What to do if a child has a seizure

This article details what action to take if your child has a seizure.

Seeing a child suffer a seizure can terrify a parent. As part of Epilepsy Awareness Month in November, an expert offered some advice on how to deal with such a situation.

All first seizures in children require a medical evaluation, said Dr. Adam Hartman, a pediatric neurologist and epilepsy expert at Johns Hopkins Children's Center in Baltimore.

"If this is the first time your child is having a seizure, seek emergency medical care," he said in a Johns Hopkins news release.

Children with known epilepsy who have a breakthrough seizure -- one that occurs despite treatment -- do not typically require urgent medical attention unless:

• The seizure lasts more than five minutes.
• The seizure looks different from previous seizures.
• Several seizures occur in a cluster.
• The child remains unconscious for a few minutes following the seizure.
• The child struggles for air and is not getting enough oxygen, signaled by bluish lips or complexion.

The symptoms listed above may mean that the child is going into status epilepticus, a persistent, severe and life-threatening seizure that always requires emergency treatment, Hartman said.

During a seizure, don't put anything in the child's mouth and don't try to hold the child down. Clear the surrounding area and have the child lie on one side, rather than flat on their back, Hartman said. You can put a small pillow under the child's head.

After the seizure ends, allow the child to rest and check for injuries. Do not give the child anything to eat or drink until fully alert. Note the length of the seizure and the date and time it occurred.

Keep a seizure diary and inform the child's neurologist or primary-care pediatrician about all seizures. Pay attention to what might have triggered the seizure. Sleep deprivation, high fever, illness, and emotional or physical stress increase seizure risk among children with epilepsy.

"Children respond individually to stressors, so it's important to notice the factors that precipitate a seizure in your child and avoid them when and if possible," Hartman said.

Epilepsy, an umbrella term that encompasses more than 40 seizure disorders, affects nearly 3 million people in the United States. More than 320,000 of them are children under 15, according to the Epilepsy Foundation. About 45,000 children in the United States develop epilepsy each year.

More information

Read more HERE on our website

The Epilepsy Foundation has more about epilepsy.

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What should you do if someone has a seizure?

This article details what one can do if one sees someone having a seizure. Remember to call EMS if you have concerns.!

THIS IS A GENERAL INFORMATION article and is not meant to substitute for seeing your dcotor. Always check with your neurologist about specifics for you or your child.  JR

If a friend, family member or co-worker has epilepsy, you should know what to do if he or she has a seizure.

Once a seizure begins, nothing can be done to make it end more quickly. But you can take steps to prevent seizure victims from hurting themselves:

• Move furniture and sharp objects away from the victim.
• Should the victim vomit, turn his or her head to the side so he or she does not choke.
• If the victim is unconscious, make sure nothing is obstructing the nose or mouth.

After a seizure ends, most people sleep deeply. Do not try to prevent this deep sleep. Once the victim awakens, he or she may be disoriented for a while.

Be sure to stay with the victim until he or she recovers fully, or until emergency medical help arrives. Also, keep an eye on the victim’s breathing rate and pulse.

Do not do the following things for a seizure victim. You will risk hurting the seizure victim and yourself:

• Do not restrain someone having a seizure.
• Do not put a spoon, tongue depressor or anything else in his or her mouth, especially not your fingers. It is a myth that seizure victims can swallow their tongues.
• Do not move the victim unless he or she is in immediate danger or near a hazard.
• Do not perform artificial respiration during a seizure, even if the victim is turning blue. Most seizures are over long before brain damage from lack of oxygen begins. However, if a seizure lasts longer than two minutes, call for emergency medical help.
• Do not give the victim food, drink or medication by mouth until the seizure has stopped and he or she is completely awake and alert.

Call immediately for emergency medical help for someone who:

• has seizures lasting longer than two minutes or has more than one seizure per hour
• does not wake up between two seizures
• is injured, ill or intoxicated
• has a seizure for the first time
• is pregnant or has diabetes or high blood pressure
• has a seizure in water

After other seizures, call the seizure victim’s healthcare provider.

