4 year old EEG Abnormal

Bethereen

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I can hardly type this. My son is 4 and has had 2 seizure spells (we thought he just fainted) in the past 6 months. The first one we called 911, went to ER, etc. They said everyone gets a free pass on their first seizure. Ok, made sense. Fast forward to a few weeks back he had another one. This time we went to his doctor. She sent us for an EEG, which came back abnormal. Here is what it says. Abnormal EEG in wake and drowsiness due to the presence of focal, intermittent spikes or sharp waves, maximal in the left temporal derivations.

My freak out concern is here where it says "a structural abnormality cannot be ruled out on EEG". Is this normal? or does that mean that his spikes were not like someone with epilepsy and they believe it could be a growth or tumor?

I want to be honest and say that I don't trust doctors to tell you how they feel really. I mean, she said that because he does not have any other symptoms that she does not think it is a tumor, but I read where left temporal lobes develop them and most of the time they only show up bc of a seizure.

I know I have to wait 2 weeks for apt with specialist and MRI but just talking and asking helps.
 

Zolt

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Hey Bethereen,

Welcome to CWE. What a horrible thing you are going through. Not sure where you live, but can't you have them schedule an MRI before the appointment with specialist? That wait can be forever. The sooner they rule out the brain tumor the better, i think. A CT scan can also rule out a brain tumor.

Basically they don't know what the problem is and are just letting you know that the eeg cannot find brain tumors, so therefor more tests are needed. Hopefully it's not a tumor!!

I had a brain tumor the size of a baseball 9 yrs ago and luckily it was not cancerous. After being taken out, all seems to be well, except i have epilepsy now. Small price to pay for not being 6 ft under ground.

They found my brain tumor after a grand mal seizure that I also thought was a faint spell. Not sure why they did not do a CT scan in the ER for your child, that's how they found mine and I went in complaining of a faint spell.

Good luck with this and let us know how it goes.

Cheers

:piano: :pop:
 

Kgartner

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First of all {{{hugs}}}. As the parent of a child with epilepsy I have a lot of compassion for what you are going through. It is very tough to see your child have seizures and to hear the words "epilepsy" and "structural abnormalities" etc.

EEGs measure brainwave activity, and "abnormal spikes and waves" are an EEG marker for epileptic activity when someone is not actually having a seizure during the test. And Zolt is correct - I believe that all they are saying is that an EEG cannot say what (possible) structural issue may be causing the seizures. That's just not what an EEG measures. Hopefully you already have an MRI scheduled - that's generally the next step.

A "structural abnormality" does not necessarily mean a tumor. In fact, it is fairly unusual for the first sign of a brain tumor to be seizures - generally there are a lot of other signs that come first. Since his EEG seems to localize his epileptic activity to the left temporal lobe, they are more likely looking for are "lesions" or areas of abnormal neurons that represent the place where his seizures started. Temporal lobe epilepsy is the most common form of focal epilepsy and in a lot of cases they can actually see the area of the brain that is damaged.

It is also possible that his MRI will be completely normal - my daughter has left temporal lobe epilepsy and a completely unremarkable MRI. That often means easier to treat epilepsy, so would be very good news!

I really wish that doctors would take the time to slowly walk us through all of this! Good luck and keep us posted! This is a great place to come for answers and support.
 

Bethereen

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The day he first fainted we had been at the dentist all morning and had not ate. The dr said at the er that it was probably from not eating and not to expose him to a ct scan. Now looking back I wish I would have pushed it....

Was ur daughters eeg abnormal? I have a note in to the dr to call me monday. She wants us to go to Scottish rite in Atlanta for the sedated mri but the soonest they can get us in is September. I know our hospital does them as well. Maybe she will get us in there quicker. We have an appt aug. 13th at the panda neuro clinic.
 

Kgartner

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The EEG that they gave her the day after her first seizures (which were 3 tonic-clonic seizures in the space of one afternoon) was normal, but it was very short - only 30 or 40 minutes. Since then she has had 2 overnight video EEGs. In the first one they didn't capture any seizures, but they did see epileptic spikes. During the second video EEG (which was phase 1 of a brain surgery evaluation) they reduced her meds because her doctors needed to see some seizures; during that test she had 4 big seizures, and they also saw epileptic activity between seizure events. So she has had both normal and abnormal EEGs, which is pretty typical for many people with epilepsy.

