Childhood seizures

Hi-My now 7yr old son has had 4 seizures, all precipitated by fever, at ages 18mo.,3yr,3.5yr,5.8yr.  He is otherwise very normal,intellectually,coordination,etc. He sees a peds neurologist and has been on Trileptal for the past 18 mo. 2 previous post-ictal EEGs showed no findings, but a 1yr follow up EEG after the last seizure showed: nothing during awake,hyperventilation or photic phases, but "drowsiness is characterized by the synchronization of the post. bkgrd activity.  As the pt. becomes drowsier and loses his alpha rhythm a L.occ.focus is easily idetnified with the presence of theta range activity w. phase reversal at 01.As the drowsy period continues, generalized paroxysm of hi amp. 1.5-3Hz activity is observed.This generalized discharge is proceeded by a short period of sm.amp.fast activity.Intermittently generalized paroxysms of this sm.amp.fast wave w.a sharp wave contour occurs intermittently during this drowsy state. The L.post.pole continues to exhibit intermittent theta range activity, again w.fairly sharp morph.Stage 2 sleep is char. by the presence of vertex sharp waves,sleep spindles and K-complexes.The pt. self aroused and resumes his bkgrd activity.The activity over the L.post.poles is again identified by the presence of the theta range activity.After arousal, interrupting his alpha rhythm,generalized paroxysms of 2.5-3.5Hz mod. to hi amp.activity continues to occur without clin.manifestations. How abnormal is this, and any thoughts on prognosis? Should I take him to a big center (?Paul Rosman)?  Thanks!

[CCF-Neuro-M.D.-JT]

Sorry to hear about your son's seizures, glad he is otherwise normal. Unfortunately, it is impossible to accurately comment on an EEG report (moreso than an MRI) without personally reviewing it. And even when two neurologists are looking at the same EEG, they can see different things. However, a pattern that keeps coming up in the report you provide suggests perhaps that there is some asymmetry between the right and left occipital regions (back of the head,) more specifically there may be some abnormal activity going on in the left occipital region. That's all I can interpret at this point. With your son's recurrent febrile seizures, I would consider a second opinion at a major epilepsy center and repeat EEG testing as well as MRI of the brain to make sure there are no abnormalities causing the seizure.

The prognosis really depends on several factors such as type of seizure, length, neurological state, and family history. The fact that your child is normal neurologically and that all of his sz are accompanied by fever are somewhat reassuring. But some experts suggest that more than 3 simple febrile seizures may lead to non febrile seizures later on.  But again, the most important prognostic sign is the neurological condition of the child. An epilepsy center would certainly be appropriate for futher evaluation.