'My child's first seizure' Why does it occur, what do I do? Dr. Arif Khan
To see your child having his or her first seizure is a frightening event in your life. It is of utmost importance to remember that you’re relating the event to the doctor in the most accurate manner will go a long way in making an accurate diagnosis. The doctor will first try to differentiate whether the event was an epileptic seizure or not. A clear first-hand eye-witness account is crucial in this assessment. We usually recommend parents to video these events in the cases of children with recurrent seizures. Video assessment of the event is probably the most important investigation in the diagnosis of epilepsy. Diagnosis of epilepsy in children is difficult as there is no one test that can give a confirmation. There are a number of conditions, which may mimic epilepsy or epileptic seizures but are not epilepsy. The two common examples of this are febrile seizures and breath-holding spells. Fortunately, the child grows out of these episodic conditions with age. To begin with, it is important to identify a seizure. In children, tonic-clonic seizures are the common types. These begin with mild irritability and unusual behaviour. The body initially goes into sudden contraction, and stiffening followed by a variable period of jerking of all or one limb. The child may cry out as they Jose tone and fall unconscious. They may have irregular breathing pattern, appear pale, drool, bite their tongue and be incontinent. These symptoms are by no means a rule and variations are usually seen. After the seizure has stopped, the child goes into a period of drowsiness, confusion and sleep. Once a seizure is identified, the main aim should be to keep the child as safe as possible. This includes putting them in a recovery position after the seizure (on their left lateral side with the head tilted back slightly). This helps to prevent the tongue from falling backward and blocking the airway and also helps in free drainage of saliva and any blood from the mouth (avoiding any lung aspiration). Do not try and move them, unless they are in physical danger. Do not put anything in their mouth or restrain them. Try to get medical help as early as possible. Your doctor will be able to provide you with information and training to provide appropriate first aid to your child. Sometimes if your child has had a prolonged seizure, your doctor will prescribe a rescue medication for you to use in case of any further prolonged seizures. You will be required to undergo a brief training session in order to administer this medication. Clearly, parents are keen to find out the reason for their child ‘s epilepsy, and are concerned about whether this can be passed on to the next generation and if it is their fault. Although we as paediatricians and neurologists are able to answer some of these questions, there are many uncertainties in the world of epilepsy. However, the fact that your child’s epilepsy is not your fault is one thing that can be clearly stated. Your doctor may be able to provide some explanation with regard to the underlying mechanism of your child’s epilepsy. However, many a times it remains unexplained. If the cause of epilepsy is unknown it is called idiopathic epilepsy. Around 60 percent of children with epilepsy fall into this group. This means that there might be an underlying genetic cause but we are not able to identify it due to the lack of understanding of the genetic basis of epilepsies. In others, the epilepsies may be linked to an illness like meningitis, brain malformation, electrolyte disturbances, and disorders of metabolism or damage to the brain. If an underlying cause can be confirmed, the epilepsy is then classed as symptomatic epilepsy.