Since your son is so young he will need sedation for the MRI, which probably makes it a bit more complicated. I was also surprised that they didn't give him a CT scan since I think that is pretty standard but your explanation makes sense. If you're going to need to wait more than a few weeks for the MRI you may want to request a CT scan just to put your mind at ease. But I do think you can trust your doctors when they tell you that it is very unlikely that the seizures are the result of a brain tumor.
 

Kgartner

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If you need a quick "snapshot" of the brain to see major issues like a stroke or tumor, a CT scan is great. But a high-resolution MRI gives you MUCH more detail about smaller and more subtle abnormalities and lesions. In most cases, a CT will not tell you much about why someone is having seizures, but it could rule out some of the most serious possibilities.

From a diagnostic point of view, however, if you already have an MRI scheduled, you probably don't need a CT scan. Also they may want you to wait for the MRI at Scottish rite because it is a higher resolution scanner, or because their radiologists are better trained for epilepsy scans. Many hospitals use 1.5 T MRIs which are great for knee scans etc., however may not be sensitive enough to see subtle brain lesions. I know my daughter's MRIs were on a 3T scanner which gives much better pictures of the brain. Since your son will need to be sedated, you will not want to have to repeat the scan!

However, I'm just guessing and these would be good things to ask your son's doctor about!

Try to relax! Doctors don't mess around when they suspect a brain tumor, so if they are saying that's very unlikely in your son's case, I'm sure that they are not hiding something from you.
 

AlohaBird

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It would be nice if the docs slowed down long enough to really explain things wouldn't it?

Yes, CT an MRI scans are both structural. An EEG is functional. It's telling you what the brain is *doing* as opposed to how it looks. So, it's not that it did or didn't detect any structural anomaly, it's just that that is not what it is meant to do.

CTs used to be the only scan available but MRIs are much more detailed.
They are looking for structural problems first as those are the easiest to "cross off the list". They are looking for not only tumors but also scar tissue from any childhood bump on the head and also blood vessel abnormalities.

Most of us will never know exactly why we have seizures. This is what the docs call "idiopathic" epilepsy. Fancy medical term for, "we don't have a clue". :)

This is basically a process of elimination, telling you what your son *doesn't* have first. It is frustrating but hang in there.
 

Emerald

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My EEG said the same thing, but after I had the MRI done, it was determined that I had a couple cells misaligned which is causing my epilepsy. Hope your son is doing better! Keep in mind that he is a kid, so let him ride his bike if he wants, etc. just be there with him in case there's a problem. Most importantly, find things to be happy about! For example you can be glad that he isn't physically handicapped, you can be glad that there are treatment options for epilepsy, etc. wishing you and your son the best bethereen!
 

Bethereen

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Thanks for all the posts and messages. It makes a huge difference having others to talk to. We just got back from the Atlanta visit, MRI was normal. They want to put him on Keppra 2 times per day.

MY question is...why? Is 2 seizures per year enough to be medicated for? Does this med fix his brain or just stop the seizures? I would rather him have 2 seizures or so than be medicated if possible. Is that horrible of me? My husband does not agree...:(

They said if he does not take the meds he could have developmental delays? I did not see anything mentioning that when googling. Anyone have an insight on not taking meds? Maybe herbs or a diet change??? What would you all do?
 

Emerald

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If you didn't want to try meds, you could talk to your doctor about trying the modified Atkins diet or the ketogenic diet. And yes, epilepsy can cause brain damage if the seizures are severe enough and uncontrolled. The goal of medication is to essentially retrain the brain and stop it from having seizures. What I would do is give the keppra some time. If you don't like the side effects or it doesn't work, then consult your neuro, but I would try a diet. The modified Atkins is easier than the ketogenic diet, but the ketogenic diet is mostly used for younger kids like your son. There is a great book called the ketogenic diet that was done by John Hopkins hospital. You can get it on amazon. It's very informative and helpful. I did the modified Atkins and it seemed to help me some. Best of luck!
 

