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.