Probe the Fall

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If an individual had an abrupt, unexplained fall, avoid keeping it a secret. Go to the doctor because it could an unexplained crisis in the brain, reports Saima Bhat

In SKIMS Emergency corridor, gloomy Rubeena is watching the wailing families of injured, barely admitted a few minutes back. Frustrated, she frequently hides her face in her arms and then suddenly she rushes towards paediatrics emergency ward where her two months old son is admitted for seizure, a disorder suggesting brain’s abnormal neuro activity.

She peeps in through a small door opening. Her eyes stare at the face of her sister, to gauge her expressions. Her sister is sitting on the bed with her still unnamed son.

“He was born perfectly alright and for more than a month his behaviour and response was normal,” says Shareefa, Rubeena’s sister. “But ten days back, we noticed the kid flickering his eyes abnormally amid high fever.”

The family mistook the medical condition as “shadow of fairies” and took the new born to a faith healer. On his advice they sacrificed two sheep. They had nice dinner but the flicketing of kid’s eyes did not stop. So they eventually reached SKIMS.

Rubeena, 28, a resident of Wayil Ganderbal, is the youngest of five sisters. She was married to Magray Furqaan, a senior student at Kashmir University, who did some paltry part time jobs. They settled with her parents.

An EEG test at SKIMS showed seizure activity and medication started quickly. “Patient was only having flickering of eyes, no frothing, no jerking,” says Dr Gowhar, the young doctors in paediatrics ward. “We advised him to go home but two days we admitted him for the same symptoms.”

“We had to immediately change his medicines because he was already on high dose otherwise lack of oxygen turns brain muscles dead,” says Dr Gowhar. “He is not having any family history of seizures. Now MRI will reveal the rest of it.”

Presently six percent of population have seizures once in their life time, says Dr Sartaj Ali, a senior paediatrician. Seizures are of two types: febrile, when seizures happen due to fever. Such patients are sent home after proper examination. All other seizures are hyper activity of brain, which could be because of genetic reasons, or brain trauma, hyperglycaemia, birth trauma, less calcium in body. If

Sodium or potassium channels in brain are not developed fully it could also lead to seizures. Even electrolyte imbalance: when sodium levels decrease or increase in body, seizures happen.

Doctors say if seizure happens in 5 years plus age, it could be fever induced but in less than 5 years of age, seizures are normally febrile. Seizures can happen any time in life. Doctors study brain structure to understand the abnormalities. In non febrile seizures, patients are prescribed metabolism related tests first. Once ruled out, it is being considered a genetic issue.

Uzair

SKIMS paediatrics emergency received 15 seizure patients in 13 days from its catchment areas, a few of whom were referred from GB Panth hospital. Doctors say this is almost the average, a patient a day.

At tertiary paediatrics hospital, GB Panth hospital, 162 seizure patients were received from January 4, to March 15, 2016. Doctors say death due to seizures has decreased as people are aware and prefer reaching hospital at the earliest.

But when Uzair, 4, from Rafiabad Baramulla, had seizures for the first time on February 20 at 3.15 am, his mother Yasmin, 22, was frightened to see her son unconscious for 30 minutes with his deshaped mouth.

“I called my father and brothers. I was wailing. I didn’t know what to do. Then my father said it must be because of black magic. “I gave him some Aab-e-Zum Zum and burnt rue seeds.”

Next day, a faith healer advised her to consult a doctor as he believed Uzair was anaemic. For next twenty days Uzair was apparently normal but then he had another attack with frothing and tickling of teeth. But this time Yasmin straightaway went to district hospital Baramulla from where they were referred to GB Panth hospital for advanced test, EEG and MRI.

In the casualty ward of GB Panth hospital, Yasmin stares at her son, apparently seeking some reassurance. “He is alright, playing. Then what happened to him,” she asks. A single parent – typhoid killed her husband three years back, she still in unaware about the problems her son has.

Patients who have one seizure without a clear cause will have another attack, usually within 6 months. And if there is a known cause for seizure (brain injury or other type of known brain condition), then patients are twice as likely to have another attack. If first seizure occurred at the time of an injury or infection in the brain, then patients are more likely to develop epilepsy. Often, more seizures don’t occur until weeks or months after the initial injury or infection, says Dr Sartaj Ali, having ten years of experience handling such patients.

Generalised seizure symptoms could be varied. Unconsciousness, convulsions, and muscle rigidity is usually associated with Grand Mal or Generalised tonic clonic seizure. In Absence Seizures, brief loss of consciousness is reported. There are isolated jerking movements in Myoclonic Seizure. In Clonic Seizure, repetitive jerking movements are reported. Muscle stiffness, rigidity is associated with  Tonic Seizure and there is loss of muscle tone in Atonic Seizure.

Attendants of such patients should first do ABC management. A-Airway, if air is going to his lungs, B-Breathing-if breathing pattern is normal and C-if circulation is ok. And then, it has to be checked if patient has got injured, if patient couldn’t be turned then they should be turned to other side when their seizure is over, attendant should use his finger to clear patients mouth of saliva or vomit if they’re having trouble breathing, and loosen any tight clothing around their neck and wrists, stay with them until they’re fully awake and alert, provide them with a safe, comfortable area to rest, don’t offer them anything to eat or drink until they’re fully conscious and aware of their surroundings and ask them where they are, who they are, and what day it is. It may take several minutes to become fully alert and be able to answer questions, suggests Dr Sartaj.

All patients having non febrile seizures are put on medication, anti convulsing drugs. If such patients continue with treatment then in 50 percent patients seizures doesn’t recur. In case of meningitis, infection in brain, they are prescribed to go for cerebro spinal fluid (CSF) test, commonly known as lumbar puncture.

But Muhammad Yousuf was unlucky enough to get proper treatment. He died in March 2008 at the age of 42, a year after he was diagnosed with brain tumour.

Yousuf was on medication for seizures since he was three years old. But then, one day while returning from his office he forgot his address. Back home his family: wife and four sons were worried. He didn’t turn up till 8pm. “We were surprised to see a friend accompanying him. He told us Yousuf was wandering outside office gate at 9pm when he had left at 5 pm. When he approached him, Yousuf didn’t know which way would lead to his house and he decided to drop him home,” One of his family members said.

That night Yousuf’s family couldn’t sleep. His wife called her brother, who is a doctor, and narrated the incident. Next day, they first went to Jammu to consult his neurologist Dr Sushil Razdan, who suggested them to consult a surgeon instead.

At SKIMS, Yousuf underwent a number of tests and finally he was diagnosed with stage four of brain tumour. It was only after his MRI report that his mother revealed an ‘untold’ truth.

“He was three years old when, at his maternal home, Yousuf had a fall from second storey and he vomited blood,” Yousuf’s mother, Mughli Begum, now 90, revealed. “I didn’t share this incident with anybody at my in-laws home because my husband was attached to him and I feared he may divorce me.”

Almost after twenty days Yousuf had seizure attack and his father straightaway took him to hospital where he was under observation and put under medication for seizures. For next 39 years he never missed his medicines for epilepsy, a chronic disorder, the hallmark of which is recurrent, unprovoked seizures.

Dr Sartaj says that in this particular case, possibility is that he had a seizure first and then fall. “Fall creates trauma but trauma is not aetiology of brain tumour.”

 

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