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February 13, 2011
The child who has a first seizure with a fever does not necessarily need special x-rays or brain scans.
Fever lowers the brain’s threshold for seizures and thus may provoke them. Indeed, as noted earlier, a seizure can be induced in anyone if the temperature is sufficiently high. Young children have a lower seizure threshold anyway, and thus are more susceptible to a seizure when a rapidly rising fever further lowers this already low threshold. This is the reason why such seizures tend to occur in young children. The threshold gradually increases over the first years of life as the brain becomes more mature, which is why these infants and young children outgrow the tendency to febrile seizures as they grow older. Febrile seizures are very uncommon after age five or six.
Susceptibility to febrile seizures appears to have a genetic base. Such seizures tend to occur in certain families.
These three factors—the lower threshold of the infant (ages three months to two or three years), the height and rapidity of rise of the fever, and the genetic threshold—all three in combination may lower the seizure threshold sufficiently to cause a seizure. A higher fever or more rapid rise in fever in an infant without a family history of seizures may be enough to trigger a seizure; a lower fever in an infant with such a family history may be enough. In an older child, whose threshold is higher, a high fever may be sufficient with a family history of febrile or afebrile (nonfebrile) seizures, but insufficient to trigger a seizure without a family history of seizures.
The first seizure with fever can be terrifying to a parent. Occasionally the seizure may be mild and brief (no more than slight slumping and loss of consciousness, or a rolling of the eyes back in the head), but often there is stiffening, a jerking, and loss of consciousness. Nine out of ten febrile seizures last only a few minutes, usually fewer than ten, but even they seem to last a lifetime to parents who have never seen a seizure before and who believe that their child is choking, or swallowing his tongue, or even dying.
April 28, 2009
The EEG is a ‘functional’ investigation, recording the brain’s function through normal and abnormal electrical activity. Imaging procedures or brain scans provide information about the brain’s structure, and revealing normal and abnormal anatomy. Most, if not all patients who have epilepsy need to have at least one EEG, fewer than perhaps 1 in 5 or 1 in 6 patients need to have an imaging investigation. Research is underway to determine who should be scanned.
Two types of imaging techniques are currently available in the developed world; these are the computerized tomographic (CT) brain scan and magnetic resonance imaging (MRI).
The CT scan-This is an abbreviation the computerized axial tomography (CAT) scan. The technique was developed in the 1970s and is a type of X-ray investigation. Tomography is a word dating from earlier X-ray techniques. The patient lies still on a table whilst a rotating X-ray machine takes two-dimensional pictures of the head from many different angles or positions. The information is then processed by a computer to produce pictures (or images) at different levels of the brain. The test is safe, and other than keeping the head still, there are no particular precautions to be taken. Children may have to be given a sedative drug or short anaesthetic so that they can keep still for the scan. The test takes approximately 15-20 minutes. If an area of interest is seen on the initial images, some contrast (special dye) is injected into a vein in the hand or arm and then the scan repeated. The dye may enhance contrast in areas of interest and give more detailed information. CT scanning has proved to be very useful in detecting structural abnormalities within the brain, such as strokes, infections, tumours, and congenital malformations which may cause epilepsy. However, only 20-25 per cent of patients with epilepsy referred to special centres will have an abnormal CT scan. Abnormalities on the CT scan in patients who have epilepsy are more likely to be found in the following situations:
• patients whose seizures affect only one side of the body;
• when epilepsy starts in newborn babies and continues;
• when epilepsy starts in later life; and
• if the patient has abnormal findings on neurological examination, for example, mild weakness down one side of the body, or changes in the reflexes.