First Seizure Clinc for Children

A common reason to be referred to neurology is concern that you may have had a seizure. I am an adult (teenagers and up) neurologist but there is a national shortage of pediatric neurology specialists. You may get referred to me or have questions because there is no pediatric neurologist for hundreds of miles. I am always supportive of referring you to a pediatric neurologist - but want to be available if it is needed for your child and your family.

Seizures in childhood are similar to seizures in adulthood - but there are some differences. More children will have seizures when they have a fever or illness than adults. Some spells that can look like seizures are different in childhood. It makes sense. The brain of a child is different than the brain of an adult.

Many things can look like a seizure and it can be difficult to tell. Some people have jerking movements after passing out that can look like a seizure. Other people have events that are a result of trauma, or changes in sleep, or other medical issues. There are dozens of patterns we look for and that is why detailed descriptions are helpful. Most people are confused for a period of 10 minutes to hours after a seizure depending on the situation and how long it lasted.

Some children who have a seizure have an easily identifiable cause. This can inlcude fevers, head injury, medication, problems with blood sugar, kidney and liver issues. This is why we recommend getting immediate evaluation in an emergency department or urgent care or primary care (which may not be available immediately). Many children do not get imaging of their brain in the emergency department because the CT scan uses Xrays and young people are more suceptible to the downsides of Xrays. Doctors are very cautious about using anything that generates Xrays with children. If your doctor thinks that your child needs to get the CT - please follow that advice and get the scan in the emergency department.

If the workup in the emergency department does not give a reason you will be typically be referred to the best neurology resource in your area. If it is with me, it is because there is no pediatric neurologist near you. I am always happy to referr to the next closest city. There was a time when I worked where the closest pediatric neurologist was hundreds of miles away.

The first seizure clinic is fairly standard. The neurologist will take a detailed history and do an exam to see if they have any unique insights. Most of the time, more testing is suggested to make sure nothing is being missed.

In most cases, an EEG is helpful at determining if there is a cause. An EEG is typically done as a scheduled test in an outpatient center. It requires a specially trained technician to attach electrical probes to your scalp. The machine amplifies and records the electrical activity so a specialist can compare the electric pattern and determine if one dozens of abnormal patterns are seen. It takes 15 - 30 minutes to set up, recording range from 20 minutes to a few hours in most cases, and then it takes another 15 minutes to take everything off. EEG technicians have a lot of experience in working with children and have worked with a lot of families in this frightening situation. Most are able to keep the child comfortable even through the smells and situation is strange.

In children, imaging of the brain does vary from location to location. Some places can do something called "Fast MRI" which is a specially designed protocol for kids. Because the body parts are smaller, sometimes special calculations can be used to make a modified protocol for children that takes less time. The Fast MRIs are typically only 10 minutes Most children can stay still for this long and the test is more common where Fast MRI is available. Unfortunteately, your area may not have Fast MRI for children. Typical MRI protocols require a patient to be in a tube for around a half hour and it can be a noisy experience. This makes it harder for children to stay still. Many children need anesthesia so they sleep through the exprerience.

Most children who have a normal EEG, lab workup, exam, and a reassuring history do not have another seizure in their lives. So if Fast MRI is not available - deciding on MRI is a case by case basis. MRI imaging is always done if more seizures occur.

If your child does have a second seizure or a condition is found that is likely to cause more seizures, your child may be diagnosed with epilepsy. Epilepsy is just the term for people who have recurrent seizures when not treated with appropriate medications. There are many forms - some that a child will outgrow and others that are like to be present for life. There is a lot of inaccurate information online about epilepsy. Consider using a site like https://www.epilepsy.com/ that is maintained by professionals. Please remember that most people with epilepsy have rare or few seizures when treated with medication. Epilepsy is fairly common (around 1-2 people in 100 in the United States) and people with epilepsy do almost everything that people without epilepsy do.