Diplomate, Board Certification of Emergency Medicine
Seizures are basically short circuits of electrical energy in
the brain. Typically they present with shaking and loss of
consciousness followed by a period of confusion. They can be
due to any problem in the brain: infection, trauma, stroke,
metabolic problems (most commonly low blood sugar) or reasons
that are unknown. Usually they can be well controlled with
medication. These people generally live normal lives and I
would not hold up a shidduch on this basis.
Febrile seizures are a special case. In kids with fever,
occasionally, there will be a seizure. These are scary, but --
despite the dramatic appearance of a shaking, unconscious kid
-- they are usually benign. They tend to run in families and
are particularly common after getting the DPT shot or a week
after getting the MMR shot. Children who have such seizures
have no risk of having life-long seizures or learning
problems. They need no blood tests (other than a spot check
for blood sugar level) and do not need admission or a spinal
tap.
All of this is only if it is a seizure with full recovery. If
it lasts more than 15 minutes, recurs during the first 24
hours or presents with shaking of only part of the body, the
seizure generally needs a more aggressive approach, which may
include spinal tap and blood tests or admission to the
hospital. Children under age a year-and-a-half may not show
normal signs of meningitis and need a more aggressive
approach as well. Neonates less than six months old are more
serious as well.
These seizures can be prevented by many drugs, but all of
them have dangerous side effects which limit their
usefulness.
Lowering the fever does not prevent these seizures. Giving
Valium or similar tranquilizers will abort a seizure but not
prevent them. Obviously they sedate the patient and make it
harder to evaluate them. Never stick anything in the mouth of
a seizing child.
Febrile seizures are a case where the best approach is not to
panic. Call for medical help if the seizure lasts longer than
five minutes and remain calm. Write me in care of the
Yated.
A message from GlaxoSmithKline, sponsor of this
column. Glaxo has a drug for seizures, and while Lamactal
is not a first line drug, it is the drug of choice for
difficult to control seizures. It has few side effects and
works well.
