Monday, September 05, 2011

Epilepsy Warrirors - Question of the Week

Ask A Neurologist Section of the Week........

Question from my blog....

My son is only XX months and is walking. At times we see him stumbling and falling forward and when we pick him up and try and get him back on his feet, he does not get up right away. He takes a while to get muscle strength and regain balance to walk again. This has happened a few times before. Until I took him into the ER this past weekend where they did a CT, MRI and blood work where they didn’t find anything. I discussed this with my friend and he told me that I should video it and talk with a neuro to do a eeg because this maybe a type of seizure, but until they do an eeg they will not be certain. Could this be a type of seizure? This has happened about 15 times within the last 6 weeks... thinking he just started walking early and just forgot how to walk.

Dr. Rotenberg's Response....

Thank you for sharing this personal story. It brings up many issues that can help many parents. I have purposefully changed some personal information, so please excuse the changes.

You describe an all to common scenario. Many people have the expectation that a full body convulsion is the only kind of seizure.

I cannot make diagnosis from your description, but, in general, there are several types of seizures that can cause falls. The most dramatic of these seizures is called in atonic seizure. Instead of displaying a stiffening of the muscles, these children will lose muscle tone...and fall. Such falling seizures can predispose them to injury.

The EEG is the diagnostic test of choice. An EEG is a functional test in that it looks at brain electrical activity AT THE TIME OF THE RECORDING.

EEG is a "SPECIFIC" test but it is not very "SENSITIVE". This means that a normal EEG does not rule out epilepsy any more than a doppler radar report showing a sunny day rules out rain yesterday. But the EEG is specific in that if its abnormal...its real. Often we need to repeat EEG's or request a longer EEG to increase sampling.

CT and MRI scans reveal that the brain anatomy is normal. Good News!! However, these scans do not diagnose epilepsy.

I think your friend has good advice. When children lose significant skills, I get very concerned. This history might suggest a developmental regression, but you need to discuss this with your physician.

Parents have described the difficulty in securing an appointment with a neurologist. I suggest that you call your primary care physician and enlist their help in expediting a consultation. Depending on the location, you may need to drive a few hours to see one. Given the choice, travel to get things started.

I’ve included a link to a pamphlet that introduces parents to epilepsy. It was composed in California and the last few pages are very specific to that state. The beginning, however, is an excellent review for parents.

Once again, thank you for stepping forward and submitting your personal story for the group.

Dr. Rotenberg

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