Friday, February 10, 2012
The Seizure Will Not Be Televised
In movies and after-school specials, seizures all look the same. Someone falls on the floor, their eyes roll back and they start to convulse. It's called a Grand Mal. For most of my life I thought that this is what all seizures looked like.
My Son Oskar had his first seizure on March 12, 2007. I will never forget the moment it happened. We had just returned home from a doctors appointment at the Consultati Bureau in Amsterdam. The windows were open, the birds were singing. It was a beautiful spring day. My babysitter, Lizzie sat on the sofa with Oskar on her lap and said " My, he's jumpy today. I think I just startled him."
He continued to be "startled" about 100 times a day, and in clusters of 30 or 40 " startles" when he woke up in the morning. Myoclonic seizures. I must have told 5 different doctors about these startles before anyone took me seriously and scheduled him for an EEG.
I am constantly surprised at the lack of knowledge about seizures. I have had therapists and even doctors who work with special needs children all day long ask me to explain what myoclonic seizures are.
So here for you now, a sexy "behind-the-scenes" tour of seizures:
First, Generalized seizures. These seizures involve the whole brain, as opposed to partial seizures, which generally start in one place and only involve part of the brain.
The Absence seizure, or Petit Mal: This seizure just looks like your kid is spacing out! It's a brief impairment of consciousness that only lasts a few seconds. You kid will just stare vacantly, not speaking or hearing what is said. Sometimes when I ask my typically developing kids to clean their rooms, they look like they are having this kind of seizure. The difference is that kids actually having a seizure will not respond to threats of having their computer taken away for the rest of the day. Seriously, this type of seizure is hard to detect and they sometimes go undiagnosed for months or years.
Myoclonic Seizures or Myoclonic Jerks: Sudden, brief muscle jerks. Can be mild and affect only part of the body or strong enough to throw the child to the floor. When I explain them to people I tell them that it's kind of like when you are falling asleep and you dream you are falling and your body jerks. They tend to come in clusters, Oskar's are clustered when he wakes up in the morning and from naps. I've asked his neurologist and he says they don't hurt. I hope this is true.
Atonic: Also called drop attacks. These seizures look like an abrupt loss of muscle tone. Sometimes just the head drops, sometimes your kids will crumble completely and fall to the floor. Imagine how scary that would be. A lot of kids who have these kind of seizures have to wear helmets cause they will hit their heads when they fall.
Tonic: Sudden onset of increased tone. An arm can fly out, the child may grimace or contort their face. Sometimes one side of the body is affected. Sometimes both . They usually last less than 60 seconds. If standing, the child may fall. Degree os impairment of conciousness varies. Sometimes a tonic seizure, will be followed by.....
Tonic-Clonic or Grand Mal: The movie star seizure! This seizure generally starts with a stiffening of the limbs ( the tonic part) followed by jerking of the limbs and face ( the clonic part). During the tonic phase breathing may decrease or stop and your kid's lips may turn blue. Oskar had the tonic part one night when he had a fever and it scared the crap out of me. I hope it never happens again.
Infantile Spasms: Onset of these seizures is generally in the first year of life. Particularly between the ages of 4 to 8 months. This one actually can look a lot like myoclonic jerks, or it can look like your baby is doing sit ups! The way they tell this from myoclonic seizures is a distinct EEG pattern. This kind of seizure is also called West Syndrome.
And now, Partial Seizures. Again, these seizures have a "focal point" in your brain and are isolated. If your kid has these kind of seizures, they are possible candidates for surgery to remove the part of the brain where the seizures occur. This used to horrify me, but if your kid has uncontrollable seizures, this surgery can be a the cure. The brain is so amazing it can re-route things to compensate for the part you have removed. Partial seizures are the most common kind of seizure and can manifest as almost any movement, sensory or emotional symptom, including visual or auditory hallucinations. So, they've got that going for them.
Simple Partial Seizures: 30-60 seconds long, no loss of consciousness, produces sudden jerking, sensory phenomenon, weakness or loss of sensation. I had a friend once tell me she had deja vu all the time and couldn't figure out why and then found out it was seizures.
Complex Partial Seizures: 1-2 minutes long. May be preceded by an aura or some other kind of warning sign. Produces automatisms like lip smacking, picking at clothes, fumbling. The kid having the seizure will be unaware of his or her environment and have mild to moderate confusion.
There is a website run by the Epilepsy foundation that I have found to be helpful. It has information about seizures (much of which I just ripped off for this post) and medications: www.epilepsyfoundation.org/aboutepilepsy/seizures/index.cfm