“Help! Doctor! Somebody help me!”
I ran out of my office toward the sound of the woman’s panicked voice. She was in the hallway outside one of my examination rooms, holding a 1-year-old child in her arms. The child’s body was stiff, her head tilted back, her arms and legs moving rhythmically. Her eyes were open, but she was not looking at her mother or at anyone else. She was having a generalized seizure.
Few things are as terrifying as a child having a seizure. Even though I’ve seen many seizing infants and children during my more than 25 years as a pediatrician, I have never gotten used to it.
The very word seizure hints at something suddenly taking hold of a person and changing his or her nature. The Hmong people of the highlands of Laos describe a seizure as qaug dab peg—a phrase that translates as “the spirit catches you and you fall down.” (The translation is the title of Anne Fadiman’s fascinating 1997 book about cultural differences in medical care.) The expression represents a belief in many cultures that the something taking hold of a person having a seizure is spiritual or divine.
Divine intervention was the furthest thing from my mind as I lifted the child out of her mother’s arms and headed for the treatment room. I needed to have her in a safe place, with access to oxygen and other therapies, and then assess what was happening and decide what to do about it. I saw that she was still stiff and unresponsive and that her arms and legs were still making rhythmic movements, but thankfully she was breathing and her lips were pink. I had some time.
A seizure is a symptom of something going on in the brain. Any of us could potentially have one, if our brain happened to be subjected to a strong enough precipitating stimulus, such as trauma, infection, or a sudden drop in blood sugar. With any of these stimuli, the complex and finely coordinated electrical activity of the brain’s cortex suddenly degenerates into a storm, a widespread, rhythmic, but purposeless pattern of electrical activity.
Imagine for a moment a huge auditorium filled with people carrying on hundreds of individual quiet conversations. Now imagine that, at the same split second, all those people suddenly begin shouting out a single meaningless sound in unison, over and over again, as if led by some maniacal cheerleader. That’s something like what happens in the brain during a seizure.
I reached the treatment room and placed the child on the examining table. One of the nurses attached the leads of a cardiorespiratory monitor, noting that the girl felt quite warm. “Let’s check her temperature and oxygen saturation,” I said to the nurse, “and bring the oxygen over in case we need it.”
“Do you think you’re going to admit her?” the nurse asked me.
“Not necessarily,” I said. If the child did have a fever and her seizure stopped within 15 minutes, and if her subsequent exam proved normal, this might be just a simple febrile seizure. Common in children between about 6 months and 5 years of age, such seizures carry an excellent prognosis, requiring neither hospitalization nor medication.
“Let’s get an IV started just in case, and draw up some Ativan.”
If the seizure persisted, I wanted to have medication ready. At this point, however, I would simply watch and wait, hoping that, like most seizures in children, this one would stop fairly quickly.
But I noticed something worrisome: The child’s eyes were not staring straight ahead but were deviated to the right. This was a subtle but significant clue, and I filed it in my mind as I continued the assessment.
I turned to the child’s mother, who stood, pale and shaky, nearby.
“Has she ever had anything like this before?” I asked her.