I would like to inquire about the diagnosis and medication for epilepsy in infants and young children?
Hello Doctor: My daughter was born in mid-June this year, with good development in utero, weighing nearly 3800 grams, head circumference at 40 weeks, and delivered via cesarean section at 38 weeks + 2 days.
Everything was normal at birth.
During the pregnancy, she underwent amniocentesis and chromosomal analysis (both normal), and a high-level ultrasound (showing slightly enlarged ventricles but deemed to be under observation without abnormalities).
In mid-August, during her newborn vaccinations and ultrasound, the pediatrician noted the enlarged ventricles and recommended follow-up observation, but there were no other issues.
Two weeks later, she experienced symptoms of seizures at home (eyes deviating upwards to the left and tongue twitching), with over 10 episodes occurring within two days, one of which was more pronounced.
She was admitted for observation, and EEG and MRI were performed; the doctor also prescribed medication (Oral Phenobarbital).
The doctor noted weak muscle tone in the neck and back, increased tone in the left arm, and both hands in a bowing posture with clenched fists, which was concerning.
After four days in the hospital, she was discharged, and her emotional responses were more pronounced after starting medication (previously, she was referred to as a good baby, crying and fussing little, eating and sleeping well).
At her first follow-up appointment after discharge, the doctor adjusted her medication dosage from 0.7ml to 0.8ml, stating that she needed a higher dose due to her larger size (she weighed 6.3 kg).
The doctor diagnosed her with epilepsy (noted as G-4089 and another item I forgot), and the EEG during sleep showed abnormal discharges in the left hemisphere.
The MRI indicated continued enlargement of the ventricles with some mild hydrocephalus, but still within acceptable limits, with no other abnormalities noted.
I would like to ask:
1.
What type of epilepsy does she have? Can the type of epilepsy change? Recently, her symptoms resemble myoclonic jerks...
I asked the doctor if it could be myoclonic seizures, but he said it didn't seem like it.
However, I am still concerned about the possibility of it evolving into myoclonic or other severe types.
2.
Will epilepsy affect her development? She shows fewer facial expressions, but her activity level is good when awake, and her limbs have adequate strength.
Currently, her neck and back muscles are stronger, and she no longer keeps her hands clenched or in a bowing posture.
However, her emotional responses are quite stable, with fewer expressions.
After starting medication, she interacts more and smiles, but it has been harder to make her laugh lately...
Is it normal for a child to be this composed?
3.
In the first two weeks of medication, her emotional responses improved, but now she seems less inclined to smile, sleeps more, and sometimes looks down.
Is this a side effect of the medication or due to her weight gain requiring a dosage adjustment?
4.
Does the medication suppress abnormal discharges? After starting the medication, will there still be abnormal discharges in the brain? Are there any other side effects from the medication, or could it cause long-term brain damage? If she continues to have similar minor seizure symptoms, could that harm her brain?
5.
Currently, her physiological development is normal; she continues to eat and sleep well, and her weight and height are increasing, with developmental milestones being met.
However, this week she has started showing signs of seizures.
She usually has seizures during sleep, which are very brief, lasting one to three seconds...
like being startled awake (without crying), with wide eyes, arms extending to the sides or upwards, gasping, and her legs remaining in a frogged position.
After confirming her condition, she goes back to sleep, but sometimes this happens several times a day (around three times); yesterday, after bathing her to stimulate her responses and sensations, she had 6-7 episodes during sleep.
Would this be considered minor seizures? If so, could frequent episodes cause brain damage? Should I schedule a follow-up appointment as soon as possible? Or could this be a startle response? The next appointment is in mid-October, and I feel anxious every day.
I apologize for the many questions, and I appreciate your understanding.
Thank you very much...
Sherry, 40~49 year old female. Ask Date: 2021/09/24
Dr. Jiang Junyi reply Neurology
Dear Ms.
Sherry,
First of all, I want to acknowledge that the process of providing support is truly not easy.
Regarding pediatric epilepsy, I recommend consulting a pediatric neurologist, as they have more extensive experience in this area.
Generally, the common treatment principle for epilepsy is that pediatric epilepsy often stabilizes as the child grows and the brain develops.
The goal is to achieve seizure control to avoid impacting the child's learning during their educational phase.
Only a small number of patients develop refractory epilepsy.
If the condition is unstable or if there are concerns, I suggest follow-up appointments weekly to adjust medications as needed.
Thank you for your inquiry, and feel free to discuss any related questions further!
Wishing you good health and peace,
Dr.
Chien-Yi Jiang, Taoyuan Medical Center
Reply Date: 2021/09/24
More Info
Infantile epilepsy is a complex condition that can significantly impact a child's development and overall well-being. Your concerns regarding your daughter's diagnosis, treatment, and developmental progress are valid and important to address. Let's break down your questions and provide a comprehensive understanding of the situation.
1. Type of Epilepsy: The specific type of epilepsy your daughter is experiencing can be challenging to determine without further detailed observation and testing. Given the symptoms you described, such as eye movements and tongue twitching, it may suggest a form of focal epilepsy, particularly since the EEG showed abnormal discharges in the left hemisphere. It's important to note that epilepsy types can evolve as a child grows. For instance, some children may initially present with one type of seizure and later develop different seizure types. Continuous monitoring and follow-up with a pediatric neurologist are crucial to track any changes in seizure patterns.
2. Impact on Development: Epilepsy can potentially affect a child's development, but the extent varies widely among individuals. The fact that your daughter is showing good physical strength and engagement is a positive sign. Emotional responses can fluctuate, especially with medication adjustments. It's not uncommon for children on anti-epileptic drugs to exhibit changes in mood or behavior. The stability of her emotional responses may improve as her body adjusts to the medication. However, if you notice significant changes in her ability to interact or express emotions, it would be wise to discuss these observations with her doctor.
3. Medication Effects: The initial weeks of medication can lead to various side effects, including changes in mood, increased sleepiness, or altered responsiveness. As your daughter grows and gains weight, her medication dosage may need to be adjusted to maintain efficacy. It's essential to communicate any behavioral changes to her healthcare provider, as they may indicate a need for dosage reassessment or a change in medication.
4. Mechanism of Medication: The primary goal of anti-epileptic drugs (AEDs) is to suppress abnormal electrical activity in the brain. While these medications can significantly reduce the frequency and severity of seizures, they may not eliminate all abnormal brain activity entirely. Long-term use of AEDs can have side effects, but serious complications are relatively rare. Regular follow-ups and EEG monitoring can help assess the effectiveness of the treatment and any potential long-term impacts on brain health.
5. Seizure Frequency and Concerns: The brief episodes you described, especially if they occur during sleep and are characterized by sudden changes in behavior, could indeed be classified as seizures. Frequent seizures, even if they are short, can have cumulative effects on brain development, so it is essential to report these occurrences to your daughter's neurologist. If the frequency of these episodes increases or if they change in nature, it would be prudent to seek an earlier appointment rather than waiting for the scheduled visit.
In summary, managing infantile epilepsy requires a collaborative approach involving regular communication with healthcare providers, ongoing monitoring of your daughter's development, and adjustments to her treatment plan as necessary. Your observations and concerns are vital in this process, and advocating for your daughter's health is crucial. If you have any further questions or if new symptoms arise, do not hesitate to reach out to her medical team for guidance. Your proactive involvement is key to ensuring the best possible outcomes for your daughter.
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