Maggie McKay (Host): Welcome to the Peds Pod by Lab Bonner Children's Hospital.
I'm your host, Maggie McKay.
Today's episode is all about seizures, what they are, how to
respond safely, And what treatment options are available for children.
We're joined by Dr.
Sarah Weatherspoon, the Associate Chief of Pediatric Neurology at
Le Bonner Children's Hospital.
She's here to help us understand seizure first aid, why accurate diagnosis
matters, And what families should know when seizures aren't well-controlled.
Thank you so much for being here today, Dr.
Weatherspoon.
Dr Sarah Weatherspoon: Thank you so much Maggie.
Maggie McKay (Host): Let's just start with what exactly is a seizure and how might
it look different from person to person.
Dr Sarah Weatherspoon: I think that sometimes seizures, we have a certain
mental image of what that's gonna look like because of maybe a movie we've
seen or a warning that's on a video game, And we think about, maybe just
it's somebody who's jerking all over or maybe staring off for a few seconds.
And although all those things are true and can happen, it's
not the same for everybody.
And fundamentally what's happening is during a seizure, it's like there's
an electrical surge or an electrical storm over the surface of the brain.
And depending on which part of the brain is affected by that, whether it's
just one side or one part, or whether it's the whole brain at once can make
seizures look a lot of different ways.
So again, sometimes somebody might just stare off.
Maybe their eyelids might flutter a little bit, but sometimes they
can be a little bit more involved.
For example, maybe somebody's head may turn to one side.
Maybe their eyes will get stuck in one direction.
And for some people, yes, seizures can even progress to the point where they
might have some stiffening or some jerking in their arms, in their legs.
Some people may fall during a seizure and sometimes people may even turn
a little blue around the mouth and that's when they can get particularly
frightening, I think, to watch.
And we don't wanna miss that diagnosis.
when a child is having seizures, in particularly, we know this
can have an impact on them, And we just don't wanna miss it.
So we want to make sure we're taking good care of those children when they're
coming to see us in the neurology clinic.
Maggie McKay (Host): Absolutely.
What are the key steps to take when someone is experiencing a seizure?
To ensure the person's safety, And also why is it important to debunk
myths like swallowing the tongue.
Dr Sarah Weatherspoon: The most important thing, first step is to
place that person on their side.
So we don't wanna leave them laying on their back, because
that's when things like.
Saliva or drool could end up in the back of the throat And that can cause
some choking or difficulties breathing.
that's when people get worried about that idea of swallowing the tongue.
You can't really swallow your tongue, but you don't want anything
blocking the mouth or the airway.
So what that means is if you put somebody on their side, then naturally
anything in their mouth is going to kind of just naturally follow gravity.
And come out, like whether it's saliva or drool.
it's again, kind of a, myth or an urban legend that somebody
might swallow their tongue.
Sometimes people might bite their tongue and because sometimes with
people having a seizure, their jaw might clench tightly shut.
It's actually really important not to stick anything in their mouth.
Because that could result in an injury to the person who's helping.
So that side positioning is really critical during a seizure and not
putting anything in their mouth.
Now, it's also, of course, really important to go ahead and call 9
1 1, but we know sometimes it can take a little time for an emergency
service vehicle to get to somebody's home or school or wherever they
may be out in their community.
For people that we take care of who do have seizures, and
we've made that diagnosis.
It's very important.
Everybody have a seizure emergency medication, or sometimes we'll use
the term seizure rescue medication.
We'll talk a little bit more about that I think in a second, but.
There are other ways to also intervene when somebody's having
a seizure, depending on what their seizure treatment is.
So, for example, some people may have a device called a
vagal nerve stimulator, or VNS.
That's actually a device that a surgeon puts in the chest of a person
with, wires under the skin that help control seizures over time.
If somebody has a VNS.
Then their caregiver or their school may have an external magnet that
they can swipe over the chest.
And that swiping of the magnet over that VNS device can also potentially
help stop a seizure in the moment.
And finally, the last thing to mention is just making sure that person is safe.
So keeping them away from any sharp corners like furniture that has
something that's very hard or pointed that could be injurious to them.
But also any hot surfaces, like a stove top or a heater, a person can
get burned during a seizure because they're not fully conscious or aware
of what's going on with their body.
So it's really important just to clear the space around them.
Maggie McKay (Host): That makes sense.
Why is accurate seizure diagnosis so important, especially in children?
And what tools help doctors tell different types of seizures apart?
Dr Sarah Weatherspoon: Making that seizure diagnosis is really critical
because if a child is having repetitive seizures then and or are at high-risk
for seizures, they may need to be on a medication that they take.