Read more here

Research on the High Fat Ketogenic Diet May Lead to New Epilepsy Drugs

A fatty diet that helps control epileptic seizures may do so by triggering a chemical change in the brain, a discovery that could lead to new treatments, according to a Harvard University study.
The diet may force a protein to switch the brain’s fuel to fat byproducts called ketones from its preferred energy, glucose, according to a study in genetically manipulated mice in the journal Neuron. Making the brain operate on ketones is known to shut down overexcited neurons that cause seizures.
This so-called ketogenic diet is used by epilepsy patients who aren’t helped by seizure-reducing drugs. The patients are only allowed a saltine cracker’s worth of carbohydrates daily, said Gary Yellen, a study author. That’s hard to do, and new treatments based on the diet’s effects in the body may lead to better control of seizures, he said.
“There are kids who go off this diet because they and their parents can’t manage it,” said Yellen, a professor of neurobiology at Harvard Medical School in Boston. “Having a pharmaceutical to help them would be important.”
Epilepsy is a brain disorder that causes repeated seizures, where neurons fire in a disorganized and sudden way, according to the National Institutes of Health. About 3 million Americans are epileptic, according to the Landover, Maryland-based Epilepsy Foundation, an advocacy group.
Mimicking the Protein
Yellen’s coauthor, Nika Danial, an assistant professor of cell biology at the Dana-Farber Cancer Institute, is working on mimicking the protein. That may lead to a treatment, or help researchers look through chemical libraries for something similar, she said.
The diet is very high in fat, with some protein and almost no carbohydrates, triggering the body to use fat as its source of energy and imitating the effects of starvation on the body. That releases ketones, which can provide energy to the brain in lieu of sugar.
In epileptic mice, the scientists tinkered with a protein called BCL-2-associated agonist of cell death, or BAD, to promote ketones and lower levels of glucose. While their seizures decreased, there was no effect in mice that had been genetically altered to take out the protein, providing evidence for how it worked, according to the study.
The switch is much like changing from diesel to unleaded fuel, causing fewer seizures, Yellen said. Something about the swap prevents neurons from firing too much, though the full extent of the changes isn’t clear. Additionally, a ketogenic diet may be effective in some neurodegenerative disorders, Danial said.
“This could have broader implications for the protective effects of being able to reprogram what the brain burns,” Danial said.
The study was funded by Harvard Catalyst, Citizens United for Research in Epilepsy, and the NIH.
Read more here: http://mobile.businessweek.com/news/2012-05-23/fatty-diet-preventing-seizures-may-lead-to-epilepsy-drugs

Symptoms of a seizure can be subtle...

Symptoms of a Seizure

A seizure is usually defined as a sudden alteration of behavior due to a temporary change in the electrical functioning of the brain, in particular the outside rim of the brain called the cortex. Below you will find some of the symptoms people with epilepsy may experience before, during and after a seizure. Seizures can take on many different forms and seizures affect different people in different ways. It is not implied that every person with seizures will experience every symptom described below.

Seizures have a beginning, middle, and end
When an individual is aware of the beginning, it may be thought of as a warning or aura. On the other hand, an individual may not be aware of the beginning and therefore have no warning.
Sometimes, the warning or aura is not followed by any other symptoms. It may be considered a simple partial seizure by the doctor.

The middle of the seizure may take several different forms. For people who have warnings, the aura may simply continue or it may turn into a complex partial seizure or a convulsion. For those who do not have a warning, the seizure may continue as a complex partial seizure or it may evolve into a convulsion.

The end to a seizure represents a transition from the seizure back to the individual’s normal state. This period is referred to as the “post-ictal period” (an ictus is a seizure) and signifies the recovery period for the brain. It may last from seconds to minutes to hours, depending on several factors including which part(s) of the brain were affected by the seizure and whether the individual was on anti-seizure medication. If a person has a complex partial seizure or a convulsion, their level of awareness gradually improves during the post-ictal period, much like a person waking up from anesthesia after an operation. There are other symptoms that occur during the post-ictal period and are detailed below.

