Medical Results

Febrile seizures- events that appear, usually, between the ages of 3 months and 5 years, in case of fever, without any signs of infection at Central Nervous System level. The causes of febrile convulsions are not very well known. It is about a brain hyperexcitability , to which three factors have an important role.

1. fever:

that can appear as a consequence of a respiratory, digestive, infectious disease;

generally the temperature is high, over 39,5C, but in 25% of cases it can be between 38C and 39C;

not all febrile seizures occur at the same temperature, even if it's the same infant;

sometimes, febrile convulsions may occur even when a big temperature begins to drop;

2. age:

febrile convulsions usually appear between the ages of 3 months and 5 years (with maximum frequency between 1,5 and 2 years), age interval when the brain is immature, insufficiently developed, and the frequency of diseases is maximum;

3. genetic factors

if the parents had febrile seizures when they were infants, the chance that their children will have febrile seizures is of 33%.

ATTENTION !

Under the age of 6 months, febrile seizures are more often associated with an infection of Central Nervous System (meningitis, encephalitis );

How can parents realise that their child has a convulsion in a febrile context ?

The child is having a cold, has diarrhea, or an infectious disease, has fever and becomes unconscious, pale, with cyanosis around his mouth or generalised cyanosis with the eyes rolled back, his whole body, or half his body will tremble. The duration of seizure is at least 5-6 minutes, ad more rarely, in 5% of cases 20 minutes. When the duration of the seizure is more that 20 minutes, it's called epileptic "status" .

 

ATTENTION !

sometimes febrile seizure can be mistaken for o shiver, but then the child is awake.

When should we worry about a febrile seizure (complicated febrile seizure) ?

the child is under 1 year old

it's repeated more than once a day ;

it lasts more than 15-20 minutes;

it's on half the body;

it appears at a child with psychomotor development inadequate for his age;

a decrease of muscle force in one of the limbs appears after a seizure.

What analysis should your child take if you suspect him of febrile seizures ?

blood analysis have a limited value;

EEG is less important for diagnosis and prognosis;

skull radiography, tomography, MRI are not indicated in current practice; a febrile seizure does not determine, most of the times, a lesion at head level;

 

lumbar puncture is not recommended by routine if there are no signs of infection in the Central Nervous System 

What is the evolution on long term and short term ?

Some data are extracted from medicine literature could calm the parents, even if, their child had a febrile seizure :

4-5% of general population had at least a febrile convulsion during their life;

febrile convulsions do not produce the disruption of the brain and affectation of the intellect;

the risk to develop epilepsy after is 2-5% (same risk as in general population);

We must not forget the fact that the risk to repeat a febrile convulsionis of 30-40% and the majority of these seizures (50-75%) are produced in the first year subsequent to the first event.

When does an increased risk to repeat a febrile seizure exist?

the first febrile seizure first appeared under the age of 15-18 months;

there is a close relative that had febrile seizures as infant;

first febrile convulsion temperature is not very high (under 38,5C) ;

short duration from the disease's debut to febrile seizure.

The risk to make epilepsy after the first febrile seizure is higher if:

it's a febrile seizure on half the body, with a long duration or febrile seizure repeats in the same day or with the occasion of other febrile events of the same disease.

 

the child is not neurological and psychically normal.

What will you do in case of febrile seizures?

Always consult a neurologist in the shortet time, or if you do not have one near, a pediatrician, even if the febrile seizure stopped. He will decide if it was a seizure and if a treatment is necessary; he will also identify the cause of the seizure, he will recommend a treatment for fever decrease and control and for acute disease .

It is important that the medic decide what to do next is your child suffered from febrile seizures.

 

CHILDREN'S EPILEPSY

Epilepsy is a chronic disease that affects the brain, having different causes, characterised by repeated convulsive seizures (convulsions). It is very important to know that a single convulsive seizure or convulsion, does not mean that is epilepsy. For example a convulsive seizure may appear (or even more) in an acute brain infection: meningitis, encephalitis or as a response to a excitative impulse: fever, alcohol, drugs or in some diseases that drive some metabolic and hydroelectrolytic disequilibrium: diabetes mellitus, dehydration, diarrhea    .

 

Causes

There are numerous implicated factors in the apparition of epilepsy, very often these are hard to identify.

