4 years old. Diagnosed with idiopathic focal epilepsy. What are the risks?
This evening she complained of some irritation at left palm, beneath left foot, area adjacent to left eye and ear and the irritation resulted in some convulsion of left wrist and palm. Fingers crawled inward, wrist became stiff and the arm too seemed to be little stiff. It happens four times. First three were some what mild and the last one was, to say about, little prolonged and little hard than the previous three. The last episode lasted for about 10/15 seconds. She became little off if compared with her usual playful enthusiastic mood.
It occurred first-time on August 18, 2012 and frequently occurred for next two consecutive days. Then she was not febrile or she never reported that earlier or she never lost consciousness for whatsoever reason in her life time.
Her main problems are, her left palm, fingers and wrist shake involuntary and slightly left toes crawled inward.The left fingers too come inward and become rigid for 10 to 30 seconds. The fingers and palm make a shape alike fist when it occurs. Sometimes, the left arm raises upto chest level and gets fixed for 15 to 40 seconds. These occurred when she was awakened and during sleep too. However, she never lost consciousness and can remember the episodes very well. Before the attack, she complains of some irritation sensation at palm and wrist, area adjacent to left eye and ear, and also at foot.
She underwent MRI at a machine of 1.5 Tesla Avanto MRI (18 Channel) at Peerless in Kolkata and EEG. The doctored found nothing abnormal with that. Her blood report showed HB 10% with little high Leucocytes count, which they ruled out of having anything serious. They did LP and found nothing.
To say about her medical history, she suffered severe dysentery, vomiting associated with fiver for 4 days when she was one and half years old, doctors called it ‘Rota’ virus’s act, as the biggest ailment. She suffered from Flu and Cough several times and once mild throat infection. That’s all I could remember about her illness. She had been given various vaccines. At the time of taking birth she breathed little late, with intervention of doctor stroking her back she signed life, however, she did not need to be kept on Oxygen.
Two of my maternal uncles have and had been suffering from general epilepsy and they are now in their fifties. One of my maternal aunts too suffered. However, none from my father’s side or my maternal cousins did/do not suffer from it or at least not reported yet.
Her mother-side is free from epilepsy, at least not kwon.
The things, I observed she developed after the onset of the epilepsy, are her left fingers almost continuously remain in movement during sleep, left eye remains half-opened, shoulder shakes with regular intervals, and she urinates at bed what she stopped two years back. Now she very often almost every night she cries or laughs in sleep, that is too little strange. She earlier did these but in very rare occasions. Usually she was little introvert, but now she donned off that mood. She has become little impatient, however, nothing that high. But she now frequently bites her mother, me and her aunt, though not the outsiders or little kwon one. This is something new she developed after the attack reported first in last month. Otherwise, she goes well, eats good, sleep fine and does school everyday.
When she was about two years old, she was frightened in seeing cartoons, tigers, etc on TV, it was lasted for 8-9 months, however, not before and later that period she showed fear seeing so. Now she enjoys without any problem.
Her school teachers though reported nothing unusual after she resumed school after she recovered from attacks last month.
Now, if you permit, may I place my quires as :
What is risk of this disease? What is the possibility of turning into a generalized epilepsy and if it continue and What we should tell her teachers if she feels so when in school?
What is the chance of full-cure and is there any threat on her life and does it affect her intellectual level as her teachers say, she is very sharp to pick lessons?
Is there any problem if I give her Valparine in morning before she takes break-fast and What the care and caution should we maintain ?
If you suggest me, I will send you a copy of the MRI done, EEG , Blood-reports,etc through courier.
And begging your pardon in advance, could I know if I should deposit any charge as consultation-fee, handling-charge for the copies, if you suggest, to be sent, etc. If so, please tell you office people to inform the amount and how it may be deposited, like Bank A/C no, etc.
Beg your pardon for going long and denting your time.
I am very concerned about this case because I would not have followed same line of treatment.
As the seizure is focal with aura… she would have better responded to carbamazepine than valparin and frisium.
Its good that eeg and mri is normal suggesting relatively better prognosis.
All seizures or medicines need not affect IQ but some seizures with abnormal mri and drugs like gardenal and frisium do.so.
…if the seizure is not tackled in time or if it doesnot settle in time, it has tendency to become generalised…
In case if she gets seizure in school… teachers need to be informed about patience,not getting panicky,turning her on one side if she gets generalised. And giving the nasal midazolam spray by nose to help reduce the seizure if it doesnot settle on own in 3 minutes.
She doesnot need special school
EEG may need repeats many times and also to look for seizure provocation on hyperventilation.
I do see 200 cases of children with seizures amonth. Reports you may courier me.may.be.beneficial in understanding the case further as all reports are highly subjective. To reports that can surely be of help are EEG.on CD and video demonstration of what she does by recording on mobile a live seizure or a fake one as you may show what she does.
You may go through my FAQ on epilepsy at pediatricianonline.in and also courier the details by my.name to dept of pediatrics. First floor college building… Topiwala.National.College mumbai central pin 0000 Maharashtra
I hope this addresses your concerns. Feel free to write back if u feel any issues need to be addressed in details.…
Dr XXXXXXX 0000 sorry for any spelling mistakes as typed on mobile.
Thank you very much.
She is on Frisium now it is more than a month.
I have kept a INSED spray in home, however not used till date.
As you have written, "if the seizure is not tackled in time or if it doesnot settle in time, it has tendency to become generalised… XXXXXXX
Could you please detail that and how could we know what the time frame at least we should consider to get it controlled, that I want to say if enough time has already has given and by this time the seizure should not return and now we can say, it is not controlled and going to be general ..............after the first attack was reported in August 20, and continued for two days, after that only this evening it came back, this one month and a week time she was free from those and what's about the movements during sleep and also urinating at bed and cries and laughs ?
Shoulder mpvements urinating etc can be associating with focal seizures too. If she. Is conscious throughout we will call it a simple seizures. Other conditions when we see shoulder twitches in sleep are almost nil .
Yeah! Issues are clear!
In-fact, I sent this supplementary query last night soon after I got the first suggestion................in speaking with you things got clear......Sorry ! I did not mention then that one supplementary was put there and you may ignore that.
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