Every day to help prevent them from having seizures.
Seizures can be dangerous in the moment.
sometimes they can affect somebody's ability to breathe.
They may affect their heart's ability to beat.
they interrupt consciousness.
So whatever they're doing in that moment, they aren't going
to be as aware in that moment.
So, for example, if a child's in the bathtub.
Even for a few moments is left unattended.
They could end up face down in that water, and that's really worrisome and scary.
So it's really important that we get seizures under good control.
It's very rare for somebody to actually die from a seizure, but it is a reality.
We see sometimes in patient's, we take care of something called sudep or
sudden unexpected death in epilepsy.
And although that's very rare, it's why it's so important that we find the right
medicine And the right treatment for each child so that we're keeping them safe.
Also, seizures can impact learning and development.
So somebody's brain is spending more time in seizures than it.
In learning and taking in new information that can be really hard to move forward
in school and to learn new information and be successful in that way.
When we're thinking about diagnosis, one of the most fundamental things
there is just us taking a good history, asking lots of questions.
When somebody comes to see me in clinic, I'll even warn them, I'm gonna
ask you a lot of questions 'cause I really wanna understand what is
happening when your child is having these events from start to finish.
So having that timeline and really creating a mental picture of what
that child's experiencing during their potential seizure helps me
decide what's going on in this day and age with how easy it is to pull
out our smartphones and use a camera.
I have a lot of families who will come to me with an actual video of their child
doing whatever the event is that they're concerned about, And that video really
is worth a thousand words for me to look at that pattern of movement or behavior
and to think about, is that something I sometimes may see in a seizure?
Then the main test that we use to diagnose seizures is called
an EEG or electroencephalogram.
An EEG is not invasive.
It doesn't require a child take any extra medicine or be sedated.
They can eat beforehand.
We just place some simple wires on the scalp And we record their brain activity
from anywhere from 30 to 60 minutes.
It's a pretty accessible test.
Here at Lab Bonner.
We're usually able to get them within 24 to 48 hours, if not
sooner, if it's truly urgent.
And so that's a very important test that helps us look at children's brain activity
to see are they at-risk for seizures?
Are they having seizures?
Yeah,
Maggie McKay (Host): What preparation should families have in place in
case their child does have a seizure?
Dr Sarah Weatherspoon: When a first-time seizure happens,
nobody's necessarily expecting it.
when I see children who may have other neurologic or genetic things
going on where I think they're high-risk for seizure, I'll talk with
families about what to watch for, and I'll go through that basic seizure
safety about being placed on the side that we talked about earlier.
But in a child where we've diagnosed with a seizure disorder,
or we may use the term epilepsy.
Every child should be prescribed a seizure rescue or seizure emergency medication.
To me, This is really critical to empower families and caregivers in
helping their child when they're having that seizure and keeping them safe.
These come in a couple of different.
Ways.
One of the main routes that we give seizure rescue medicine at home now is
giving it via a nasal spray, and these are readily accessible at pharmacies.
They do require a prescription, but they can work just as well
as IV seizure medications can.
For very young children, we have a.
Preparation That is given rectally, which is also safe to give.
And what's so important about these seizure emergency medications is
that they are safe to give at home.
The seizure is much more dangerous than these treatments that we have available.
The main side effects of our seizure emergency medications
usually are drowsiness, which is something a seizure can also do.
Now some children and some families may feel it's beneficial to have some
sort of seizure detection device.
This isn't universal, these cost money, and currently they're
not covered by insurance.
Although there are some philanthropy organizations like the Danny Did
Foundation that can provide some financial support for families who are interested
in having a seizure detection device.
There are several kinds out there, and it's not a
one-size-fits-all sort of thing.
You wanna find the right device for the kind of seizure that that child is
giving And what their situation may be.
So it's just a really important thing to talk to with the doctor,
with a neurologist, and to do some investigation online.
Maggie McKay (Host): Dr.
Weatherspoon, how safe are today's seizure medications And what side
effects should families watch for?
I know you mentioned drowsiness.
Dr Sarah Weatherspoon: every medication that's out there, whether
it's over-the-counter acetaminophen, ibuprofen, or whether it's a
prescribed seizure medication.
Everything has a potential side effect, and when I'm talking and meeting with
families and patient's, I definitely wanna go over what to watch for.
Even though the reality is most people will be able to take a seizure
medication and our goal should be that they not have any major side effects.
So that's always the goal.
No seizures, no side effects, but everything does have
a potential side effect.