1. Factors that take action over the embrio and fetus and that can produce:

brain development stoppage;

abnormal development of the brain;

destruction of normal cerebral structures, initially formed.

a. previous infections of the mother or infections contracted during pregnancy, that lead to cerebral malformations :

toxoplasmosis

 cytomegalovirus infection,

type 2 herpes virus infection;

vericella zoster virus (chickenpox) infection;

syphilis.

b. toxic exogenous:

medicine, alcohol, drugs, tobacco, industrial pollutants.

c. toxic endogenous:

 maternal diabetes mellitus.

Tobacco:

- delayed intrauterine baby growth=new born with low weight at birth;

Alcohol:

- possible effect over cognitive development,

- delayed intrauterine baby growth,

- cerebral malformations,

- dysmorphic facies;

Cocaine:

- affects cerebral vessels and has as result cerebral malformations clinically translated by neurological signs, and intellectual affectation.

c. Feto-placental pathology:

- abnormal intrauterine position of the fetus,

- low lying placenta,

- short, knotted, lying around the babi's neck umbilical cord.

d.Labour abnormalities 

- slow labour or too fast labour,

- C section: anesthesia or sudden modification of pressure .

e. Mother trauma, especially the ones directly on the abdomen.

2. Factors that take action during birth and in the first month after birth:

a. All causes that determine a difficult birth, having as effect unfitted oxygenation of the brain, with the apparition of secondary cerebral lesions or cardiorespiratory affection with the same consequences over the brain.

b.Infections determined by bacteria, viruses: encephalitis, meningitis, cerebral abscess.

c. intracranial hemorrhage made by obstetrical or spontaneous trauma (cerebral vessels of a new born are extremely fragile).

d.metabolic factors: hypoglycemia, hypocalcemia.

3. Factors that take action after the first month of life and are frequently involved in producing of epileptic seizures:

a. acute infections of brain:encephalitis, meningoencephalitis, cerebral abscesses determined by bacteria, viruses, parasites and TB chronic infection (tuberculosis)neurosyphilis. They have a low risk tof epilepsy determination; the high risk appears when epileptic seizures occur in the acute period and when the infection is very severe.

b. cranial trauma : epileptic seizures can occur:

immediately (seconds, minutes); they are not considered epilepsy by majority of specialists,.

in the first week (early epilepsy)

after months or years (even 10 years) (late epilepsy)

 

The risk to develop the disease decreases with aging: 50% of people with trauma can do seizures in the first year, and only 25% have seizure after 4 years.

c.Cerebral tumors: are rare causes for infant epilepsy

d.Toxic factors (medicines make part of this category)

4.Genetic factors presume the predisposition to brain seizures of other members of the family (it is not mandatory that every generation's members has seizures) or the inheritance of a disease that determines a cerebral lesion with epileptogenic potential.

 

Clinical aspects for epilepsy

There are two main epileptic seizures:

-partial seizures (focal) that affect only a part of the body, for example the superior limb and the inferior right limb, or the left half of the mouth and the left eye. Consciousness can be kept at the beginning  or for the entire seizure (in case of a simple seizure), or it can be lost at the debut of the seizure. Sometimes, the patient can be partially conscious, but with affected consciousness performing automatic acts, like walking. These seizures occur by discharge of a of a neuronal group from one side of the brain.

-generalized seizures that affect the entire body from the beginning, or only one part of the body, initially, and then the entire body. These seizures
presume the abolition of consciousness, at least in the generalized phase. It is due to the electric discharge of all brain neurons.

Seizure's aspect is different. They can be:

motor seizures that manifest through: -tightening and/or involuntary contractions of the right or left limbs, or all limbs (the patient is unconscious and convulsive)

                                   -involuntary movement of the head and eyes to the right or to the left

                                   -involuntary contractions of the corner of the mouth and the eyelids

sensitive seizures: pain, tingles, numbness, itchiness on one or more body parts such as: tongue, face, superior limb, inferior limb

visual: seeing lights that flicker, colored spots, geometrical figures, images like in a movie

auditory: hearing noises or voices that do not exist. ATTENTION! there could be auditory hallucinations because a psychic disorder; in this case, the patient can also have visual hallucinations, he is more confuse, the episode lasts longer.

olfactory: the perception of some disagreeable smells; frequently with taste sensation.

psychic symptoms: fear sensation (easily mistaken with panic attack), dream sensation, familiarity sentiment, knowing (deja vu, deja connu), alienation sentiment (jamais vu, jamais connu).

absence type seizure: manifested by sudden loss of consciousness, the patient interrupts any activity, like talking, eating, writing, for a few seconds, and he reprised the activity after that.

