Blog #39: Mimics of Nonconvulsive Epileptic Seizures in the Classroom

(This blog was originally posted on October 25 2013)

 

 

     A woman recently wrote a comment on Amazon.com concerning my epilepsy novel, DINGS. Her teenage grandson was newly diagnosed with epilepsy. Prior to that, he was thought to suffer a “learning disorder.” If she had read the novel earlier she would have considered nonconvulsive epilepsy as it affected the protagonist in DINGS. She suspected that her grandson’s true diagnosis could have been made much sooner.

     Parents, teachers, school nurses, psychologists, pediatricians and anyone who works with children commonly observe youngsters who are in the midst of an epileptic seizure that is not associated with convulsive jerking, tongue biting and loss of urine or bowel control. These can be difficult to recognize. These very common nonconvulsive seizures—temporal lobe or psychomotor seizures, and absence or petit mal seizures—are characterized by the child just staring, or stopping to walk, or smacking lips with swallowing movements. They have lost contact with their surroundings and do not respond when spoken to. They will have a blank and confused expression that can last 10-20 seconds up to several minutes.

     I know of people who had petit mal seizure blank outs lasting 5-15 seconds up to 30 or 40 times/day for years during childhood and their teens who assumed these frequent blank outs were normal. One said to me, “Doesn’t everybody have them?”

     The following symptoms for which absence and complex partial seizures are commonly mistaken include:

 

• Stuttering: some children will utter the same sound repetitively without responding when spoken to. They will have no recollection of what happened during that time.
• Hearing problem: since the child doesn’t respond or answer when addressed, people unfamiliar with nonconvulsive epilepsy might assume some hearing difficulty.
• Daydreaming: the child will appear to absently look off and not respond when addressed. Individuals are aware of their thoughts during true daydreaming. However, the mind is blank during a nonconvulsive seizure.
• Learning disorder: children who experience frequent unrecognized blank outs will fall behind in their class work. It is common for the child not to understand his confusing blank out experience and will not complain of it.

• Attention Deficit disorder (ADD): the child’s transient lack of attention due to a nonconvulsive seizure can be confused with ADD.

 

     Now that you know which behaviors can mimic the nonconvulsive forms of epilepsy, it is worth investigating. This common elusive form of the condition could be the cause of the child’s lack of classroom success.

 

 

 

 

 Lance Fogan, M.D., is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel