Is your pediatric neurologist board-certified?

It is important to ask if your physician, in my case, a child neurologist is board-certified.

Pediatric Neurology Services at Home During Corona / Covid -19

Social Distancing Saves Lives in Child Neurology Too

19 March 2020

To: HSC Houston Specialty Clinic Child Adolescent  Neurology Patients

Subject: Dr. Rotenberg, Kara Schmidt, Testing and EEG  - Appointments during Coronavirus Emergency 

• The State of Texas is in the midst of a public health emergency due to coronavirus. 
• It is imperative to “flatten the curve” of this pandemic by practicing strict social distancing. 
• Our practice is committed to our patients' needs. 
• We need to make changes to safely deliver care under these unusual circumstances. 
• Telemedicine visits are an established part of our practice.  It's business as usual. 

Therefore, effective immediately: 

1. All appointments will be moved to telemedicine status ONLY. 
2. New patients will be completed by telemedicine ONLY. 
3. Most testing, dietician consults will be completed by telemedicine.  
4. There will be very few exceptions based on medical need. 
5. EEG visits will be rescheduled to a different time or place. 

Regarding pulmonary:  Dr. Susarla to release updated guidelines later today. 

This process will stay in place during the course of this emergency. 

Please call your insurance and/or employer to check telemedicine benefits. 

Thank you, 

Dr. Rotenberg 

Information on Covid19

https://www.facebook.com/groups/coronavirus.houston/

http://publichealth.harriscountytx.gov/Resources/2019-Novel-Coronavirus

Texas Telemedicine

Governor Abbott Waives Certain Regulations For Telemedicine Care In Texas

March 17, 2020 | Austin, Texas | Press Release

Governor Greg Abbott today waived certain regulations and directed that the Texas Department of Insurance (TDI) issue an emergency rule, all relating to telemedicine care for patients with state-regulated insurance plans to help doctors across Texas continue to treat their patients while mitigating the spread of COVID-19. The suspensions and emergency rule will work together to allow telemedicine visits for patients with state-regulated plans to be paid the same as in-office visits for insurance purposes. These actions build upon waivers the Governor issued last week of portions in the Occupations Code to expand provider flexibility in providing medical services over the phone.

“As the State of Texas responds to COVID-19, we continue to work to maintain regular health care services and operations throughout the state, and telemedicine is one of the most valuable tools we have to ensure Texans continue to receive the health services they need,” said Governor Abbott. “Expanding telemedicine options will help protect the health of patients and health care professionals, and help Texas mitigate the spread of COVID-19.”

Doctors will be eligible for payment from insurance plans regulated by TDI for medical visits they conduct over the phone instead of in-person at the same rate they would receive for in-person visits. 

Medical providers seeking guidance on the impact of the new rule can expect guidance from the Texas Medical Board to be issued in the coming days, including administrative guidance for billing to ensure that claims are processed smoothly.

Insurers seeking guidance on implementation of the emergency rule should contact TDI or visit their webpage for more information.

This coordinated efforts between the Office of the Governor, the Texas Department of Insurance, the Texas Medical Board, and health insurance plans will increase access to health care for all Texans. Today’s action will expand telemedicine options by giving health care providers greater flexibility to perform audio-only telephone consultations with their patients.

As a reminder, Texans covered by CHIP or Medicaid will not be charged copays for test or telemedicine consults. Individuals covered by Medicare or large employer plans should check with their health plan administrator to determine their specific benefits. 

Relationship between epilepsy and autism may be...

A study looks into the relationship that may exist between epilepsy and autism.

Researchers at the University of Veracruz (UV), in the west coast of Mexico, study the neurobiological link between the Autism Spectrum Disorder (ASD) and epilepsy, in order to understand the reason why the brain of an autistic child is 20-30 percent more susceptible to seizures that an infant without this condition.

To know said relationship, Angel Alberto Puig Lagunes, a doctoral student in Brain Research of the UV works with two experimental models, one with autism and other of epilepsy because 30 percent of autistic people may have at some point in their lives some form of epilepsy, especially during childhood and adolescence.

The research seeks to understand the differences in the amount of neurotransmitters and receptors that may determine susceptibility to seizures. "If we know what happens in the brain structures of lab rats using these models, we can generate new insights into the characteristics that patients with ASD present that make them more susceptible to having seizures and may in the future provide new drugs or non-pharmacological interventions treatments for such illness, "says Angel Puig.

The World Health Organization estimates that worldwide one in 160 children under 12 years of age has autism. In Mexico, there are about 46,000 people with this disease.

The specialist refers that one to 1.5 percent of the global population have epilepsy, the equivalent to 50 million people. Various epidemiological data indicate that between 20 and 35 percent of children with autism have this condition; however, the neurobiological causes of such comorbidity are yet unknown.

In response, Puig Lagunes in collaboration with Maria Leonor López-Meraz, Jorge Manzo Denes and Rebeca Toledo Cárdenas assess neurochemical changes that occur in brain structures such as the hippocampus, amygdala, cerebellum and frontal cortex exposed to valproic acid, areas involved in autism and epilepsy.

The researcher analyzes seizures through drugs like pentylenetetrazol, used to induce crisis, and valproic acid, an anticonvulsant that is applied prenatally to rats, since research has shown that when it is administered to a pregnant woman there is greater likelihood that her child is born with ASD or congenital malformations.

With this method, says Angel Puig, we study whether fetuses exposed to the drug are more susceptible to presenting seizures and can identify, at a neurobiological level, what happens in the brain of an autistic person.

The results of this research show that like children with autism, laboratory rats that were prenatally exposed to valproic acid are more susceptible to presenting tonic-chronic seizures, common in people with generalized epilepsy.

With this research, Angel Puig won third place at the Annual Congress of the Mexican Chapter of the International League Against Epilepsy (Camelice) conducted in León, Guanajuato, center of Mexico.

Read more here

Medication to help children with life threatening seizures

Research has shown that an investigational medication can help treat children with potentially life threatening seizures.

In its first clinical application in pediatric patients, an investigational medication developed and manufactured at UC Davis has been found to effectively treat children with life-threatening and difficult-to-control epileptic seizures without side effects, according to a research report by scientists at UC Davis and Northwestern University.

The investigational formulation of allopregnanolone was manufactured by UC Davis Health System's Good Manufacturing Practice Laboratory. Two children were treated with the allopregnanolone formulation, one at UC Davis Children's Hospital, the other at the Ann & Robert Lurie Children's Hospital in Chicago. Both children were weaned from general anesthetics and other seizure treatments and their seizures resolved. In both instances the children are recovering.

The research is published online in Annals of Neurology, an official journal of the American Neurological Association and the Child Neurology Society.

Super-refractory status epilepticus is a condition diagnosed in patients with refractory status epilepticus being treated with infusions of general anesthetics when seizures continue for longer than 24 hours, despite anesthesia, or when seizures recur on reduction or withdrawal of the anesthesia. Super-refractory status epilepticus has high morbidity and mortality. There are no Food and Drug Administration (FDA)-approved treatments for the condition.

Allopregnanolone is a positive allosteric modulator of GABAA receptors in the brain. Research in animals has shown that allopregnanolone protects against seizures and can stop status epilepticus. Although the allopregnanolone used to manufacture the investigational treatment was produced by chemical synthesis according to procedures regulated by the FDA, it is synthesized normally in small quantities in the body from progesterone.

"Our laboratory studies have shown that allopregnanolone is effective in stopping status epilepticus that is refractory to treatment," said Michael Rogawski, professor in the UC Davis Department of Neurology and a co-author of the report.

In both of the clinical cases, the patients continued to have seizures despite weeks of intensive treatment with medications, including infusion of anesthetics. Emergency treatment with the investigational medication was approved by the FDA; the two patients received the medication over a five-day period, during which time both were weaned from anesthetics and other seizure medications. Status epilepticus did not recur after treatment. There were no adverse drug effects, the researchers said.

Mortality rates in super-refractory status epilepticus can be as high as 50 percent, and those who survive experience high rates of subsequent neurological impairment. The authors note that progesterone and ganaxolone, a chemical analog of allopregnanolone, have been studied in clinical trials for epilepsy and have shown benefit. Researchers at UC Davis, led by Rogawski, currently are investigating the use of allopregnanolone as a treatment for traumatic brain injury.

"Neurosteroids, including allopregnanolone, are a promising treatment for epilepsy and refractory status epilepticus that may overcome resistance to benzodiazepines and barbiturates and facilitate the withdrawal of these agents by preventing rebound seizures, a key problem in treatment of super-refractory status epilepticus," Rogawski said.

Read more here

Diet changes to help tough-to-treat epilepsy

This article explains low-carb high-fat diets and how they help tough-to-treat epilepsy.

Diets high in fat and low in carbohydrates, such as the ketogenic or modified Atkins diet, may reduce seizures in adults with tough-to-treat epilepsy, according to a review of the research published in the October 29, 2014, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Epilepsy is a nervous system disorder in which the nerve cells in the brain work abnormally, causing seizures. About 50 million people have epilepsy worldwide, according to the World Health Organization.

"We need new treatments for the 35 percent of people with epilepsy whose seizures are not stopped by medications," said study author Pavel Klein, M.B.,B. Chir., of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, Md., and a member of the American Academy of Neurology. "The ketogenic diet is often used in children, but little research has been done on how effective it is in adults."

The ketogenic and modified Atkins diets include items such as bacon, eggs, heavy cream, butter, leafy green vegetables and fish. The ketogenic diet consists of a ratio of fat to protein/carbohydrates of three or four to one by weight. The modified Atkins diet has a one-to-one fat to carbohydrate/protein ratio by weight.

Scientists reviewed five studies on the ketogenic diet with a total of 47 people included in the analysis and five studies on the modified Atkins diet with 85 people included.

Researchers found that across all studies, 32 percent of people treated with the ketogenic diet and 29 percent of those treated with the modified Atkins diet experienced a 50 percent or better reduction in their seizures. Nine percent in the ketogenic treatment group and 5 percent in the modified Atkins group had a greater than 90 percent reduction in seizures.

The positive results occurred quickly with both diets, within days to weeks. The effect persisted long-term, but, unlike in children, the results did not continue after participants stopped following the diet. Side effects of both diets were similar and not serious, with weight loss the most common side effect.

Fifty-one percent of the ketogenic diet group and 42 percent of the modified Atkins group stopped the diet before the study was completed.

"Unfortunately, long-term use of these diets is low because they are so limited and complicated. Most people eventually stop the diet because of the culinary and social restrictions," said Klein. "However, these studies show the diets are moderately to very effective as another option for people with epilepsy."

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Link found between migraines and seizures

This article explains a link found in the brain between migraine headaches and seizures.

Seizures and migraines have always been considered separate physiological events in the brain, but now a team of engineers and neuroscientists looking at the brain from a physics viewpoint discovered a link between these and related phenomena.

Scientists believed these two brain events were separate phenomena because they outwardly affect people very differently. Seizures are marked by electrical hyperactivity, but migraine auras -- based on an underlying process called spreading depression -- are marked by a silencing of electrical activity in part of the brain. Also, seizures spread rapidly, while migraines propagate slowly.

"We wanted to make a more realistic model of what underlies migraines, which we were working on controlling," said Steven J. Schiff, Brush Chair Professor of Engineering and director of the Penn State Center for Neural Engineering. "We realized that no one had ever kept proper track of the neuronal energy being used and all of the ions, the charged atoms, going into and out of brain cells."

Potassium and sodium contribute the ions that control electricity in the brain. The Penn State researchers added fundamental physics principles of conservation of energy, charge and mass to an older theory of this electricity. They kept track of the energy required to run a nerve cell, and kept count of the ions passing into and out of the cells.

The brain needs a constant supply of oxygen to keep everything running because it has to keep pumping the ions back across cell membranes after each electrical spike. The energy supply is directly linked to oxygen concentrations around the cell and the energy required to restore the ions to their proper places is much greater after seizures or migraines.

"We know that some people get both seizures and migraines," said Schiff. "Certainly, the same brain cells produce these different events and we now have increasing numbers of examples of where single gene mutations can produce the presence of both seizure and migraines in the same patients and families. So, in retrospect, the link was obvious -- but we did not understand it."

