A Person Can Remain Active In Spite Of Convulsions
Question: Our teenage daughter was a perfectly healthy girl until a few weeks ago. One morning, she suddenly fell on the floor and started jerking. We were very scared and called the ambulance. When she arrived at the emergency room, her jerking movements had stopped. From our description, the doctor told us that she had a grand mal seizure. She had a CT scan of the head, which was completely normal. A brain wave test was also done, but we don’t have the result as yet. Our daughter appeared to have recovered completely until yesterday, when she had another convulsion. This time it happened at the hockey rink just before her game. It scared her coach and teammates, not to mention us. We are terrified that she can have convulsion any time, and she may die or hurt herself. We don’t want to stop her from participating in sports because she is a very athletic child. However, we are very insecure and not sure what to do. Please give us suggestions.
I fully understand your concern about your daughter’s convulsions as well as her safety. However, I don’t believe you should stop all of her activities. If you follow a few simple rules which I will explain later, both you and your daughter can continue to lead a fairly normal life, even though she may still have more convulsions in future.
Let me begin by explaining briefly about convulsions and seizures. Both of these terms have the same meaning, and are used interchangeably by the medical profession. There are many kinds of convulsions, the one that you described is called grand mal seizure. It is caused by a sudden burst of electrical current that starts from one part of her brain, and spreads throughout the whole brain. Because all activities of the brain depend on small electrical signals from one brain cell to another through nerve fibers; a sudden large burst of current throughout the brain actually stops all normal brain activities. That is the reason why this kind of convulsion leads to loss of consciousness.
When the current passes through the part of the brain that controls the muscles, these brain cells get stimulated, resulting in the uncontrollable jerking movements of all four extremities. At the same time, the whole body gets stiff as a result of muscle contraction. Sometimes a person can lose his bladder or bowel control during a convulsion.
As scary as it looks, very rarely would anyone die from a grand mal convulsion. A person can get hurt from falling against sharp objects during a convulsion. At the height of the convulsion, breathing may become more noisy and frothy saliva can come out of the mouth. It is important to roll her on one side to prevent choking if vomiting happens.
Many people thought that a person can swallow the tongue during a convulsion; the truth is that it can never happen. Therefore, it is important not to pry open her mouth during the convulsion. Trying to do that can damage and dislodge her teeth, which can be inhaled into the lungs.
Most grand mal seizures last only a few minutes, although they appear to be forever. She can remain unconscious for a short time after the jerking movements have stopped. At the beginning, the speech is often slurred and unclear.
Most of the time, there is no obvious reason why a person should have convulsions. Sometimes, previous serious injury to the head or brain infections (meningitis) can lead to scars in the brain, which can be the source of the strong electrical current that starts a convulsion. A brain tumour can also cause convulsions. CT scan is a good test to look for brain tumour or other brain abnormalities. Sometimes additional scans like MRI are necessary if convulsions are hard to control.
Very infrequently, low blood sugar and abnormal electrolytes in the blood can trigger convulsions. A simple blood test would pick up these abnormal findings. In small children, high fever can cause convulsions that are called ‘febrile seizures.’
Another test that is frequently done is called electroencephalogram (EEG) or brain wave test. Wires are connected to different parts of the scalp to record electrical currents from the brain underneath. This can pick up the abnormal burst of electricity that occurs in seizures. Although it is a good test if abnormal currents are detected, it is not always positive in everyone who has convulsions. The reverse is also true: EEG can pick up abnormal brain waves even when a person doesn’t have obvious convulsion at the time.
The difficulty for most parents and doctors is that it is not possible to predict whether convulsion will occur again, and when it will actually happen. As a result, it is not possible to be fully prepared.
With repeated convulsions, many specialists recommend anti-convulsant medications which can reduce the chance of convulsion. There are may anti-convulsants available nowadays, and most of them are very safe for children to use. It is important to remember that convulsions may still occur, and the dose of medicine needs to be adjusted from time to time, especially when a child gains weight.
It is important not to stop your daughter from all physical activities because of her convulsions. However, it is prudent to make sure that responsible adults are always present to give her support if she needs it. Both of you should discuss with her teachers and her coaches in terms of the kind of sports she can safely participate. You may also wish to involve your doctor in this kind of decision. The idea is to allow her to grow and mature in spite of her convulsions. You cannot keep her in a safe little cocoon because this will interfere with her growth and development.