Please note: Below is only a partial list, some people may experience other symptoms not listed below. These lists are meant to help patients communicate with their physicians.

Early seizure symptoms (warnings)
Sensory/Thought: Deja vu/ Jamais vu
Smell
Sound
Taste
Visual loss or blurring
Racing thoughts
Stomach feelings
Strange feelings
Tingling feeling
Emotional:
Fear/Panic
Pleasant feeling
Physical:
Dizziness
Headache
Lightheadedness
Nausea
Numbness
No warning:
Sometimes seizures come with no warning
Seizure symptoms
Sensory/Thought:
Black out
Confusion
Deafness/Sounds
Electric Shock Feeling
Loss of consciousness
Smell
Spacing out
Out of body experience
Visual loss or blurring
Emotional:
Fear/Panic
Physical:
Chewing movements
Convulsion
Difficulty talking
Drooling
Eyelid fluttering
Eyes rolling up
Falling down
Foot stomping
Hand waving
Inability to move
Incontinence
Lip smacking
Making sounds
Shaking
Staring
Stiffening
Swallowing
Sweating
Teeth clenching/grinding
Tongue biting
Tremors
Twitching movements
Breathing difficulty
Heart racing
After-seizure symptoms (post-ictal)
Thought:
Memory loss
Writing difficulty
Emotional:
Confusion
Depression and sadness
Fear
Frustration
Shame/Embarrassment
Physical:
Bruising
Difficulty talking
Injuries
Sleeping
Exhaustion
Headache
Nausea
Pain
Thirst
Weakness
Urge to urinate/defecate

If you or someone you know has the symptoms listed above -- you are not alone. Below are personal stories by people who have either experienced or witnessed seizure symptoms.

http://www.epilepsy.com/101/ep101_Symptom

Adapated from: Schachter SC, editor. Brainstorms: epilepsy in our words. New York: Raven Press; 1993; and Schachter SC, editor.The brainstorms companion: epilepsy in our view. New York: Raven Press; 1995.

What is a Seizure

A seizure is a sudden surge of electrical activity in the brain that usually affects how a person feels or acts for a short time. Seizures are not a disease in themselves. Instead, they are a symptom of many different disorders that can affect the brain. Some seizures can hardly be noticed, while others are totally disabling.
The seizures in epilepsy may be related to a brain injury or a family tendency, but often the cause is completely unknown. The word "epilepsy" does not indicate anything about the cause or severity of the person's seizures.

If I have one seizure, does that mean I will get epilepsy?

About half of the people who have one seizure without a clear cause will have another one, usually within 6 months. You are twice as likely to have another seizure if you have a known brain injury or other type of brain abnormality. If you do have two seizures, there's about an 80% chance that you'll have more....

http://www.epilepsy.com/101/ep101_seizure

Suicide-Related Events in Patients Treated With Antiepileptic Drugs
Arana A, Wentworth CE, Ayuso-Mateos JL, Arellano FM N Engl J Med. 2010;363:542-551

Based on a meta-analysis of clinical trial data, use of antiepileptic drugs has previously been linked to suicidal ideation and/or behavior. Using observational data collected during clinical care of 5,130,795 patients representative of the general UK population, this study looked at the association between the use or nonuse of antiepileptic drugs and suicide-related events, which were defined as attempted or completed suicides in patients with epilepsy, depression, or bipolar disorder. ...
Adjustment using logistic regression analysis showed that the use of antiepileptic drugs was not associated with an increased risk for suicide-related events among patients with epilepsy (odds ratio [OR], 0.59; 95% CI, 0.35-0.98) or bipolar disorder (OR, 1.13; 95% CI, 0.35-3.61). However, the use of antiepileptic drugs was associated with a significantly increased risk for suicide-related events in patients with depression (OR, 1.65; 95% CI, 1.24-2.19), as well as in patients without epilepsy, depression, or bipolar disorder (OR, 2.57; 95% CI, 1.78-3.71).

http://www.medscape.com/viewarticle/727156

From Dr. Rotenberg - This is exciting news for people who have to take anti-convulsants for epilepsy. The article did not find an association between suicide-related events and the use of anti-seizure medications. On the other hand, I would caution readers from infering that there is a protective efffect of anti-convulsant use. The odds ratio of .59 might lead one to conclude that the risk of suicide was lower and that the medications are protective. Despite the indications of this number, please recall that this is a single statistic and that the study was not designed to show this inverse relationship.