The researchers, who also included Yina Wei, recent Penn State Ph.D. in engineering science and mechanics, currently a postdoctoral fellow at University of California-Riverside, and Ghanim Ullah, former Penn State postdoctoral fellow, now a professor of physics at University of South Florida, explored extending older models of brain cell activity with basic conservation principles. They were motivated by previous Penn State experiments that showed the very sensitive link between oxygen concentration with reliable and rapid changes in nerve cell behavior.

What they found was completely unexpected. Adding basic conservation principles to the older models immediately demonstrated that spikes, seizures and spreading depression were all part of a spectrum of nerve cell behavior. It appeared that decades of observations of different phenomena in the brain could share a common underlying link.

"We have found within a single model of the biophysics of neuronal membranes that we can account for a broad range of experimental observations, from spikes to seizures and spreading depression," the researchers report in a recent issue of the Journal of Neuroscience. "We are particularly struck by the apparent unification possible between the dynamics of seizures and spreading depression."

While the initial intent was to better model the biophysics of the brain, the connection and unification of seizures and spreading depression was an emergent property of that model, according to Schiff.

"No one, neither us nor our colleagues anticipated such a finding or we would have done this years ago," said Schiff. "But we immediately recognized what the results were showing and we worked intensively to test the integrity of this result in many ways and we found out how robust it was. Although the mathematics are complex, the linking of these phenomena seems rock solid."

The ability to better understand the difference between normal and pathological activity within the brain may lead to the ability to predict when a seizure might occur.

"We are not only interested in controlling seizures or migraines after they begin, but we are keen to seek ways to stabilize the brain in normal operating regimes and prevent such phenomena from occurring in the first place," said Schiff. "This type of unification framework demonstrates that we can now begin to have a much more fundamental understanding of how normal and pathological brain activities relate to each other. We and our colleagues have a lot on our plate to start exploring over the coming years as we build on this finding."

The National Institutes of Health and the Mathematical Biosciences Institute of the National Science Foundation supported this work.

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Difficulties of treating epilepsy while pregnant

This article explains the difficulties of pregnant mothers with epilepsy treating the condition while pregnant.

A new study published in The Cochrane Library, highlights the difficult decisions women with epilepsy have to face when they become pregnant. Taking certain drugs used to control epilepsy during pregnancy may be linked to developmental problems in children. The authors of the study say evidence on the safety of anti-epileptic drugs is limited and that more research is needed to ensure women and their doctors make the most informed choices.

Studies on children born to women with epilepsy increasingly suggest that some anti-epileptic medications affect development in the womb. However, most women with epilepsy rely on these medications to control seizures during pregnancy.

To assess the safety of taking anti-epileptics during pregnancy, the researchers drew together evidence from 28 studies. They measured children's global cognitive ability using either intelligence quotient (IQ), for school aged children, or developmental quotient (DQ), for younger children, to provide a summary of development across a range of cognitive skills. The researchers looked at DQ and IQ scores in the children of three groups of women: those with epilepsy who took anti-epilepsy medication, those with epilepsy who did not take epilepsy medication and those without epilepsy.

The children of women who took one drug, sodium valproate, had lower DQs and IQs than the children of women in the other groups. Higher doses of this drug were linked to larger effects on IQ or DQ. However another drug, carbamazepine, did not appear to have any significant effects on DQ or IQ. Younger children born to women who took carbamazepine did have lower DQs but the researchers concluded that this effect was due to random variation between the results of studies.

"This review highlights the need for preconception counselling in women with epilepsy," said Rebecca Bromley, lead researcher of the study based at the Institute of Human Development at the University of Manchester in Manchester, UK. "Counselling should take account of the fact that many pregnancies are unplanned and cover the risks of anti-epileptic drugs, whilst considering how well they control epileptic seizures."

"The review also highlights the need to counsel patients about risks and benefits of treatment alternatives at the time of epilepsy diagnosis and treatment initiation, so that informed decisions can be made. This is particularly important for women with idiopathic generalised epilepsy for whom valproate is the most effective treatment. Some women may choose to initiate valproate as they have no plans to conceive, while others may choose to avoid valproate and try a less effective drug accepting the associated risk of further seizures." Tony Marson, Coordinating Editor Cochrane Epilepsy Group, University of Liverpool.

