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Re: Nocturnal Seizure Disorder

Posted By peds neuro md bm on April 22, 1998 at 15:43:24:

In Reply to: Nocturnal Seizure Disorder posted by Kathy on April 16, 1998 at 18:09:17:

: My 17 year-old son has had two grand mal seizures upon falling asleep within the last 8 months.  The first occured last August,and the second occured in January.  He has had an MRI, which showed nothing abnormal.  He had a sleep deprived EEG.  This showed a little seizure activity in the two front lobes of his brain when he was in the transition from being awake to falling asleep.  There was no seizure activity while awake or while in a deep sleep.  The two seizures he has had both lasted for one to two minutes, the last one being a little shorter and less severe. Based on the results of the EEG, the neurologist said that any subsequent seizures he might have would most likely be during the transition of falling asleep.  Because of this, my son has chosen not to take any medication.  The neurologist was supportive of his decision, so long as the frequency and nature of the seizures do not change. We are trying to find a balance through the use of supplements.  He is taking a couple of homeopathic cell salts which are indicated for seizures.  He has started taking Manganese daily for the same reason.  Do you know of any other means of controlling seizures besides the typical anti-convulsants?  My sons seizures have been few and far between at this point.  What is a lilely scenario? Will this pattern remain steady?  Will he outgrow them as he matures?  Are they likely to become more frequent?  My guess is that seizure disorders are so varied that no one can really answer these questions! Is there a general trend in how such disorders progress or disappear?    
dear kathy,
a little more information would be helpful such as:
1. are there any preciptating factors to the seizures?
2. is he awake late at night on the days he has had the seizures?
3. he is on any medications?
4. any history of drug or alcohol use?
5. has he only had 2 seizures?
6. over what period of time these these two seizures occur?
7. has he had other seizure types: staring episodes, single/multiple jerks, etc.
The answer to the first four questions is no.  He has had only two seizures, one last August and one in January. He was not overly tired on either occasion.  They both occured around 10 p.m. He has not shown any other seizure activity. There is no histoy of epilepsy in the family.
in terms of your question will he outgrow them, at this point it is
diffciult to say so until all the facts are available. There is a
syndrome of grand mal seizures upon awakening which is a rare syndrome
and controlled with medication, it also runs in families.
once you give me the information I may be able to answer your questions
thank you for your response. There are times when seizures only occur at
night. So far the eeg, by your report shows seizure activity arising from
the frontal lobes.
Some neurologist will elect not to treat thses seizures if they only occur
at night, since the patient is not in danger of harming others, such as by
driving, climbing heights, etc.
Other neurologist would treat the patient and then there are othere who
would look at the diagnostic test (i.e. eeg, mri)before making a decision.
Although at present his seizure had occurred only at night there is no
telling if it will occur during the daytime.
In my practice in a child who has had at least 2 seizures without provocating
factors and a normal examination and normal diagnostic testing, i do not mind
waiting for a 3rd seizure. However when I have an abnormal eeg with 2 seizures
it is my practice to offer treatment to the patient and his/her family. The
ultimate decision is yours to make.
I suggest you seek a second opinion from the cleveland clinic epilepsy section
to help clear your thoughts.
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