Eira at Metro Davao Medical and Research Center - EEG Clinic | November 10, 2017
After consulting with the neurologist, the next step is an EEG test before starting any medications.
That was the doctor's orders in Eira's case. For others, neuroimaging studies (CT or MR scan) may be necessary.
What is EEG?
An EEG tracks and records brain wave patterns. Small flat metal discs called electrodes are attached to the scalp with wires. The electrodes analyze the electrical impulses in the brain and send signals to a computer that records the results1.
Preparing for an EEG test requires a little bit of conscious effort. Karla Blocka1 suggests the following steps when preparing for an EEG test:
The night before your scheduled EEG test, wash your hair. Do not apply any hair products.
If you are taking any medications, consult with your doctor if you should skip your medications before and during your EEG test. It is also recommended for you to submit the list of your medications to the technician performing the test.
You should avoid food and drink with caffeine. It is recommended abstain from caffeine for at least eight hours before the procedure.
Usually, you have to sleep during the procedure and your doctor may advise you to deprive your sleep like what Eira’s neurologist recommended. For children (and it may also apply to adults), a mild sedative is given to help relax and sleep before the procedure starts.
Choosing EEG Clinic
If you are in Davao City and needs an EEG test, we recommend you schedule your EEG at the Metro Davao Medical and Research Center (MDMRC).
This was recommended to us by our neurologist for two reasons:
It’s the cheaper option. It only costs approximately Php3, 250.00. But with Eira’s PWD (persons-with-disability) ID, we only paid a little over Php2, 800.00.
The EEG results come with a detailed report-type copy of the reading. They print every page of the recording and this is what our neurologist was after to have a comparative reading with the next EEG tests scheduled yearly for us. We were told in other hospitals, we will only get the summary report of the reading, not the the print copy of the entire recording.
The service at Metro Davao Medical and Research Center’s EEG clinic was commendable with helpful and accommodating staff. They helped us through the entire process of the procedure for a convenient experience.
_________________
References:
6Blocka, Karla. 2017. “EEG (Electroencephalogram).” Medically Reviewed by Deborah Weatherspoon, PhD, RN, CRNA on September 14, 2017. Retrieved on November 16, 2017 from https://www.healthline.com/health/eeg#overview1
Description: An award-winning book used as the standard resource for parents in need of comprehensive medical information about their child with epilepsy.
Description: From a leading neurologist, experienced nurse practitioner, and registered dietician comes the complete guide to help your child achieve and maintain a high quality of life.
Description: Drugs commonly used to treat epilepsy have some extremely harmful side effects. This book is an empathetic, practical, empowering look at treatment options, lifestyle choices, and ways of living well.
Description: This concise, accessible handbook for families, friends and carers of children with seizures provides all the information they need to approach seizures from a position of strength.
There were no signs. At least to our untrained observation skills.
Diagnosed with global developmental delay, we had a list of things to worry about including recurring pulmonary infection, low muscle tone, failure to thrive, speech, genetics and other areas of development. We never anticipated a seizure attack.
We should have.
Then, a week ago, it was just sudden. Her body dropped limp and unconscious from a sitting position. Her skin turned pale and her face blue-ish. For parents like us, who have been a frequent flyer to the ER, that was our cue to another ER rush.
She was already non-responsive but her eyes were open and seemed wide awake.
We were clueless that she was having a seizure attack, but she did not exhibit body convulsion. We did not suspect a seizure episode because we never knew until now that there are different types of seizure. Some seizures like the type Eira experienced does not necessarily have to be dramatically convulsive with rapid, violent shaking movement of the whole body.
As we drove to the nearest hospital, I kept on tapping her back and reaching inside her mouth for any object she might have swallowed.
Big mistake.
I could have put her in greater danger by forcing her tongue down. Thankfully, ignorance towards proper response to seizure attack did not cause her condition to get worse.
And all it did to her was help release a quick burp. But no one should take chances like that.
A brief look into treatment history
Prior to her first seizure episode, we’ve been treating her recurring lung infection, fighting fever due to the infection. We were also working on her nutrition to improve her weight gain.
She lost so much weight fighting pneumonia after pneumonia.
The first seizure episode occurred on the 10th day that we were giving her antibiotics. We’ve been working with her pulmonologist to strengthen her lungs, prevent triggers and fight infection.
