Medication for Very Infrequent Seizures in 7-yr-old

[nrwillia]

Hello,

I am so anxious and confused.  Our youngest daughter, who will be 8 in March, had a seizure induced by a fever in early November.  The seizure lasted about a minute or less and she was convulsing and lost consciousness.  I was shocked and scared because she had not had a febrile seizure since shortly before her third birthday.  The only other seizure she had was at 15 months, and again, was a febrile seizure.  She had had numerous fevers in the intervening 4 years but no seizure, even when her fevers were caused by tropical viruses.  She has had no further seizures.  We did a follow-up EEG and an MRI. The neurologist here in HK where we are living at the moment said that the MRI was normal but there was some slight abnormality in the EEG on both sides of the brain.  He said she had a 70% chance of having another seizure in the next 3 years and suggested we put her on Keppra.  (He previously ordered the MRI because he thought that her earlier seizures, which both lasted less than a minute and were about 18 months apart, may have caused hippocamal sclerosis).  When we asked if she had epilepsy, he said no that she has "epileptic tendencies."  He also said that we could try giving her anti-convulsant medications -- Frisium -- whenever she gets a fever to reduce the possibility of a seizure. We found him rather alarmist and are really opposed to medicating her if it is not necessary. Does this make any sense?  We plan to go back to NYC to visit a pediatric epilepsy center for an evaluation but will not be able to do so for some weeks.  Any thoughts on whether this seems to be jumping the gun or appears within customary treatment norms would be greatly appreciated.

[nrwillia]

Thank you so very much for your thoughtful and reassuring response. We will be taking her to ny presbyterian's epilepsy center in April. Until then we will try to aggressively control any fevers with ibuprofen and Tylenol.

Again, thank you so much for your response. We appreciate it immensely.

[wipharmtec]

Hello,

I can understand your anxiety.  Seizures are scary things.  However, they are treatable.  It sounds like your daughter might have a low seizure threshold.  Since all of her seizures seem to be due to a fever, I would agree with that doctor regarding keeping her fevers under control.  On the whole, though, the seizures she's had have been minor, and not uncommon in children.  I would disagree, though, with using a drug like Frisium without a better workup.  In my opinion, keeping her fever low by using acetaminophen or ibuprofen would be a better idea at this point.  If she does indeed have a seizure disorder, there are many drugs available to treat it.  Until she is able to swallow pills, treatment options are somewhat limited.  Keppra and Neurontin both come in liquid forms and taste decent.  Valium, or diazepam, is similar to Frisium also comes in a liquid form, but patients can develop a tolerance and dependence to that class of drug.  The class also can cause significant drowsiness, so I would try to keep those in reserve.  I don't think the doctor was trying to be alarmist.  If she has a low seizure threshold, something like a fever can cause a seizure.  If she does have a seizure disorder, she probably has other triggers too.  With that in mind, it is best to start treatment sooner rather than later to prevent future seizures.  At her age, seizures are generally not as disruptive to daily life as they are for adults.

After all of that, I would suggest seeing an epilepsy specialist who can do a complete workup.  Though this my prove to be inconclusive, it may also identify a problem that can be treated. I wouldn't be too concerned at this point.  The seizures she's had have been really quite mild and she's come out of them quickly.  I would chalk it up to the fever, but it's still worth a second look.

Good luck!