Neurologist said she doesn't think son is having seizures, but should get EEG anyway

[Anonymous]

Anonymous wrote:Don't mean to derail but am interested in experiences
with absence seizures. My daughter zones out and her pre k teacher has mentioned it it its not usually while walking or eating or anything. I have inattentive ADD and just assumed that's what we are dealing with. Is it worth seeing a neurologist?

Beth

I would talk to your ped. We had a few months of zoning out. One incident scared me so we went to the ER who sent us to neurology. They did an EEG and the neurologist said it was probably the absence seizures but did not recommend the overnight test as they were not severe enough to medicate (but come back in if I was still concerned). We had a few more incidents but nothing major. I'm wondering if it was the Benadryl that I gave him when he had a cold. I wouldn't ignore it. It could be the ADD or something else or nothing. If she is on medication it could be the meds. I'd rather be safe and check it out than ignore but our testing was free through the insurance.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It sounds like overkill to me. Kids zone out.

You're mistaken if you think most kids zone out. Typically, it's those with identified special needs and neurological involvement.

+1, its a different kind of zoning out where the child does not respond and can't respond vs. choosing to ignore you. If you actually saw it, its very scary and very different.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It sounds like overkill to me. Kids zone out.

You're mistaken if you think most kids zone out. Typically, it's those with identified special needs and neurological involvement.

+1, its a different kind of zoning out where the child does not respond and can't respond vs. choosing to ignore you. If you actually saw it, its very scary and very different.

Inattentive adhd = kid who zones out. There is an obvious difference between zoning out and absence seizures that a trained clinician understands, and the hyperventilation test elicits over 90% of absence seizures.

[Anonymous]

Anonymous wrote:

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Anonymous wrote:Just to be clear, it sounds they are suggesting a sleep deprived EEG which is where you wake the kid early, maybe skip a nap, and the child is awake but sleepy during an outpatient test of an hour or so.

This isn't about an overnight E.E.G. That is done inpatient, where the child is monitored in their sleep and during the day for 24 -48 hours.

Yes, everyone has a seizure threshold, but most people's seizure thresholds are a lot higher than functioning on reduced sleep. If they weren't then new parents and frequent travelers would be having seizures left and right.

The fact that the OP's child's behavior changes so dramatically when sleepy that she's afraid of this completely noninvasive test is an indication that she should have this checked out. It will probably be negative, bit given that ADHD meds can increase seizures in kids with low seizure thresholds, and that he's at a critical point in his educational journey, thus particular vulnerable to the disruption that seizures cause, it makes sense to try.

Comparing an EEG to almost drowning someone is absurd. Compare it to a cardiac stress test where someone provides a common level of stress by asking the person to walk on a treadmill.

it's just not standard of care to do an EEG on all ADHD kids who get nuts when they are sleep deprived ... I am not encouraging OP to go against considered medical advise, but instead to have another convo with the neurologist about it. These things can be subjective, and if the dr knows that OP isn't the "do all the tests!" type then she may reconsider her recommendation.

But it is the standard of care to investigate the possibility of absence seizures when a child is reported to have lapses in attention that aren't explained. Given that the neurologist feels that seizures haven't been ruled out, it makes sense to continue to investigate, especially since the test, while annoying is not at all invasive or risky.

My kid had similar lapses and the neuro asked for an eeg that was negative and a sleep study that showed apnea. He was diagnosed with having episodes of microsleep caused by apnea.

But it sounds like she has ruled out absence seizures, due to the clinical picture and the hyperventilation test.

No. They are ruled out after the sleep deprived eeg which is why you do it. I can't believe this is the same forum who usually encourages all kinds of evaluations and recommends that everyone see a dev ped if they have issues. You don't do all that and then for some reason refuse to do a basic test to rule out seizures when they aren't that insanely rare at this age and cause what school has seen.

look, absence seizures have been all but ruled out for OP's child. absence seizures are one of those things that untrained teachers will claim to see whenever a kid is acting spacey. if OP's doctor strongly pushes the EEG that is one thing. but I suspect the neurologist might be fine with watchful waiting for a few months. there is no need to do All The Tests at once.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Just to be clear, it sounds they are suggesting a sleep deprived EEG which is where you wake the kid early, maybe skip a nap, and the child is awake but sleepy during an outpatient test of an hour or so.

This isn't about an overnight E.E.G. That is done inpatient, where the child is monitored in their sleep and during the day for 24 -48 hours.

Yes, everyone has a seizure threshold, but most people's seizure thresholds are a lot higher than functioning on reduced sleep. If they weren't then new parents and frequent travelers would be having seizures left and right.

The fact that the OP's child's behavior changes so dramatically when sleepy that she's afraid of this completely noninvasive test is an indication that she should have this checked out. It will probably be negative, bit given that ADHD meds can increase seizures in kids with low seizure thresholds, and that he's at a critical point in his educational journey, thus particular vulnerable to the disruption that seizures cause, it makes sense to try.

Comparing an EEG to almost drowning someone is absurd. Compare it to a cardiac stress test where someone provides a common level of stress by asking the person to walk on a treadmill.

it's just not standard of care to do an EEG on all ADHD kids who get nuts when they are sleep deprived ... I am not encouraging OP to go against considered medical advise, but instead to have another convo with the neurologist about it. These things can be subjective, and if the dr knows that OP isn't the "do all the tests!" type then she may reconsider her recommendation.

