Neurologist

The first thing everyone wants to know is how did Zachary's EEG turn out? Normal. Perfectly, absolutely, beautifully, normal. We got a copy of the report, and the doctor said we can get a CD of his whole EEG, so I'll be looking into that.

The next item of interest is what did the doctor say? He says that it wasn't a seizure. When Zachary shook, he trembled all over, whereas a seizure will produce more jerky motions. I tried asking if postictal symptoms often follow a breath holding spell, and he had me describe Zachary's behavior after the event over and over, but he never really answered my question. He kept talking about an experiment that was performed by a group of German students where they induced themselves to lose consciousness (faint) and it was shown that losing consciousness can cause a person to twitch and shake. Something about syncope. I was a little irritated at the doctor because he was rather dismissive in his behavior. Curtis says he was trying to be reassuring. I also told him about the possible connection between the hemangioma on Zachary's chest, lipomas (which my dad has) and seizures. He looked Zachary all over (looking for other discolorations) and determined that Zachary absolutely does not have whatever that condition is. Then Dr. Reyes examined Zachary, checked his reflexes, checked his muscle tone, looked in his eyes, and asked about my pregnancy and Zachary's development. Everything was normal. When he went to check Zachary's reflexes, he tapped his right knee with the rubber thingy and Zachary's leg kicked (like it's supposed to). When Dr. Reyes tapped the other knee, his leg didn't kick. My first reaction was, "How weird! Zachary doesn't have a reflex in his left knee!" But then the doctor tapped the right knee again and the leg didn't kick and we all laughed that Zachary was purposely holding his legs still. Silly boy! Throughout the whole exam Zachary sat very cooperatively on Curtis' lap and watched everything the doctor did. He didn't even try to grab the instruments. Most of the things the doctor did Zachary thought were funny, he was smiling almost the whole time. The doctor kept commenting how social he is, how happy he is, etc.

After the exam, the doctor reaffirmed what he had said before: it wasn't a seizure. He explained that a child that is perfectly normal in every other aspect has no reason to have a seizure. Children with seizures usually have symptoms in other areas (their development, primarily). Then he brought in the doctor we thought we were going to see, Dr. Garza. I had to go through the whole explanation again (some parts of it more than once), and Dr. Garza agreed with Dr. Reyes that it was a breath holding spell, not a seizure. He told us the story of the German students too. I still felt like they were dismissing Zachary's behavior after the event. I tried explaning it better, and Curtis tried to help, but the doctors never explained whether Zachary had really experienced postictal symptoms or not and whether postictal symptoms can follow a breath holding spell. I asked if seizures can be caused by a combination of factors and I explained that Zachary's blood sugar and sodium had been low. I can't actually remember how the doctor answered, but it wasn't very satisfactory. Something about how all seizures are caused by a combination of factors, and then the same thing that the ER doctor has said about how the glucose and sodium levels weren't low enough. I get so frustrated! These people don't listen and they don't try to understand what was going on. At the time of the event, we don't know what Zachary's glucose and sodium levels were. It is entirely possible that, in combination, they were low enough to cause a seizure. When the ambulance personnel tested Zachary's blood sugar on the way to the hospital, he said it was low, but not outside the range of normal. This makes sense, as Curtis explained, because the body is able to bring glucose levels up in an emergency. Finally, when Zachary's blood was taken at the hospital, he had eaten some cheerios, thus skewing the results. But all the doctors look at is the results, and they say, "Nope, levels aren't low enough, that couldn't have caused it."

So I looked up "breath holding spell" on the internet. The following paragraphs are taken from different webpages.

Breath-holding spells are brief periods when young children stop breathing for up to 1 minute. These spells often cause a child to pass out (lose consciousness). Breath-holding spells usually occur when a young child is angry, frustrated, in pain, or afraid.

Breath-holding spells are categorized as either cyanotic or pallid.

• Cyanotic breath-holding spells, the most common type, usually occur in response to anger or frustration. A child's skin typically turns red or blue-purple.
• Pallid breath-holding spells produce a pale appearance to a child's skin. These spells usually occur in response to fear, pain, or injury, especially after an unexpected blow to the head.

The pallid form typically follows a painful experience, such as falling and banging the head or being suddenly startled. The brain sends out a signal (via the vagus nerve) that severely slows the heart rate, producing loss of consciousness. Thus, in this form, the loss of consciousness and stoppage of breathing (which are both temporary) result from a nerve response to being startled that leads to slowing of the heart.

The child stops breathing, rapidly loses consciousness, and becomes pale and limp. A seizure may occur. The heart typically beats very slowly during an attack. After the attack, the heart speeds up again, breathing restarts, and consciousness returns without any treatment. Because this type is rare, if the attacks occur often, further diagnostic evaluation and treatment may be needed.

http://www.drgreene.com/21_557.html
http://www.webmd.com/parenting/tc/breath-holding-spells-topic-overview
http://www.merck.com/mmhe/sec23/ch269/ch269g.html
Also, Wikipedia: http://en.wikipedia.org/wiki/Breath-holding_spells - this article lists four, rather than two types, and considers one followed by seizure activity to be a "Complicated" one.

So, Zachary didn't turn blue or purple, and his experience followed a painful event (bumping his mouth on the deck). Also, his blood pressure was really, really low in the ambulance. So, if he experienced a breath holding spell, I think it would be the pallid form. And, oh look! A seizure may occur. Wait, but I thought the doctor said it wasn't a seizure. He made it sound like if a child experiences a breath holding spell, it's not a seizure. Now I'm thoroughly confused. Was it, or was it not a seizure? Is Zachary now at a higher risk for experiencing another seizure? Or are breath-holding-spell-induced seizures not that same as other seizures? A neurologist should be able to answer these questions! I think part of the problem is that most of the seizure patients that neurologists see are suffering from epilepsy, or some other seizure condition. So when a patient comes in with no seizure condition, they're hesitant to say it was a seizure. There's no wiggle room. I realize as I'm writing this that it may sound like I want it to have been a seizure. This is not at all the case! I want to know what happened, what made Zachary shake, what caused it, and how to prevent it. Or at least know how to predict it. Ugh. Anyway.

The good news is that Zachary is perfectly normal, all the way to his brain waves (of course, we already knew that :) ). Whether he experienced a seizure is in doubt, but whatever it was is not due to a condition, and he's extremely unlikely to have an experience like that again. Thanks for reading my "book", and please feel free to leave comments - I'd love to know what you think! (And that goes for all my posts, by the way.)