The most common ones usually affect our brain or our gut.
So things like drowsiness, sleep disruption, potentially
a mood or behavior change.
And then on the other side of things, some GI symptoms whether
it's increase or decrease appetite.
Nausea, et cetera.
Of course, everything out there has the potential to cause a rash.
So I always have families and I tell families right away to call me if
they have any concerns about rash.
The reality is most of the side effects, if they're mild or moderate,
do get better once somebody's been on it a couple of weeks.
But if side effects aren't getting better or they're severe or extreme,
then that's something to communicate with the neurologist about so we can
make a plan on what to do instead.
Maggie McKay (Host): When should families consider a referral to
a comprehensive epilepsy center?
Dr Sarah Weatherspoon: Anytime seizures are not controlled with the treatment that
that person is on, I think it's good to look for a broader opinion on what may be
contributing to those seizures And what other treatment options are out there.
So for example, anybody who has been on.
At least two or more seizure medications, but they're either not able to tolerate
them because of side effects, but particularly if they're still having
seizures, it can be really helpful to get that other set of eyes to look
at that case through a comprehensive epilepsy center, what we sometimes
call a level four epilepsy center.
And what that means is you have, experts, not just epilepsy, neurologists
or epileptologists, but also.
Very experienced.
EEG techs, other specialists on the team, like a neuropsychologist
or a genetic counselor.
People who are really looking at the whole child and not just the seizures
to say what else could be going on and contributing to what's happening.
But really that idea of if somebody has been on two seizure medicines
and they're not well-controlled, then it's good to think about
what other options are out there.
Maggie McKay (Host): And when a child is receiving epilepsy care at
Lab Bonner, what can parents expect?
Dr Sarah Weatherspoon: So I feel very fortunate that I get to work here at
one of these comprehensive or level four epilepsy centers because we're able to
offer a variety of different sorts of tests and specialists to help take care
of that child and to support their family.
So in the outpatient setting, it may look like coming in and having an EEG
done very soon after a referral is placed from maybe their pediatrician or
another specialist, And then getting to see a board-certified child neurologist
or a pediatric epileptologist.
Being at a big center like this, we see so many.
Cases such a wide variety of epilepsy that we really have just a great amount of
experience to be able to understand what's going on within our epilepsy center,
especially if somebody were to come be admitted to our epilepsy monitoring
unit, which is a special admission that's pre-planned, where somebody is
being admitted to the hospital for 24 hours or potentially up to several days.
For video, e, EG, meaning e, EG, usually throughout their stay as
well as a variety of other tests.
If those other tests might include a three Tesla or high quality brain MRI.
It can also include a test called Magneto Celo, which we're
very fortunate to have here.
Not every epilepsy center has one of those that allows us to look at brain function.
Transcranial magnetic stimulation, which is an amazing non-invasive way
to see where is critical function localized to somebody's brain.
Our ability to speak, our ability to move these kinds of
tests can help us sort that out.
And then we have other specialists, like I mentioned before, a genetic counselor
to say, is there anything genetic contributing to this person's seizures?
A neuropsychologist, somebody who can look at how a child is learning
And what sorts of memory or learning challenges they're having, and help
us put that whole picture together.
If in the end we discover somebody is having seizures and they're
not being well-controlled on medication alone, we have a variety
of other options to treat them.
One of those is the ketogenic diet, where we have specially trained
ketogenic dieticians who help manage that diet to treat seizures.
We have the ability to do different kinds of devices like that VNSI
mentioned earlier, as well as some other device options like RN.
And we have a special robot called the Rosa Robot, And what that allows us
to do in conjunction with our epilepsy neurosurgeon is actually put EEG directly
into a child's brain in a safe and precise manner so we can figure out exactly
where their seizures are coming from, And then potentially move towards a surgical
option for treating their seizures.
That that may be right for some children and not for everybody,
but it's important that we think at that level, especially for a child
who's having uncontrolled seizures.
Maggie McKay (Host): Well, this information is, gotta be so
encouraging to parents going through this with their child.
It sounds like Lab Bonner has all the bases covered when it comes to this.
So thank you so much for sharing your expertise and giving us
this invaluable information.
We appreciate it.
Dr Sarah Weatherspoon: Thank you so much.
Maggie McKay (Host): Again, that's Dr.
Sarah Weatherspoon.
To find out more, please visit lab bonner.org.
If you found this podcast helpful, please share it on your social channels and
check out our entire podcast library.
For topics of interest to you, I'm Maggie McKay.
Thanks for listening to the Peds Pod from Lab Bonner Children's Hospital.