Some studies made comparisons between different drugs. The children of women who took valproate had lower IQs than children exposed to carbamazepine or lamotrigine in the womb. They also had lower DQs and IQs than children born to women who took phenytoin. There were no differences between the IQs of children exposed to either carbamazepine, phenytoin or lamotrigine.

Only a few studies analysed the effects of newer anti-epileptic drugs like lamotrigine, levetiracetam and topiramate. "Data was not available for all anti-epileptic drugs that are in use today and data on newer anti-epileptic drugs was especially scarce," said Bromley. "This makes it difficult for women and their doctors to know which medications are safe to use during childbearing years. Future research needs to be carried out in a timelier manner to ensure that when prescribing decisions are being made the risks are already established. Women should however not stop or make alterations to their medication without first seeking medical advice."

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Home testing and monitoring for epilepsy - Available in the Houston Area ..and now in London.

A hospital in London is pioneering a home diagnosis test and monitoring for epilepsy. This is described as a first of its kind. 

But, as an epilepsy specialist, I noted the value and convenience of such a service. My pediatric neurology practice has been offering home EEG service for the Houston area a number of years. 

-JR

A London hospital is the first in Britain to pioneer home testing for epilepsy patients.

The brain-scanning service rolled out by King’s College Hospital NHS Foundation Trust will benefit hundreds of people who suffer devastating seizures, and improve treatment.

Home monitoring allows patients to carry on with daily life without the disruption of days in hospital — it is also thought to be a more accurate method.

The service is called Home Video Telemetry and the patient wears a special head device fitted with electrodes which records brain activity over several days.

A video camera also captures the physical seizures. A technician visits the patient’s home and collects the data on a daily basis which is analysed by a consultant.  Epilepsy affects about 600,000 people in the UK including more than 60,000 children. The condition affects the brain and causes multiple seizure attacks in severe cases. Brain scanning is crucial for doctors to diagnose patients with suspected epilepsy correctly and provide them with tailored treatment.

Hospital checks have been the gold standard until now for those who suffer multiple attacks. However, other NHS trusts are now expected to adopt home testing following the success of pilots by King’s. It comes as new research reveals that testing epilepsy patients in hospital may produce biased results. Dr Franz Brunnhuber at King’s has carried out work revealing that people are about half as likely to experience seizures in hospital than at home.

The consultant clinical neurophysiologist said this can make it difficult for doctors to determine the exact nature of a patient’s condition.

He added: “Misdiagnosis is a major problem with epilepsy because there are lots of conditions which mimic the disorder so it’s crucial to capture seizure attacks accurately. The home service is more convenient for patients. Hospital is a huge stress factor for them. Home testing means patients can lead a normal life.”

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What is the best medicine for children with seizures?

This article discusses what is the best medication for children with seizures.

A recently published clinical study in the Journal of the American Medical Association has answered an urgent question that long puzzled ER pediatricians: Is the drug lorazepam really safer and more effective than diazepam – the U.S. Food and Drug Administration-approved medication as first line therapy most often used by emergency room doctors to control major epileptic seizures in children?

The answer to that question – based on a double-blind, randomized clinical trial that compared outcomes in 273 seizure patients, about half of whom were given lorazepam – is a clear-cut "no," said Prashant V. Mahajan, M.D., M.P.H., M.B.A, one of the authors of the study.

"The results of our clinical trial were very convincing, and they showed clearly that the two medications are just about equally effective and equally safe when it comes to treating status epilepticus [major epileptic brain seizures in children]," Dr. Mahajan said. "This is an important step forward for all of us who frequently treat kids in the ER for [epilepsy-related] seizures, since it answers the question about the best medication to use in ending the convulsions and getting these patients back to normal brain functioning."

Describing the brain convulsions that were targeted by the study, its authors pointed out that status epilepticus occurs when an epilepsy-related seizure lasts more than 30 minutes. Such seizures – which occur in more than 10,000 U.S. pediatric epilepsy patients every year – can cause permanent brain damage or even death, if allowed to persist.

