Childhood Absence Seizures
Hello, Doctor Jiang.
My son is currently 2 years and 10 months old.
When he was about 6 months old, he had a febrile seizure and was diagnosed with complex febrile seizures.
Then, at 1 year and 10 months, he experienced another seizure of unknown origin.
At 2 years and 6 months, he suddenly had episodes of absence seizures where he became limp for about 3 minutes before slowly regaining consciousness.
Last Sunday, he had another episode of absence seizures, during which his lips turned slightly cyanotic, and he experienced urinary incontinence.
It was unclear if he was aware during the episode, and afterward, he fell asleep immediately.
Yesterday, during dinner, he had another episode.
I pressed on his philtrum firmly, and he regained consciousness in about 2-3 minutes, sweating and expressing fatigue and a desire to sleep.
So far, he has had two EEGs; the first report was normal, and the second one was done last week, but the report has not yet come out.
He has also had an ECG and an echocardiogram, both of which were normal.
I researched some information online and suspect that he may have childhood absence epilepsy.
I would like to ask if, given that the EEG is normal, further tests such as an MRI or other examinations are necessary? What is the validity period of an EEG? Additionally, does he need to have an EEG every time a seizure occurs before a diagnosis of epilepsy is made?
Furthermore, when a child experiences absence seizures, should we try to wake him up to bring him out of the seizure state, or is it sufficient to just monitor his breathing? Besides pressing on the philtrum, are there other methods to help the child regain consciousness? Is it still necessary to seek medical attention?
yul, 30~39 year old female. Ask Date: 2018/11/12
Dr. Jiang Junyi reply Neurology
Hello: In the field of neurology, pediatric neurological disorders often involve various genetic or metabolic diseases.
Regarding epilepsy, if it is absence epilepsy, there will be a specific pattern observed on the electroencephalogram (EEG).
Benign focal epilepsy should also be considered; it primarily occurs in school-aged children.
Typically, these children experience seizures during sleep, and the condition is usually easy to treat.
Generally, seizures do not recur after the age of 15 or 16.
Pediatric neurologists are more familiar with these types of disorders, and I recommend consulting one of them.
Wishing you good health, peace, and joy.
Dr.
Jiang from Taoyuan Medical Center cares about you.
Reply Date: 2018/11/12
More Info
Understanding absence seizures in young children can be quite challenging, especially when parents are faced with episodes that seem alarming and confusing. Based on the information provided, it appears that your son has experienced multiple episodes of altered consciousness, which could potentially be indicative of absence seizures or other types of seizure disorders.
Symptoms of Absence Seizures
Absence seizures, also known as petit mal seizures, are characterized by brief lapses in consciousness. In children, these seizures may manifest as:
1. Staring spells: The child may appear to be staring blankly into space, often for just a few seconds.
2. Unresponsiveness: During the seizure, the child does not respond to external stimuli.
3. Postictal state: After the seizure, the child may be confused or tired, sometimes requiring a few moments to regain full awareness.
4. Physical signs: In some cases, there may be subtle movements, such as eye blinking or lip smacking.
In your son's case, the episodes you described, including the loss of tone (the body going "soft"), the duration of 2-3 minutes, and the accompanying symptoms like cyanosis (bluish lips) and urinary incontinence, suggest that these may not be typical absence seizures. Instead, they could be indicative of a more complex seizure disorder, possibly generalized seizures or focal seizures with secondary generalization.
Next Steps
1. Further Testing: Given that your son has had multiple episodes and the EEG (electroencephalogram) results are normal, it may be prudent to consider further imaging studies, such as an MRI (magnetic resonance imaging), to rule out any structural abnormalities in the brain. While EEGs are crucial for diagnosing epilepsy, they do not always capture every seizure type, especially if the episodes are infrequent.
2. Monitoring and Documentation: Keep a detailed log of each episode, including the duration, symptoms, and any potential triggers. This information can be invaluable for your healthcare provider in making a diagnosis.
3. Follow-Up with Specialists: It may be beneficial to consult a pediatric neurologist who specializes in seizure disorders. They can provide a more comprehensive evaluation and recommend appropriate treatment options.
4. Emergency Protocol: During a seizure, it is essential to ensure the child's safety. Do not attempt to wake them forcibly; instead, gently guide them to a safe position. If the seizure lasts longer than 5 minutes, or if another seizure follows immediately, seek emergency medical assistance.
5. Postictal Care: After a seizure, children may be disoriented or sleepy. Allow them to rest and recover, and monitor their breathing. If they are having difficulty breathing or do not regain consciousness, seek medical help immediately.
6. Medication Considerations: If your son is diagnosed with a seizure disorder, medication may be necessary to help control the seizures. The choice of medication will depend on the type of seizures and the child's overall health.
Conclusion
In summary, while the EEG results are normal, the recurrent episodes your son is experiencing warrant further investigation. It is crucial to work closely with a healthcare provider to ensure a proper diagnosis and treatment plan. Keeping a detailed record of the episodes and consulting with a pediatric neurologist will be key steps in managing your son's condition effectively. Remember, your child's safety and well-being are the top priorities, and timely medical intervention can make a significant difference in their quality of life.
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