Absence seizures–a few questions and some answers

One of my readers wrote to me today asking me a question about Absence seizures. She is a teacher and is concerned about a student in her care. I always feel teachers pick up Absence seizures far more frequently than parents. One of the reasons for this is that they spend so much time with the children (today most parents work and have limited time to spend with children). Teachers also are astute observers of children behavior and usually have a pretty good feel if something is wrong.

Here is what Ms. Lynn says, my answers to her query follow:

 

Ms J Lynn

Hi Dr Sethi,
I am a teacher and I have a student who is exhibiting these types of behaviors:
staring episodes, often says he can’t remember something we just talked about 30 seconds prior, he said recently that he feels like his “brain just wouldn’t work sometimes,” he has frequent meltdowns, easily agitated (but not aggressive), social (but very sensitive and easily hurt or offended), seems to have a low threshold for frustration and emotions escalate quickly, and he seems to overly react in situations when he feels physically hurt (if a ball hits him on any part of his body he is very upset, needs time to calm and he complains of feeling lots of pain).
Could all of these symptoms be related to some type of seizure activity?
Thank you for you help.

Dear Ms. Lynn,

                               thank you for writing in. Clinically seizures in children frequently look different from seizures in adults. In the case of Absence seizures, all the child may do would be to stare (hence the name staring spells), there are no gross convulsive movements seen (the child does not shake or have jerks of his arms and legs). During the time the child is having a seizure (staring), his brain is malfunctioning and hence the child is unable to recall things said or spoken to him during that time. Children may have hundreds of these small Absence seizures during the course of a day and hence you can imagine what follows. These children start slipping in their grades as compared to their peers.

I have to add here though, that not all staring spells in children turn out to be Absence seizures. As you are well aware there can be many behavioral and developmental problems in children which at times may mimic seizures (children who have Attention Deficit Disorder too do not do well in school etc).

I would advise you to report your observations to his parents. The child can be assessed by a pediatrician and further investigations if needed can then be carried out.

I sincerely appreciate your concern for your student. Teachers lay the foundation of our society. I am what I am today because of the hard work of my teachers and my parents.

Personal Regards,

Nitin Sethi, MD

Seizures in children: febrile convulsions

In this post I would like to talk about seizures in children. Seizures are among the most common conditions for which pediatric neurologists are consulted. Seizures in children differ from seizures in adults. Also the etiology of seizures in children differs from that in adults. There are many epilepsy syndromes which have been described in the pediatric age group, each has its own natural history and prognosis.

Typical febrile convulsion: as the name suggests this is a seizure (convulsion) associated with fever. Febrile seizures/ convulsions are mostly seen in the age group of 6 months to 6 years of age. Classically the child has high fever (may be on account of a sore throat or any other condition), as the fever is rising, the child is noted to have a brief seizure/ convulsion. I used the word brief because in its typical form a febrile seizure is brief lasting for a few seconds to minutes. Also in a typical febrile seizure, the seizure is a generalized tonic clonic seizure (the child stiffens up and then shakes). Typical febrile seizure has a good prognosis and does not lead to epilepsy later on in life. As a result these children need not be treated with anti-epileptic drugs. Children outgrow the seizures after the age of 6 years or so. All we advise parents is to keep the fever down. At times the neurologist might prescribe rectal diazepam. This is marketed under the name Diastat. Rectal diazepam is a benzodiazepine drug which can be given by the rectal route. Parents can give it by themselves, the drug is rapidly absorbed across the rectal mucosa and may abort a prolonged febrile convulsion. Usually febrile seizures run in the family and if a careful history is taken, one finds that one of the child’s parents too had febrile seizures as a child.

Atypical febrile convulsion: a febrile seizure is said to be atypical when either it is very prolonged (remember I said febrile seizures are usually brief) or when it is not generalized but rather focal (one arm or limb shakes not the whole body).  Sometime the seizure may occur without fever or even with temperature less than 100 F. Atypical febrile seizures may lead to epilepsy later in life and hence these children have to be closely followed. If a child has multiple febrile seizures or has a seizure everytime he or she has fever, your doctor may recommend an anti-epileptic drug for a short time. The drug most commonly used in this age group is phenobarbital. Phenobarbital is a safe drug which has been around for awhile now. Its most common side-effect is sedation.

Dr. Sethi