Published in JAMA, the study, "Lorazepam vs Diazepam for Pediatric Status Epilepticus: A Randomized Clinical Trial," was designed to test earlier assertions by many clinicians that lorazepam was more effective at controlling pediatric seizures. The study-authors wrote, "Potential advantages proposed in some studies of lorazepam include improved effectiveness in terminating convulsions, longer duration of action compared with diazepam, and lower incidence of respiratory depression. Specific pediatric data comparing diazepam with lorazepam suggest that lorazepam might be superior, but they are limited to reports from single institutions or retrospective studies with small sample sizes, thus limiting generalizability."

Based on data collected over four years at 11 different U.S. pediatric emergency departments, the new study found that "treatment with lorazepam [among pediatric patients with convulsive status epilepticus] did not result in improved efficacy or safety, compared with diazepam."

That determination led the study authors to conclude: "These findings do not support the preferential use of lorazepam for this condition."

Dr. Mahajan, a nationally recognized researcher in pediatric emergency medicine and a Wayne State University School of Medicine pediatrics professor recently appointed chair of the American Academy of Pediatrics Executive Committee of the Section on Emergency Medicine, said the JAMA study provides "a compelling example of how effective research in pediatric medicine, based on treatment of patients right in the clinical setting, can play a major role in improving outcomes."

Children's Hospital of Michigan Chief of Pediatrics Steven E. Lipshultz, M.D., said this recent breakthrough will "undoubtedly result in better care for pediatric patients who present in the emergency room with seizures related to epilepsy.

"There's no doubt that combining excellent research with excellent treatment is the key to achieving the highest-quality outcomes for patients – and Dr. Mahajan's cutting-edge study is a terrific example of how kids are benefiting from the research that goes on here at Children's every single day," said Dr. Lipshultz.

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Neural transplant reduces seizures in mice

A neural transplant reduces a specific type of
epileptic seizures in mice.

New research from North Carolina State University pinpoints the areas of the cerebral cortex that are affected in mice with absence epilepsy and shows that transplanting embryonic neural cells into these areas can alleviate symptoms of the disease by reducing seizure activity. The work may help identify the areas of the human brain affected in absence epilepsy and lead to new therapies for sufferers.

Absence epilepsy primarily affects children. These seizures differ from "clonic-tonic" seizures in that they don't cause muscle spasms; rather, patients "zone out" or stare into space for a period of time, with no memory of the episode afterward. Around one-third of patients with absence epilepsy fail to respond to medication, demonstrating the complexity of the disease.

NC State neurobiology professor Troy Ghashghaei and colleagues looked at a genetic mouse model for absence epilepsy to determine what was happening in their brains during these seizures. They found that the seizures were accompanied by hyperactivity in the areas of the brain associated with vision and touch -- areas referred to as primary visual and primary somatosensory cortices in the occipital and parietal lobes, respectively.

"There are neurons that excite brain activity, and neurons that inhibit activity," Ghashghaei says. "The inhibitory neurons work by secreting an inhibitory neurotransmitter called gamma-aminobutyric acid, or GABA. The 'GABAergic' interneurons were recently shown by others to be defective in the mice with absence seizures, and we surmised that these malfunctioning neurons might be part of the problem, especially in the visual and somatosensory cortical areas."

Ghashghaei's team took embryonic neural stem cells from a part of the developing brain that generates GABAergic interneurons for the cerebral cortex. They harvested these cells from normal mouse embryos and transplanted them into the occipital cortex of the genetic mice with absence seizures. Absence seizure activity in treated animals decreased dramatically, and the mice gained more weight and survived longer than untreated mice.

"This is a profound and remarkably effective first result, and adds to the recent body of evidence that these transplantation treatments can work in mouse models of epilepsy. But we still don't understand the mechanisms behind what the normal inhibitory cells are doing in areas of the visual cortex of absence epileptic mice," Ghashghaei says. "We know that you can get positive results even when a small number of transplanted neurons actually integrate into the cortex of affected mice, which is very interesting. But we don't know how the transplanted cells are connecting with other cells in the cortex and how they alleviate the absence seizures in the mouse model we employed.