But we could not point to a single cause that would have provoked her seizure attack. She had no irregular activities, no fever, and had her meal two hours earlier.
Post seizure side effects
In the ER, her heart rate was elevated (although she’s always been tachycardic, which means her heart beats faster than normal). They also heard crackles from the lower right lung (back and front areas).
These are all typical observations after a seizure episode, says her pediatricians.
Soon after we took her home, she was feeling lethargic. She seemed exhausted and rested all night. It’s another common response following a seizure attack, mostly among those who had generalized seizure attacks.
These details are important to specialists; and if you are about to see a neurologist, you might want to keep notes of details to share with your doctor for proper diagnosis and optimized treatment.
First neuro consult and initial diagnosis
We had our first neuro consult four days after her seizure following the referral from her pulmonologist. Eira’s first seizure attack was not repeated up to the time of this writing.
I have no clue if it ever recurs.
Or, if she is having seizures during sleep as what studies1 suggest considering that she had not been achieving developmental milestones.
During our first neuro consult, we discussed Eira’s medical history:
Eira was diagnosed with global developmental delay and partially diagnosed with RSS (Russell-Silver Syndrome). The Magic Foundation dedicated in the research and support services for families affected with growth disorders describes this syndrome:
Russell-Silver syndrome (or Silver-Russell syndrome) is a rare genetic disorder characterized by delayed growth in-utero (IUGR) that spares head growth (meaning the newborn has a head size that is large for his body) and ongoing postnatal growth failure.2
Eira’s RSS diagnosis has yet to be confirmed with genetic tests that we left on hold for a little while longer so we can focus to resolve her immediate issues. [I will talk more about RSS in the next blogs...]
After our narrative of the incident, Eira's neurologist suspected a possible generalized seizure. She needed to undergo an electroencephalogram (EEG) test to confirm the initial diagnosis.
What is generalized seizure?
A seizure episode is “a sudden, abnormal electrical activity in the brain”3 and there are different classifications for seizure. There are seizures that affect just partial part of the brain and there are types that affect both sides.
Eira’s seizure affected nerve cells on both sides of the brain and classified under generalized seizure. This suspicion was confirmed by the EEG results.
What happens during seizure?
Sudden bursts of electrical activity in the brain can cause different responses depending on the affected parts of the brain.
For Eira, I have no way of telling what it's like in terms of thoughts and feelings because she has speech delay and communication is a bit of a challenge.
I can only discuss the physical reaction of her body during the attack. It was like dropping in slow motion; and while it seems she is wide awake, she is unresponsive and unaware of her surroundings. The visible change of skin color turning her pale all over and her face changing to blue-ish tone hints for real trouble.
It was the most frightening part for a first time experience of seizure attack.
Eira just had one seizure episode to the best of our knowledge. Those who experience recurring seizure may observe that each episode occurs under similar circumstances.
Watch the video published by Pfizer discussing seizure with Dr. Freda Lewis-Hall, Chief Medical Officer of Pfizer, and Dr. Travis Stork. It’s a helpful resource understanding what happens during a seizure and what you can do if you see someone having one.
If you watched the video, you probably caught the key takeaways—
Stay with patient until seizure ends
Ease them to the floor so they won't fall
Loosen anything around their neck
Keep their airway clear by turning them to one side if possible
Don't stop their movements
Don't force anything into their mouth to hold the tongue down
Looking back, I regret forcing her mouth open because I was worried she might have swallowed something causing her to choke; but not realizing that I could have caused more danger.
Final Thoughts
I am still horrified learning that my daughter just had seizure.
But we can only move forward from here and I am more inclined to understanding seizure and how we can control and manage it than to remain petrified that it is indeed happening to our daughter.
We started Eira on a three-year treatment program that could extend up to five years depending on her response.
Every seizure episode has risks for brain impairment, not to mention it is life-threatening. Medical intervention is necessary to treat seizure and prevent any further impairment to the brain.
I’m committed to further learn and understand seizure. You can email me for questions related to seizure or any other neuro-related query and join me again in the next blog for answers from our neurologist.
______________
References:
1Fliesler, Nancy. 2012, May 4. “When a child loses milestones, consider sleep EEG studies. Retrieved online on November 12, 2017 from https://vector.childrenshospital.org/2012/05/when-a-child-loses-milestones-consider-sleep-eeg-studies/
2Magic Foundation. “What is Russell Silver Syndrome. Retrieved on November 13, 2017 from https://www.magicfoundation.org/Growth-Disorders/Russell-Silver-Syndrome/#1
3Medline Plus. Seizure. Retrieved on November 16, 2017 from https://medlineplus.gov/seizures.html
Description: An award-winning book used as the standard resource for parents in need of comprehensive medical information about their child with epilepsy.
Description: From a leading neurologist, experienced nurse practitioner, and registered dietician comes the complete guide to help your child achieve and maintain a high quality of life.
Description: Drugs commonly used to treat epilepsy have some extremely harmful side effects. This book is an empathetic, practical, empowering look at treatment options, lifestyle choices, and ways of living well.
Description: This concise, accessible handbook for families, friends and carers of children with seizures provides all the information they need to approach seizures from a position of strength.
I asked my daughter’s neurologist this question when we went for a consult soon after experiencing her first seizure attack.
What I learned after our neuro consult last week (Wednesday, November 8) is that seizure is typical among children with developmental delay.
The risk of a child with a developmental disability experiencing an unprovoked seizure by age 5 is about 4 times greater than in the general population1.
An overview on pediatric first seizure, published in Medscape, suggests that a recurrence may not be experienced by most children2. That's a relief... But a seizure attack could mean two things:
an initial presentation of a more serious medical condition; or
subsequent epilepsy.
Like every parent, I have questions about how I can help my child from a life-threatening seizure? Then, I also have these questions in mind—
what does this seizure episode mean for my daughter in the long term?
will it further slow down her development?
If you are a parent seeking answers for the same questions we have, I hope this post helps you gain some insights.
What research tells me so far…
According to a neurologist in the Epilepsy Center at Boston Children’s Hospital, Tobias Loddenkemper, MD, he suspects seizure-like activity in the brain at night among some children with developmental delay3. These spikes of electrical activity in the brain gets easily undetected because “very few physicians have been looking to see what’s happening at night,” says Loddenkemper3.
Excess brain electrical activity at night can disrupt development — but if found, may be treatable3.
The above image shows Eira’s EEG result. Notice the electrical brain activity in different regions with every wavy horizontal line. See the spiky triangular waves appearing continuously during sleep. This reflects constant seizure-like activities that is not seen in her daytime EEG.
Final Thoughts...
Let’s go back to our initial questions:
what does this seizure episode mean for my daughter in the long term?
will it further slow down her development?
It is good that we consulted with a neurologist earlier than later.
It means we get the opportunity to manage and control episodes with proper medical treatment. Treatment for seizure usually takes three up to five years.
From a neuro perspective, if seizure recurs especially at frequent intervals, there could be developmental milestones that may be slower to achieve.
If you suspect your child having seizure attacks, consult with your pediatrician right away, especially if your child has developmental delays.
I’m committed to learn more and understand seizure.
You can email me for questions related to seizure or any other neuro-related query and join me again in the next blog for answers from our neurologist.
____________________
References:
1Epilepsy Foundation Metropolitan New York. "FAQ Epilepsy and Developmental Disabilities." Retrieved on November 13, 2017 from http://www.efmny.org/faq/epilepsy-and-developmental-disabilities/
2Waite, Shelley R. November 29, 2016. "Pediatric First Seizure." Medscape. Retrieved on November 13, 2017 from https://emedicine.medscape.com/article/1179097-overview
Description: An award-winning book used as the standard resource for parents in need of comprehensive medical information about their child with epilepsy.
Description: From a leading neurologist, experienced nurse practitioner, and registered dietician comes the complete guide to help your child achieve and maintain a high quality of life.
Description: Drugs commonly used to treat epilepsy have some extremely harmful side effects. This book is an empathetic, practical, empowering look at treatment options, lifestyle choices, and ways of living well.
Description: This concise, accessible handbook for families, friends and carers of children with seizures provides all the information they need to approach seizures from a position of strength.
Seizures and Epilepsy in Childhood: A Guide
Epilepsy in Children: What Every Parent Needs to Know
Treating Epilepsy Naturally: A Guide to Alternative and Adjunct Therapies
Children with Seizures: A Guide for Parents, Teachers, and Other Professionals
