Q. I

Have a 6-year-old cousin who, in the past three...

April 06, 2000|By Dr. Allen J. Douma.

Q. I have a 6-year-old cousin who, in the past three weeks, has had increasing occurrences of seizures, passing out, disorientation, and has actually walked out into traffic. She is not normally absent-minded and the passing out has occurred up to 12 times a day. After these occurrences, she has no memory of the attacks. What might cause such symptoms? She goes in for testing in a few days, but we are all beside ourselves with worry. I understand you are unable to diagnose anything without seeing the patient.

A. You're right, I'd be foolish to attempt to diagnose your cousin's condition from afar, especially without test results. But perhaps I can help by discussing the symptoms you've described.

A seizure is a sudden, transient disturbance of brain function resulting in uncontrollable nervous actions, often accompanied by loss of consciousness. Recurrent seizures are called epilepsy.

Seizures occur most frequently at the extremes of life, incidence is highest in infants and young children and in the elderly. They are caused by anything that can irritate the brain.

Seizures are characterized as either symptomatic (cause is known or suspected) or idiopathic (cause is unknown).

Common causes of seizures include brain abnormalities present at birth, trauma, tumors, lack of oxygen to the brain, fever, infections and adverse reactions to drugs or toxic chemicals.

The key to diagnosis is a detailed medical history. Answers to questions about events occurring just prior to, during and after a seizure episode can be very effective in classifying the seizure disorder.

For example, the fact that your cousin only began having the seizures three weeks ago is very important.

Often, children aren't able to describe these events and adult observers need to add their input. Writing down immediately what was observed provides better information than trying to remember it for days or weeks.

Many tests are recommended for a person with seizures. These may include blood and urine tests and CT and MRI scans. One test is routinely recommended, the electroencephalogram, which measures the electrical activity of the brain.

Syncope (the "e" is pronounced) is the medical term for passing out or fainting. It's usually caused by too little oxygen reaching the brain, which in turn is almost always caused by too little blood getting there. But seizures can also cause loss of consciousness.

Syncope is a very common occurrence. It's usually due to too much blood being shunted to the skin and abdominal organs during times of stress (vasomotor syncope) or not enough getting to the brain when a person stands up too fast.

Syncope can be an indication of a major problem with the heart, which in rare cases may also cause seizures. But the chances are much greater that your cousin's seizures and fainting are related to something irritating the brain directly.

I hope that appropriate tests will be performed and their results, together with a good medical history from people who have observed the behavior, will lead to an accurate diagnosis.