"Our next steps will be to explore these questions. In addition, we are very interested in methods being devised by multiple labs around the world to 'reprogram' cells from transplantation patients to generate normal GABAergic and other types of neurons. Once established, this would eliminate the need for embryonic stem cells for this type of treatment. The ultimate goal is to develop new therapies for humans suffering from various forms of epilepsies, especially those for whom drugs do not work."

The research appears online in Cerebral Cortex.

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How a child's fever can turn into a seizure

This article discusses how a child's fever can turn into a seizure, and explains the different types of seizures.

When a child has a fever, their body can ache. They are restless and they just don’t feel well. While a fever is a part of our natural response to infection, the fever itself can lead to complications. One rare complication is a febrile seizure. A febrile seizure is when your child (ages six months to six years of age) experiences convulsions that occur in the setting of a fever.

Parents can’t imagine too many things more distressing than seeing their already-ill child suffer through a seizure, but febrile seizures are usually not life threatening.

During a febrile seizure, a child:

• Will lose consciousness
• Experience body stiffness
• Have full-body shaking

A seizure lasts only a minute or two, but can go on longer. Febrile seizures rarely require medication. The majority of the cases physicians see do not require hospital admission.

Facts about febrile seizures

• Majority of seizures occur between 12 and 18 months of age.
• The most common type of childhood seizure, affecting 2 to 5 percent of children.
• The exact cause in which a fever can provoke a seizure in this age group is not fully understood, genetic predisposition is a factor.
• Children who suffer a febrile seizure do not have epilepsy. That diagnosis requires the presence of two or more seizures that were not caused by a fever.
• Seizures due to an infection of the brain and its protective lining (meninges) or seizures associated with metabolic problems are not febrile seizures.

Two categories of febrile seizures

Febrile seizures are divided into two categories: simple and complex febrile seizures.

1. Simple

These types of seizures are more common. They involve full-body shaking and last less than 15 minutes. Studies show that simple febrile seizures do not affect future school performance or intelligence.

2. Complex

A febrile seizure is considered complex if it affects only a part of the body, lasts longer than 15 minutes or recurs within 24 hours. Complex febrile seizures have a slightly higher rate of future complications.

Is there a connection between epilepsy and febrile seizures?

The chances of epilepsy developing in a healthy developmentally typical child who has had a simple febrile seizure are estimated to be 2 to 4 percent, while the rate in the general population is about 1 to 2 percent. Although febrile seizures are scary, they are usually not associated with significant health problems. Short febrile seizures do not cause brain damage.

Four Steps: What you can do if your child has a seizure

If your child has a seizure, febrile or otherwise, it is important to stay calm. While you’re remaining calm, follow these four steps:

1. Your child should be placed on his or her side to prevent choking. There is no need to restrain or try to stop the shaking; the seizure will run its course regardless.
2. Never put anything in your child’s mouth. This can lead to chipped teeth, damaged gums or even a blocked airway.
3. Time the seizure. If your child’s seizure lasts more than five minutes, call 911. Medication may be needed to end the seizure.
4. Have your child evaluated that day. While brief seizures don’t require emergency services, the evaluation is mainly to check for the cause of your child’s fever.

Follow up care after a seizure

Treatment of febrile seizures is usually limited to fever-lowering agents such as acetaminophen or ibuprofen. These will not decrease the chance of having another febrile seizure, but will make your child more comfortable. Daily anti-seizure drugs are not recommended. Even though your child will be evaluated on the day of their seizure (step 4 above), certain situations require further diagnostic testing. If your child experiences a simple febrile seizure, he or she may not need to be hospitalized once their fever evaluation is complete. Blood and urine tests are only performed if needed to evaluate the fever.

If your child has a prolonged febrile seizure, they’ll be given a medication to use only if they have another long seizure. The chance of recurrence is generally 30 to 35 percent. Factors such as young age (less than 12 months) or a family history of seizures can increase the recurrence rate.

Seizures are scary, but knowing what to do if one occurs is important. If your child has a febrile seizure, make sure he or she sees your pediatrician or an emergency department physician as soon as possible. While simple febrile seizures are not harmful, we need to make sure they are not a symptom of a more serious illness. Talk with your pediatrician to determine if a consultation with apediatric neurology specialist is appropriate for your child.

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