February 17, 2010, 12:07 pm
Easing the Tics of Tourette’s Syndrome
By THE NEW YORK TIMES

...In other cases, medications that were initially developed to help patients with seizure disorders have been helpful for people with Tourette’s. Periodic injections of botulinum toxin, or Botox, into specific muscle groups can also be helpful for localized tics. .....

An interesting converstation about tics and Tourette's

Are you sure its epilepsy? Nonepileptic paroxysmal events in children are common, and may be more diverse in etiology than those seen in adults.

Epilepsy Behav. 2010 Jan 19. [Epub ahead of print]

Nonepileptic paroxysmal events in a pediatric population.

Kutluay E, Selwa L, Minecan D, Edwards J, Beydoun A.

Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.

Nonepileptic paroxysmal events in children are common, and may be more diverse in etiology than those seen in adults.

We determined the types of nonepileptic events that are most prominent in the pediatric population, and stratified those events by age group. Ninety-four of 416 pediatric patients monitored during a 3-year period (23%) were found to have had nonepileptic events. Thirty-eight percent of these children were diagnosed with psychogenic nonepileptic seizures, and 72% of those were adolescents.

 In children younger than 5 years of age, behavioral events and parasomnias were the most common mimickers of epilepsy. Other events, including stereotyped movements and myoclonus, were also diagnosed.

We suggest that children with refractory paroxysmal events should be considered for early inpatient monitoring.

Copyright © 2009 Elsevier Inc. All rights reserved.

PMID: 20093099 [PubMed - as supplied by publisher]

Academy Diagnostics LLC Achieves Accreditation by the American Academy of Sleep Medicine

Academy Diagnostics LLC Achieves Accreditation by the American Academy of Sleep Medicine

The American Academy of Sleep Medicine announced the accreditation of Academy Diagnostics LLC, Sleep Center. The San Antonio-based center is the first pediatrician-directed facility in South and Central Texas to receive such accreditation. Academy Diagnostics serves patients throughout the life-span, providing testing and treatments for sleep disorders, including: sleep apnea, fatigue, snoring, restless legs syndrome, insomnia, and sleep seizures. Staff physicians include: Tarak Patel, M.D.; Joshua Rotenberg, M.D.; and Avie Grunspan M.D. 

 All three oversee the Center and are board certified in sleep medicine as well as pediatric pulmonology, neurology (CN) and internal medicine. As the national accrediting body for sleep disorders centers and laboratories for sleep-related breathing disorders, the American Academy of Sleep Medicine (AASM) is the leading voice promoting the highest quality of medical care for people with sleep problems. Accredited "Sleep Centers," must meet technical and professional benchmarks of excellence, adhere to evidence-based practice parameters and offer community leadership. The AASM offers accreditation as an internationally recognized gold-standard of quality. "We are delighted at receiving this prestigious accreditation as one of only a handful of pediatrician-directed sleep centers in the United States. A

cademy's perspective is unique, since pediatricians are experts in the care of children." added Rotenberg. "Accreditation ensures the quality and attention that patients deserve. Consumers should be able to easily recognize the higher standards offered by an AASM accredited sleep center. " 

San Antonio-based Academy Diagnostics LLC Sleep Center was founded in 2007 under the directorship of Joshua Rotenberg, and M.D., Tarak Patel, M.D. Both physicians are extensively published and nationally-recognized for their work in sleep medicine. Dedicated to bringing the highest quality sleep medicine services to all patients, the Center's multi-disciplinary approach and state-of-the-art sleep and neurodiagnostic technology allows for all patients to be evaluated and treated from the perspective of different specialties.

 For more information on Academy Diagnostics, call (20-616-9500) or visit online at (http://www.academydxsleep.com/).