AlohaBird

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Also do a google on the side effects of Keppra. I don't take it myself, but what I hear around here is that there is a well known phenomena called "kepprage" which is flying off the handle about nothing and hurting those closest to you. Anything that fundamentally "messes with" a person's personality, who you are, has got to be, IMO, some pretty heavy duty chemical intervention.

Since your child is so young, the ketogenic protocol has a very good chance of resolving the seizures completely. The ketogenic diet is actually statistically more effective in children than any medication out there. This is not some hair brained theory pulled off a blog somewhere. This is decades of research by Johns Hopkins.

Nobody but you can make decisions like this but you can't make the decisions if you don't have information for all the options.

I would suggest you look up the movie (starring Meryl Streep) called "First Do No Harm". It's on youtube for free I believe.
 

resaebiunne

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They want to put him on Keppra 2 times per day.

MY question is...why? Is 2 seizures per year enough to be medicated for? Does this med fix his brain or just stop the seizures? I would rather him have 2 seizures or so than be medicated if possible. Is that horrible of me? My husband does not agree...:(
He had an abnormal EEG, that is why. He has seizure like activity in his brain and that means that the risk is high that he will have another seizure based on the EEG results. You say he has 2 seizures per year, but I would like to point out he's had two seizures so far this year. With each seizure you have, you are statistically more likely to have another.

Taking medication for seizures will never cure the problem that is causing the seizures. Epilepsy medications "treat the symptoms" (like most drugs do) and not the cause of the problem. This doesn't mean that the seizures can't go away on their own.

AlohaBird said:
Also do a google on the side effects of Keppra. I don't take it myself, but what I hear around here is that there is a well known phenomena called "kepprage"
Please don't let this comment scare you. All medications have side effects and it is well known that anticonvulsants have some of the worst of the side effects. That said, I have been on Keppra for about 5 weeks now and I can't say I've experienced any side effects from this medication. Side effects vary and it depends on the individual as to what you will experience, if anything. Keppra is not a bad medication to be on, as far as I am concerned. It's also worth pointing out that many of the members on this site seem to have had some of the worst experiences with anticonvulsants or are very picky about the medications that they take. You have to weigh the benefits of being on medication with the disadvantages. Is it worth it to have fewer seizures at the cost of the side effects? It may very well be, depending on the seizure.

In my opinion, it is best to let your son make the decision about whether he'd like to be on medication to try to control his seizures. Ultimately it is him who has to take the medication, not anyone else.
 

Kgartner

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In my opinion, it is best to let your son make the decision about whether he'd like to be on medication to try to control his seizures. Ultimately it is him who has to take the medication, not anyone else.
I agree with everything that you have said in your post - but I think you may have missed that her son is 4 years old! Obviously he is not able to make this type of decision for himself - and honestly, even with much older children (my daughter was 15 when she had her first seizures) we can't necessarily just leave it up to them. They don't always have a clear enough idea of risks vs. benefits. My daughter is 17 now and has dealt with epilepsy for two years so she has a LOT of input into her own health decisions - but if she told me that she just didn't want to take her meds any more that would not fly!

He had an abnormal EEG, that is why. He has seizure like activity in his brain and that means that the risk is high that he will have another seizure based on the EEG results. You say he has 2 seizures per year, but I would like to point out he's had two seizures so far this year. With each seizure you have, you are statistically more likely to have another.
This is really well said and puts the situation in a nutshell.
 
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Emerald

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I'm 15 and I've pretty much given my parents the go ahead to make the choice they feel is best. My memory and mental clarity was really bad for a while, and I recognized that and the fact I most likely would not make good choices regarding my health. Which is when I handed it over. I have a say in what happens, but my parents see everything that I experience, and have a good feel for what it's like. In regard to your son Beth, it's up to you and your husband to make the choices for him. Listen to him, and act on it if he has a valid concern. When push comes to shove, you might think you know what it's like for him, but trust me, as a kid trying to explain to parents, you really have no clue what it's like. I'm not being mean, but unless you've experienced it too, you only know what you see. Best wishes!
 

