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Daily Dose

Seizures In Healthy Children

Whys do healthy children have seizures? I received a phone call from a patient whose 11 year old son had suffered a seizure, which actually occurred while he was playing a video game.

It is hugely coincidental that I  had just gone to a conference the day before (to get my required CME hours) where we discussed “First Seizures in Otherwise Healthy Children”.  A seizure, as defined from my lecture notes is “ the clinical manifestation of an abnormal excessive excitation and synchronization of a population of cortical neurons”.  In layman’s terms "it is the abnormal and excessive electrical activity within the brain that results in a change in movement, attention or level of awareness”. About 3% of children under the age of 15 years will have a seizure.  The majority of these will be related to having a fever.  (We have discussed febrile seizures before.) When reviewing data I also found that even the Nintendo website states that 1 /4,000  people may have a seizure brought on by playing video games.  It is more common for children and teens to have a seizure due to a photosensitivity reaction which occurs while playing video games. The first question that people as is what is the risk of having another seizure? The risk of having a second seizure is reported to be about 40 – 50% and several authors report that the recurrence rate after a second seizure is about 80%. In other words, more than half of the people who have a first seizure may never have another.  Having a second seizure within 6 months of the first is a risk factor for additional recurrences.  Having an abnormal EEG also increases the risk of having another seizure, and those patients with a normal EEG after a first seizure only have a 25% risk of recurrence. Children who experience a seizure which is thought to be related to playing video games are not “forbidden” from playing video games but should be cautioned to take frequent breaks while playing, every 30 – 60 minutes. (This is another good reason to limit your child’s video game playing.) It is also recommended that children not sit too closely to the TV and to use a smaller screen TV to play video games, and to have the room well lit. The question then is this, should you treat a first seizure?  There are  both risks and benefits of treating with anti-epileptic drugs. Although treatment with anti-epileptic drugs does reduce the recurrence rate of another seizure by about 50%, it does not alter the long term prognosis. In general most pediatric neurologists think that treatment of a first seizure in otherwise healthy children should be deferred until a second seizure has occurred.  This will require educating both the parent and the child about the risk of another seizure, how to handle a seizure and also warnings about bathing or swimming alone.  Close follow up with your pediatrician and a  child neurologist is recommended. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Concussions Are on the Rise

As our children become more and more involved in competitive athletics the incidence of concussions is also on the rise.

Not surprisingly, football still has one of the highest rates of concussions, with one in five high school or college players experiencing a concussion each year. Cheerleading has also seen a rise in number of concussions reported, as cheerleading stunts become more about athleticism and tumbling, putting cheerleaders at risk for a head injury from a fall. A concussion is defined as a trauma induced alteration in mental status that may or may not cause loss of consciousness. A concussion is a functional rather than a structural brain injury. The injury, typically arising from a direct or indirect blow to the head sets off a cascade of neuro-pathological events leading to a confusional state or memory dysfunction. Because a concussion is more of a metabolic crisis of the brain, neuroimaging studies with CT scans and MRI are rarely helpful. Concussions are typically diagnosed based upon symptoms including amnesia, confusion, impaired level of consciousness, poor concentration, headache, dizziness, fatigue, nausea or vomiting. Many symptoms may be non-specific in nature, but impaired mental status of any degree is the hallmark of a concussion. Because young athletes want to continue playing, even after a concussion is suspected, it is important to assess the athlete’s mental status immediately after the injury. There are several tests that may be performed even while the athlete is on the field, including orientation to person, place and time; attention; memory and higher cognitive functions. It is also important to assess the athlete’s judgment, and mood. Both coaches and parents should be aware of the hazards of returning a student to play after even a mild “ringing of the athlete’s bell”. Recent studies have shown that the still developing brains of adolescents and children are slower to heal from concussions. The younger you are the longer it takes to recover from a concussion; the brain is just more vulnerable. Allowing a teen to re-enter a soccer or football game, or cheerleading stunt immediately after a head injury puts them at risk of second – impact syndrome, a rapidly progressive brain injury that can lead to brain swelling and death. Concussions may lead to one fatality for every 300,000 children participating in sports. Current guidelines regarding return to activity and athletics are tending to be more conservative as studies have shown that the likelihood of long term and permanent impairment in cognitive function increases with each concussion. While a simple concussion typically resolves in seven to 10 days and requires no further intervention than rest, a more significant injury may take more than two to four weeks to reach full recovery. Once the athlete has rested, meaning no exercise or exertion for at least a week and all symptoms of headache, “feeling foggy” and fatigue have resolved, they may begin light exercise, such as walking or riding a stationary bicycle. If there are no recurrence of symptoms with light exercise then running, and resistance training may begin. With each increase in activity level the athlete should remain asymptomatic and may gradually move toward full activity and return to competitive play. Parents and coaches must remind student athletes that while missed games may feel like an unnecessary restriction, it is really only a minor inconvenience, which will help maintain long-term brain health. That’s your daily dose, we’ll chat again tomorrow.

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