Absence Seizures in Young Children: Symptoms and Next Steps - Neurology

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Understanding absence seizures in young children can be quite challenging, especially when parents are faced with episodes that seem alarming and confusing. Your son’s history of seizures, including complex febrile seizures and episodes of loss of consciousness, raises valid concerns about the possibility of epilepsy, specifically absence seizures.
Absence seizures, characterized by brief episodes of staring or loss of awareness, can sometimes be mistaken for daydreaming or inattentiveness in young children. During these episodes, the child may appear to be unresponsive, and they typically last only a few seconds. However, in your son's case, the episodes seem to be more complex, especially with the accompanying symptoms of muscle weakness, cyanosis (bluish lips), and urinary incontinence.

Given your son's age and the nature of his episodes, it is crucial to continue working closely with a pediatric neurologist. Here are some key points to consider regarding your questions:
1. Further Testing: Since your son has had two EEGs (electroencephalograms) with normal results, it may be necessary to consider additional imaging studies like an MRI (magnetic resonance imaging) if the neurologist deems it appropriate. An MRI can help rule out structural abnormalities in the brain that could contribute to seizure activity. The decision to perform further tests often depends on the clinical picture and the neurologist's assessment of the situation.

2. EEG Validity: EEGs can capture electrical activity in the brain at the time of the test, but they may not always detect intermittent seizure activity, especially if the seizures are infrequent. If your child has another seizure episode, it may be beneficial to discuss with your neurologist whether a repeat EEG is warranted. Continuous EEG monitoring may also be considered in some cases.

3. Management During Seizures: When your child experiences an episode of loss of awareness, the best approach is to ensure his safety. You should not attempt to wake him forcibly, as this can be disorienting and potentially harmful. Instead, observe his breathing and ensure he is in a safe position. If he appears to be having a prolonged seizure (lasting more than 5 minutes) or if he has multiple seizures in a row without regaining consciousness, it is crucial to seek emergency medical assistance.

4. Recovery from Seizures: After an episode, children may be confused, tired, or irritable. It is common for them to want to sleep afterward. Allow him to rest and monitor him closely. If he seems excessively lethargic or unresponsive after the seizure, it is advisable to consult a healthcare professional.

5. Emergency Response: In addition to pressing on the philtrum (the area between the upper lip and nose), which is sometimes suggested, ensuring that your child is in a safe environment is paramount. If he has a seizure, clear the area of any potential hazards. If he is having difficulty breathing or does not regain consciousness, call emergency services immediately.

6. Follow-Up Care: Regular follow-up with your child's neurologist is essential to monitor his condition and adjust treatment as necessary. Keeping a detailed log of his seizure episodes, including duration, symptoms, and any potential triggers, can be helpful for the healthcare team.

In conclusion, managing a child with potential seizure disorders requires a comprehensive approach involving careful observation, appropriate testing, and collaboration with healthcare professionals. Your vigilance and proactive approach are crucial in ensuring your child's safety and well-being. Always feel empowered to ask questions and express your concerns with your child's healthcare providers, as they can provide the most tailored advice based on your child's specific situation.