Hi everyone! I'm a 2nd year resident doctor in an inner city hospital. This is a blog to document some of the experiences I encounter as a training doctor, and some of the things that I learn in the process. After all, being a physician means that I'll be learning some fascinating topics for the rest of my career, and seeing how I can use those to help patients.
Let's get started with today's topic, inspired by some reading I did today:
Seizures in children
Seizures in children can have multiple different causes, including but not limited to: epilepsy, febrile seizures (those caused by a fever), medications, electrolyte imbalances, abnormal brain structures, brain injury, genetic syndromes, genetic predisposition, and sometimes unknown/unclear causes.
There are also further subdivisions of seizures:
Anatomical: generalized seizures (those that occur through the entire brain), focal seizures (those that occur in a certain part of the brain).
Types: tonic-clonic (the entire body shakes and stiffens, drooling, eyes rolling), tonic (stiffening of the body or body parts), clonic (shaking of the body or body parts), myoclonic (parts of the body shake via musculature), absence (the child appears to lose attention for a few moments and cannot recall this) are the most common variants, among many other types.
Febrile seizures
I’ll talk to you about the most common seizures seen in children – febrile seizures. These seizures occur when a child is sick with a viral or bacterial infection, and spikes a fever usually >100.4 degrees Fahrenheit (38 degrees Celsius). Their cause is not always clear, but there’s a suspicion that the stress of the fever on the brain can cause electrical abnormalities, leading to the seizure. It’s most common in children under 1.5 years of age, but can also occur as late as 5 years old, and is more likely to happen if close family members have also had febrile seizures.
These seizures can be simple or complex. The simple ones usually last a few minutes and go away on their own. In such seizures, you may see the child shaking all over, eyes rolling, lose consciousness, pee or vomit on themselves, and moan. They’re directly associated with the presence of a fever. They look very scary and can be worrisome.
The complex seizures are more likely to last longer (>10 minutes), occur on one side of the body (hence, affecting a specific part or parts of the brain), and reoccur more than once in 24 hours.
Are febrile seizures dangerous?
For the most part, these seizures are not dangerous. It’s also not likely that they’ll occur more than once; there’s a 33% rate of recurrence in the future. Uncommonly, they can lead to epilepsy, but a single episode is never diagnostic of epilepsy. The best treatment for such seizures is to give a fever-reducing medication (such as Children’s Tylenol or Motrin) and treat the underlying infection that is causing the fever; you take away the fever, you take away the seizure that’s being caused by the fever.
In case a child is having such a seizure, it’s best to make sure that they are not restrained or choked, and are able to breathe. If they are turning blue, unable to swallow, or unable to breathe, this can be dangerous and needs to be addressed immediately.
In complex seizures, it may be necessary to use an anticonvulsant (a medication which is used to stop seizures). Seizures that are not easily breaking may require further medications to be administered rapidly.
Typically, febrile seizures don’t need to be evaluated further, as they are only due to fevers. If they occur more frequently, become more complex, or occur without the presence of a fever, then it would be essential to have the child evaluated by a pediatric neurologist (a neurologist who specializes in children). They would obtain an extensive history of the child’s development, including prior seizures, vaccinations, genetic history, illnesses, injuries, medications, and family history. The pediatric neurologists would probably want to see an EEG (electroencephalogram), which would give a reading of brain activity and show a seizure if it occurs. Sometimes they’ll suggest other imaging, such a CT scan of the head. They may also get some bloodwork to see whether there’s an electrolyte problem, or if something else within the bloodstream could reveal a clue as to what could be causing the seizure. It all depends on what believe to be the cause of the seizure.
I hope you've enjoyed this little snippet of a topic I learned as a resident in an inner city hospital. I'll have many more stories and learning experiences coming in the future, so stay tuned.
Sources:
- https://lakesidemedicalcare.com/history-osteopathic-medicine/
- https://kidshealth.org/en/parents/seizure.html
- https://kidshealth.org/en/parents/febrile.html
- Me 😊
Disclaimer: this blog is for entertainment (and possibly educational) purposes only. This is not medical advice. If you have any questions or concerns about your own health, please contact a healthcare provider.
Here are the previous editions of this blog:
Chronicles of an Inner City Hospital Resident Doctor #3
Chronicles of an Inner City Hospital Resident Doctor #2
Chronicles of an Inner City Hospital Resident Doctor #1