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A. Molina García, C. García Mauriño
Residentes hospital infantil universitario La Paz
6. Role play: Seizures
Father: Doctor, I came to the health center because my daughter has suddenly lost consciousness today when she was playing at home a few minutes ago.
Doctor: Did she make any type of body movements when she was unconscious? Was there anyone there who can describe the incident?
Father: Her older brother was there, and he told me she was standing up and abruptly fell to the floor. She started shaking her legs and arms uncontrollably, until it gradually stopped. She bit her tongue and a lot of saliva was coming out of her mouth. I shook her to see if she had recovered consciousness when it all stopped, and she looked me in the eye, but she just wanted to sleep.
Doctor: Tell me, how old is she? How was she feeling before this took place? Was she acting strangely? Was she able to talk properly? Was she doing unusual movements with her face?
Father: She has just turned 4. Her brother says she was playing and talking normally, just said she had a headache this morning. She started vomiting last week and started spiking fever yesterday, but she seemed OK, so we thought we could keep her at home and wait until she got better.
Doctor: How long would you say the whole episode lasted? Was your child having a fever when it happened? Besides the vomiting, did she have diarrhea, or cold symptoms or any concerns while urinating? Any head trauma?
Father: Well, I can’t actually say because I wasn’t there, but it took me about one minute to reach the room they were in, so I think, probably no longer than 3 minutes. Her brother was with diarrhea last week but she wasn´t. A few minutes before this happened I had to give antipyretics because I found her flushed, and the thermometer read 38.2ºC. She urinates fine. No cough or head traumas that I can recall.
Doctor: What your daughter has had is called a seizure, probably associated with the fever. A febrile seizure is a convulsion that is caused by a sudden rise of body temperature, normally related to infections. Your child having a febrile seizure can be alarming, and the few minutes it lasts, can seem hours. Fortunately, they’re usually harmless and generally don’t associate any subjacent neurological disorder. However, it’s true that they can recur and the probability of this happening rises up to 50% if a second febrile seizure occurs. These children have no higher risk of developing epilepsy. If the episode just lasts a few minutes, it will not affect your child´s neurodevelopmental outcome or diminish her IQ.
Her physical examination is normal, including the neurological, although its true she is still a bit sleepy. So what we are going to do, is verify her blood glucose levels, and leave her in the observation room for a few hours until she is totally recovered.
KEY WORDS:
Consciousness: conciencia.
Headache: cefalea.
Head trauma: traumatismo craneal.
Antipyretic: antitérmico.
Febrile seizure: crisis febril.
Neurodevelopmental outcome: desarrollo neurológico.
Diminish her IQ: empeorar su cociente intelectual.
Subjacent neurological disorder: alteración neurológica subyacente.
Sleepy: somnolienta.
