EEG can appear normal in a child who in fact has a seizure disorder.
- The most important use of the EEG, however, is to identify characteristic brain-wave patterns that, when correlated with the child’s symptoms during a seizure, allow the physician to classify the seizure disorder. This helps determine which medications will be most effective in controlling the seizures. An EEG involves attaching electrodes to the scalp but does not deliver any electrical shock and is not painful. In some cases the child may be sedated for the procedure, while in others he will be studied after he has been kept awake all night (a tactic that increases the odds of seeing abnormal activity).
- CT, MRI, or other imaging of the brain. This may be needed if there is a history or evidence of trauma to the head or any concern about other physical abnormalities within the brain that might be causing seizures.
Not all of the tests just described will necessarily be done as part of an evaluation of possible seizure activity. After a classic febrile seizure, for example, a child may simply be observed for a while in the doctor’s office or emergency room and then sent home. Depending upon the entire picture, however, some or all of these studies may need to be done.
If the diagnosis of a particular type of recurrent seizure disorder is confirmed, it is likely that the physician will recommend that one or more anticonvulsant medications be given over a period of time. These drugs will decrease the likelihood of further seizures (or eliminate them altogether), hopefully without interfering with normal activities or school performance. Febrile convulsions are an exception to this approach and normally are not treated with ongoing preventive medication. Details regarding specific drugs and their potential side effects are beyond the scope of this book but should be carefully reviewed with the prescribing physician. It is very important to take the medications consistently as they have been prescribed. Some children may require periodic blood tests to confirm that drug levels are appropriate and that certain adverse effects are not taking place. All these measures may seem burdensome for children and parents alike, but haphazard use of these medications may allow more seizures to occur or increase the risk of side effects. If your child with seizures is taking one or more medications that you feel are adversely affecting his life (for example, causing excessive drowsiness or poor school performance), you should not change the dose or discontinue any drug without discussing the problem with his physician.
Occasionally seizures that are disruptive and not adequately controlled with medication may be improved with surgery. Extensive evaluation and highly technical procedures are required for this type of treatment, which typically is carried out by a team of specialists at a regional children’s hospital.