Medical Weblog

(PETIT MAL SEIZURES)

Although a translation of petit mal is the ‘little illness’, petit mal does not mean the same as ‘minor epilepsy’ as there are all sorts of small attacks which are not attacks of petit mal. True petit mal seizures, or typical absences are, by definition, associated with a characteristic EEG discharge. Short-lived partial seizures arising from a focus of abnormal nerve cells in one temporal lobe of the brain may be somewhat similar on clinical grounds, but the distinction is worth making because of the difference in cause, treatment, and outcome between the two.

Absence epilepsy is virtually invariably a disorder of childhood. A typical attack is very brief, lasting only a few seconds. The onset and termination are abrupt. The child will suddenly cease what she is doing, stare, look a little pale, perhaps flutter her eyelids, and drop her head slightly forwards. Posture of the limbs and trunk is usually maintained so she does not fall. After the seizure, the child resumes what she has been doing. Because the interruption of the normal stream of consciousness is so brief, attacks may be unobserved by parents, and not remarked upon by the affected children. One of us has seen a typical attack in a supermarket. A girl aged about nine was helping her mother unload a wire basket at the checkout. She suddenly paused, with a pot of honey held in the air between basket and counter, fluttered her eyelids, and then continued transferring the purchase without further pause.

Whereas one would be unfortunate to have more then one grand mal seizure in a day, absence seizures may be very frequent—10 to 50 seizures a day being occasionally encountered. Fortunately most children have far fewer attacks.

Absence seizures are often associated with myoclonic jerks, which are particularly frequent soon after waking. These are brief shock-like contractions of the muscles, which are so

short-lived it is not really possible to tell whether consciousness is disturbed or not. We have heard this described by one family as ‘the flying saucer syndrome’ in reference to the broken crockery that may occur as a result of jerks at breakfast-time!

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Signs and symptoms

Hives appear as itchy, red, raised welts that can range in size from 5 millimeters to several centimeters across. The most noticeable characteristic of hives is that they change appearance rapidly – they come and go and change in size from one hour to the next. No other type of rash has these same characteristics, so you can be pretty sure that any welts that itch and change appearance rapidly are hives.

Sometimes an insect bite looks like a hive at the point of a bite; however, it does not come and go as rapidly. Hives that are triggered by an allergic reaction to an insect bite appear at sites distant from the bite itself. Hives can also accompany allergic arthritis, which is signaled by stiff, swollen, red joints.

The form of hives known as erythema multiforme appears as welts that look like red targets of different sizes painted on the skin.

You can sometimes pinpoint the cause of your child’s hives by considering his or her activities in the minutes or hours before the hives appeared.

Home care

Unless the child has been given medication with instructions to take it when the hives recur, home treatment of hives should be confined to measures to relieve the itching. Cold water compresses, calamine lotion, and corn flour baths may help make the child more comfortable. Frequent or repeated cases of hives require medical attention. Also, if the child has been given medication but the medication fails to relieve the symptoms, you should call the doctor.

Precautions

• If hives appear on the tongue, make the child cough, or cause difficulty in breathing or swallowing, see your doctor immediately.

• If hives are accompanied by fever see your doctor to rule out a strep infection.

• If antihistamines don’t help relieve a case of hives, telephone your doctor for advice.

Medical treatment

When your child has hives the doctor may administer epinephrine to reduce the intensity of the outbreak and then prescribe antihistamines to be taken by mouth. If the hives recur and it’s not possible to pinpoint the cause, the doctor may order skin tests or refer the child to an allergy specialist. The doctor may also order a throat culture to check for strep infection. If the child shows symptoms of arthritis, tests are necessary to confirm or rule out that possibility. If the hives are caused by an allergy to the venom released in an insect bite, the doctor may suggest a long-term course of injections to decrease the child’s sensitivity to the venom; these shots may be given over a period of years. In the case of an allergy of this type, the child may also be given medication and instructed to take it if he or she gets bitten.

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