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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.

Your Child

Naps Help Preschoolers Learn Better

2.00 to read

There are two things adults envy about youngsters – their bountiful energy and their naps.

A new study says that those afternoon siestas that many preschoolers enjoy are not a waste of time.  In fact, a daily nap may improve their ability to learn by improving their memory skills.

Preschooler’s brains are busy. On a daily basis they are processing new and exciting information. Their brains are storing the input from these experiences in short-term storage areas said Rebecca Spencer, lead study author and a neuroscientist at the University of Massachusetts, Amherst.

"A nap allows information to move from temporary storage to more permanent storage, from the hippocampus to the cortical areas of the brain," she said. "You've heard the phrase, 'You should sleep on it.' Well, that's what we're talking about: Children need to process some of the input from the day."

Many of the nation's preschoolers put in longer days than do their working parents, arriving at school as early as 6:30 a.m. and getting picked up after 5 p.m., Spencer said. "We're all short on sleep, and the kid's sleep is affected by the parents' schedules," she said.

For the study, the researchers taught 40 children from six preschools in western Massachusetts a visual-spatial memory game in the morning. The children were asked to remember where nine to 12 different pictures were located on a grid.

During the afternoon, children were either encouraged to nap or to stay awake. Naps lasted about 80 minutes. Later in the afternoon and the following morning, delayed recall was tested between both groups -- children who were encouraged to sleep and those who were kept awake.

The researchers found that although the children performed similarly in the morning, when their retention was fresh, children forgot significantly more when they had not taken a nap. Those who had slept remembered 10 percent more than those who were kept awake. The next day, the kids who had napped the previous afternoon scored better than those who hadn't napped. The data showed that a child doesn't recover the memory benefit from nighttime sleep, the researchers said.

To better understand whether memories were actively processed during naps, the researchers took 14 preschoolers to a sleep lab for polysomnography, a sleep study that shows changes in the brain. The children took naps for about 70 minutes. The napping children showed signs of signals being sent to long-term memory from the brain's hippocampus.

"Thus, there was evidence of a cause-and effect relationship between signs that the brain is integrating new information and the memory benefit of a nap," Spencer said.

The study was published in the September issue of the journal Proceedings of the National Academy of Sciences.

Spencer is concerned about the trend in many public preschools to discontinue naps. She said naps need to be put back into the preschool day, and she wants to see exploration of ways to enhance the napping experience -- with darkened rooms and comfortable cots or pads, for example.

What’s the bottom line? "Naps are not wasted time," Spencer said.

Source: http://www.nlm.nih.gov/medlineplus/news/fullstory_140919.html

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