But it is the standard of care to investigate the possibility of absence seizures when a child is reported to have lapses in attention that aren't explained. Given that the neurologist feels that seizures haven't been ruled out, it makes sense to continue to investigate, especially since the test, while annoying is not at all invasive or risky.

My kid had similar lapses and the neuro asked for an eeg that was negative and a sleep study that showed apnea. He was diagnosed with having episodes of microsleep caused by apnea.

But it sounds like she has ruled out absence seizures, due to the clinical picture and the hyperventilation test.

No. They are ruled out after the sleep deprived eeg which is why you do it. I can't believe this is the same forum who usually encourages all kinds of evaluations and recommends that everyone see a dev ped if they have issues. You don't do all that and then for some reason refuse to do a basic test to rule out seizures when they aren't that insanely rare at this age and cause what school has seen.

look, absence seizures have been all but ruled out for OP's child. absence seizures are one of those things that untrained teachers will claim to see whenever a kid is acting spacey. if OP's doctor strongly pushes the EEG that is one thing. but I suspect the neurologist might be fine with watchful waiting for a few months. there is no need to do All The Tests at once.

If they weren't considering medication that lowers the seizure threshold you might be right, but sorting this out before ADHD media makes sense.

And no, I am not a anti meds. My kid takes them. But I am also a special ed teacher who has seen kids have very bad reactions to ADHD meds when used in kids who didn't actually have ADHD.

[Anonymous]

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Anonymous wrote:Also - almost all kids with epilepsy have adhd.

Person with epilepsy here. Have never ever heard this.

^^^ This. I've had epilepsy since I was a toddler and this is the most asinine thing I've ever heard, and Ive heard a lot of dumb stuff.

Given that it's four times higher in the epilepsy population, so around 40%, which is a huge percentage compared to the average population, it's not really the most asinine thing ever, is it? You should get out more.

Did you ever stop to think that it's selection bias? Kids under treatment by a neuro are more
Likely to be looked at for other neuro reasons and to undergo neuropsych testing. Or it could be the meds, not all of which have particularly pleasant side effects and small kids are generally not self aware to notice. I had ADHD-like side effects on Topamax, Keppra, Phenobarbital, and specific combinations of medications.

And your article pointed specifically to febrile seizures, which are not technically epilepsy. Those of use with specific syndromes (genetic) and other types of epilepsy don't count in that category.

Finally, I somehow doubt my 41 years with epilepsy and treatment at multiple research facilities (for near complete seizure control), places me in the category of needing to get out more.

You are being obsessive about this issue and you are flatly wrong. There are literally thousands of studies on the issue, but these guidelines make it clear. Look, I am glad it is not the case for you, but 4 out of 5 kids with epilpesy have another issue. That is 80%. Do some research and talk to a modern, real time pediatric neuro. I just did at Childrens, Georgetown, and John Hopkins. I do not doubt that you have epilepsy and you are an expert on your epilepsy but you're not neurologist.


https://my.clevelandclinic.org/ccf/media/Files/Neurological-Institute/pediatric-epilepsy-and-adhd-fact-sheet.pdf?la=en

https://consumer.healthday.com/cognitive-health-information-26/epilepsy-news-235/80-percent-of-children-with-epilepsy-have-another-health-problem-713377.html

[Anonymous]

Op again- thank you for all the opinions. In my child's notebook yesterday (they send home a notebook with notes on his day) his teacher said that he zoned out and when they were calling his name he did not respond for until the third or fourth time.
Now I have seen him do this before but usually when he's playing something or eating and just seems like he is ignoring me or so engrossed in what he is doing (hyper focused) he filters it out. There have been a few other times in the past I had to physically touch him to get him to respond. but these examples are all part of what I told the neurologist already.

[Anonymous]

Get the sleep deprived EEG. Then you will have important information as to what you are dealing with.

I had a sixth grade math teacher--who was on my DD's case constantly--tell me that my DD was spacing out wouldn't go back to the right problem on the page when called upon and all the kids were noticing it. I took this with a grain of salt because it was clear she wanted to kick her out of her math class and put in the alternative (lower level) class.

But I took this to heart and got her vision tested, a neuropsych test done etc, etc and no problems. Two years later after two unexplained episodes of losing consciousness, she had an overnight EEG. I was expecting absolutely nothing--was just covering bases--and she had a temporal lobe seizure during the EEG.

[Anonymous]

Anonymous wrote:Op again- thank you for all the opinions. In my child's notebook yesterday (they send home a notebook with notes on his day) his teacher said that he zoned out and when they were calling his name he did not respond for until the third or fourth time.
Now I have seen him do this before but usually when he's playing something or eating and just seems like he is ignoring me or so engrossed in what he is doing (hyper focused) he filters it out. There have been a few other times in the past I had to physically touch him to get him to respond. but these examples are all part of what I told the neurologist already.

It sounds as though it's probably hyperfocus, but probably isn't good enough for this. You need to be 100% sure before trying the medication.