Seize The Moment

By Ian K. Smith, M.D.

This year roughly 125,000 americans--half of them children and adolescents--will be overcome by a sudden, abnormal discharge of electrical currents in the brain marking their first seizure. A seizure can be pretty scary, especially when the person starts twitching uncontrollably or, in rare cases, stops breathing altogether. Seizures in children under age 5, however, are usually the result of high fevers--typically 103[degrees]F or higher--and most kids grow out of them.

But 25,000 to 45,000 U.S. children each year have a first seizure that is nonfebrile (not brought on by a fever), and they stand a significant chance of having epilepsy, a true seizure disorder, diagnosed.

How do you tell if your child has epilepsy? That is the focus of a new set of guidelines jointly published last week by the American Academy of Neurology, the Child Neurology Society and the American Epilepsy Society. After reviewing hundreds of studies, they strongly recommend that an electroencephalogram (EEG) be performed on all children when they experience their first non-fever-related seizure. The procedure records bursts of the brain's electrical activity and is quick (less than an hour), painless and safe. It can tell you not only what kind of seizure your child has had but also what the chances of recurrence are.

Unfortunately, the test is not foolproof. As many as half of epileptic patients will have a normal EEG, while others who have never had a seizure will show abnormalities. It's unclear when to perform the test, though most studies suggest that the best chance of spotting abnormalities is in the first 24 hours. If a serious underlying brain disorder is suspected, doctors may also recommend an MRI scan (which is now preferred over C.T. scans), but these tests won't tell you much about epilepsy.

The new guidelines also cover spinal taps. These tests involve inserting a long needle into the backbone and extracting cerebrospinal fluid for analysis. While this can be quite useful for determining whether children with high fevers are suffering from meningitis, it has limited diagnostic value for kids who don't have a fever.

It's important to know what to do when someone you know--child or adult--is having a seizure.

First, try to place the victim on a flat, soft surface such as a rug or sofa or, if you're outside, on the grass. Then turn him (or her) on his side to prevent him from swallowing secretions. Never try to restrain anyone who is having a seizure--you will just end up hurting yourself or the victim. Instead, provide protective supervision to keep him from falling onto the floor or hitting his head on anything sharp or hard. If he stops breathing or his lips turn blue, make sure his airway is clear of any obstructions before beginning mouth-to-mouth resuscitation.

Despite a popular misconception, seizure victims don't swallow their tongue. This is a dangerous myth; placing a bite stick or any other object in the mouth of someone having a seizure can do more harm than good.

Stay by the person's side until the seizure is over, then call for immediate medical assistance. As with most illnesses, the sooner the cause is diagnosed and treated, the better the chances of a positive long-term outcome.

Dr. Ian appears on WNBC-TV. E-mail him at ianmedical@aol.com To learn more about seizures, try www.efa.org