 

The presented seizures are just a few types of seizures, the most frequent types. There are many more types of seizures, and more epileptic syndromes.

 

Necessary analysis for diagnosis in case of epilepsy

 

A.Biochemical investigations 

Usual blood tests are less important for diagnosis, they have a role in:

-new born convulsions, that can be caused by hypoglycemia, hypocalcemia, hyponatremia.

-in anti-epileptic treatment prescription, that implies a normal hepatic and bone marrow function (the place where blood cells are produced).

-in further observation of the possible negative effects of the medication over the organism.

B.EEG

Is an important method for diagnosis of the disease, because on the way (recording) pathological suggestive elements appear. A normal EEG pattern does not exclude an epilepsy diagnosis. The presence of some pathological elements on the EEG of a child that does not have epileptic seizures, does not impose a treatment and does not mean that he has the affection. A normal child cand have modifications on the EEG without having the disease.

C.Imagistic investigation

CT and brain MRI are important when we search for a cause of epilepsy, that can be:

-a tumor

-an arteriovenous malformation, ex.:cavernoma,

-a cerebral parasitosis: cisticercosis, toxoplasmosis,

-a tuberculoma (cerebral localisation of TB infection),

-a cerebral abscess caused by an infection: sinusitis, otitis.

All of these can be treated neurosurgical, which presumes medication elimination or decrease of anticonvulsive medication.

The cause of epilepsy could also be a cerebral malformation, from intrauterine life, inoperable, that we only identify.

The presence of modifications in the brain level (malformations, calcifications) always determine more severe seizure and more difficult to control therapeutically. Sometimes, these investigations are without modifications, then the lesions are too small to identify, or there are modifications t chemical substances level that transmit the information to brain cells.

 

Anamnesis

Is one of the most important elements for diagnosis of the affection. That is why the information must be obtained from the person who witnessed the seizure, even if she/he was impressed with what he/she saw. It would be important for that person to answer some questions such as:

-what triggered the seizure?

-was the patient awake or asleep?

-was the patient pale or livid?

-how were his eyes (looking right, looking left, rolled over), his head (back, left, right), his mouth (tight, deviated to the left, deviated to the right)?

-was the seizure on a part of the body, or generalized?

-was the patient unconscious or awake?

-was the patient soft, tense, struggling?

-did he have fever?

-hot long did the seizure last?

-what happened after the seizure: was he sleepy, did he sleep, he accused cephalalgia, he couldn not speak, he had a soft arm or leg for a period of time. All these details help us to make a difference between a seizure and other non-epileptic manifestations, or it suggests the type and origin of the seizure (the place in the brain from where the impulses start).

 

Epilepsy treatment

 

There are many medicines used in epilepsy treatment. They are recommended by the neurologist depending of:

 

-type of seizure-for example there are more effective medicine in partial seizures and other in generalized seizures; in absence seizures a specific medicine can be used, ineffective in other type of seizures;

-the age of the child-there are some medicines that are not suitable for certain ages;

-the presence of other diseases, especially liver diseases. The introduction of a medicine is made progressively, starting with small dosage and increasing the dosage once in a few days. We prevent the apparition of an adverse reactions , that could frighten the parents and that could determine them to stop the treatment. Some of the adverse reactions, like dizziness, sleepiness, disappear once the organism gets used to the medicine. In case of frequent and severe seizures, the dosage must be increased quickly.

The medicine are administrated once, twice, three times a day, not necessarily at a certain hour, but we must know that the ones administrated once a day have a 24 hours action period, twice-12 hours, three times-8 hours.

 

The treatment is long, 2-3 years, maybe 5 years from the last seizure, or even more.

 

Never interrupt the treatment without medical advice. The sudden interruption of treatment can trigger epilepsy seizures.

The majority of seizures can be controlled with a single medicine. In 5-10% of patients, the seizures can be controlled with 2 medicines. At 15-25% of patients, seizures can never be controlled. Here, it is important to reduce the number of seizures, using a combination of medicine. Other used treatment methods: acupuncture, homeopathy, bioenergy did not have significant results. Epilepsy surgery is a method that can be used in some types of epilepsy, where the precise part of the brain that produces excitation has been identified.Is is not a very common method in our country. Observe your child, even if from distance, related to the treatment, try to empower him and explain to him how important every dosage is.