AlohaBird

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Please people. Lets not get into a polarizing debate pro vs anti medication.

First of all it doesn't have to be one or the other, meds or ketogenic diets. What is wrong with both? Many people use meds to stabilize the situation in the short term while they work on turning things around by diet and then taper off the meds.

The OP might want to look up the story of the poster here on CWE named KarenB. She has a wonderful son named Jonathan who is now several years seizure free and also med free.

I was trying to correct the fact that the OP was being told about meds and the dire consequences of not taking them but not given any info on real, viable, proven alternative treatments.

Ketogenic diets don't always work. Meds don't always work. Why not try them both and improve your chances?
 

Kgartner

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Please people. Lets not get into a polarizing debate pro vs anti medication.
Is that's what's happening here??? I didn't read that into any of these posts at all. I don't think anyone was arguing against considering the ketogenic diet.

Ketogenic diets don't always work. Meds don't always work. Why not try them both and improve your chances?
I totally agree that both are excellent options! And it is up the the family what approach they want to take, and extremely useful to know all the different options that are out there. What I was hearing in the OP's question was whether "two seizures a year" is serious enough to strongly consider treating with medication - and I think that we would all agree that the answer to that is "yes." If ultimately they choose another treatment option (or even choose not to treat at all) that is up to them.
 

AlohaBird

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We're saying the same thing.

I just don't like being accused of trying to "scare" people by giving them additional information. Kepprage is real and should be a factor in their decision. No, it doesn't happen to everyone who takes it but it is a big enough phenomenon to have its own name. And they should be aware that this is a serious medication. They should also be aware that it is not the only medication that could be tried.

Yes, this condition is serious enough to *consider* treating with medication.
Other options are worthy of consideration too. They can't do that however with zero info coming from their MD about anything other than "take the pills".

resaebiunne said this, "Taking medication for seizures will never cure the problem that is causing the seizures. Epilepsy medications "treat the symptoms" (like most drugs do) and not the cause of the problem."
And I think this is the key. The dietary treatments can actually cure the problem. Especially in children.
 

Bethereen

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Thanks for all the posts. I understand what you all are trying to say. I know seizures are serious and nobody wants to have any. However, my son is just 4 and his "seizure" is like a faint that lasts only 5 seconds or so. Then he acts completely normal the remainder of the day. I know i might sound like i am trying to ignore it all together, but I do just want to know everything that is out there before I make a decision.

I could see meds if he were having them more often or even if he was out for a while, shaking, or jerking. But he isn't. He stays at home with my mother in law and does not go to school till next year even. Am I trying to avoid what is happening? I don't know...maybe I am and I need to reevaluate my thoughts...

I just don't want my son on a med, that causes or can cause crazy side effects, if it might/might not happen. Is it bad of me to wait and see what the future holds? I don't want anything to damage his brain either, meaning seizures. I love my baby and if meds will fix him, I am willing to try. I just want to make sure that the meds will not do more than stop the seizures, because I can live with those over meds and side effects right now. Now if it gets worse, of course I will consider it. But right now, at least we know his MRI was normal, he has a normal brain and contract did not show any abnormalities. He is a perfect 4 year old in every way but these 2 spells...

I also think people generalize seizures. I even have a picture of what I think happens in my head. The doctor said her primary concern was to protect him from getting hurt. But if he feels them come on and can stop and tell me, I can help him lay down and that will help. I think people hear seizure and they think they are horrible. But, his were not that bad in my opinion. Now I don't know what is going on in his brain at the time and maybe I am not seeing the big picture.

Finally, if the meds do not fix the brain and only stop the seizures, possibly, and he is only having these 2 5 sec spells, and I know he could have more but...is it best to medicate? Do I have a choice? I totally get it if he was 17 and driving...
 

Bethereen

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one more thing...resaebiunne said this, "Taking medication for seizures will never cure the problem that is causing the seizures. Epilepsy medications "treat the symptoms" (like most drugs do) and not the cause of the problem."

So, if we say he does not have another seizure until 6 more months, am I risking brain damage because he is not taking daily meds? I guess that is my main question now. Will not taking meds cause you to have brain damage or to get worse in anyway?
 
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