Jake, a third grader, was referred to me for evaluation of possible ADD. As I had never seen Jake before I began with a detailed medical history about the pregnancy, birth, his growth and development, and family history. Nothing seemed out of the ordinary. We moved onto his academic history.
His mother reported that in kindergarten the teacher warned that he seemed to have a hard time focusing and paying attention, even when she was reading the class a very interesting story. He would just tune out. “It probably was just a maturity thing…and, he IS a boy. You know how boys are,” the teacher offered.
Because Jake was a bright child he met all of his benchmarks without a problem and was easily passed to the next grade. First and second grades were the same as kindergarten. He received good marks but the teachers always commented that he could not stay focused. Looking at the report cards from these grades, the comments by the teachers were “He’s a daydreamer” or “He often drifts into La-La land”. He was never disruptive or impulsive. But the second grade teacher easily became upset because, “I’ll be talking directly to Jake, and he just tunes me out!”
Again, he received very good grades and was promoted to the third grade with no particular issues. However, the second grade teacher warned Jake’s mom to watch him closely for ADD, as this was a concern of hers.
The third grade teacher had been forewarned about Jake. And she also had a good understanding of ADD. She watched him very closely and called mom for a conference after a few weeks. “I’ve been teaching for many years and I think I know enough about ADD to recognize it. I’m not certain that Jake has ADD. But I feel he should be evaluated. SOMETHING just isn’t right as he spaces out at the darndest times.”
As I was gathering this history from mom I had the nurses take Jake out of the room to check his eyes and get his blood pressure. When he came back into the room I began talking to him about school and sports. Then I did his examination. I was able to witness what the teachers were reporting. When asked about his homework, Jake’s eyes fluttered briefly and he “zoned out” for about five seconds. Later when I was examining him, he just stared off into space at least a couple of times. When he came to, he looked at me as if he was trying to figure out if I had asked him a question.
Upon finishing the exam I told mom that before we look into the possibility of ADD I wanted to see if Jake had a type of seizure known as Petit Mal, or absence seizures. She looked at me with disbelief. But after we discussed this type of seizure, she nodded in agreement that we should do as EEG. The EEG confirmed that Jake did in fact have Petit Mal seizures. I referred him to a neurologist who treats these seizures successfully. As it turned out, Jake did NOT have ADD and thrived in school as soon as he got on his medication.
There are actually many different types of seizures that can occur. When one hears the word “seizure”, what usually comes to mind is a violent convulsion where the arms and legs shake uncontrollably, there is loss of bodily function, and the person loses consciousness. This is what occurs when one has a Grand Mal seizure.
Petit Mal, or absence seizures are very subtle types. They usually start in childhood with symptoms that include: eyelid fluttering, staring into space, lip smacking or ruminating (chewing). This seizure activity is usually brief, lasting only a few seconds. Afterwards, the patient is not confused. However, they do not remember the incident. The entire event is very subtle. If a patient happens to be walking when these occur, they do not fall down or even stumble because they are so brief. If they are performing a complex task, they may seem to drift off for a second.
One can easily diagnose Petit Mal seizures with an EEG, or brain wave test. There is a classic tracing that one sees with this type of seizure and this is a three second spike and dome pattern. The EEG tech can trigger these events by having the patient hyperventilate, or expose them to strobe lights during the EEG.
Petit Mal seizures respond well to certain medications. These include Zarontin, Depekane, and Lamectil. The choice would be up to the neurologist. These medications are usually prescribed until one has been seizure free for around two years. Most individuals with Petit Mal seizures outgrow them by the teenage years. However it can occur well into adulthood.
Although Petit Mal seizures are brief and subtle, they can be very dangerous when one is doing certain activities such as swimming, bathing in the case of a young child, riding a bicycle, skateboarding, skiing or driving a car. Parents of children with Petit Mal seizures should specifically ask the doctor about precautions and restrictions regarding these activities. The Department of Motor Vehicles has specific restrictions about driver’s licenses for patients with ANY kind of seizures. This must be addressed by a neurologist.
In Jake’s case, the neurologist started him on Zarontin. Within a week the teacher noticed a dramatic turnaround. He was engaged and focused, participated in class and his grades even improved such that he was one of the top students. His baseball coach even noticed a big difference. He told Jake’s mom that before, he was out in the outfield in his own little world. But now he was thoroughly into the game and was even moved to third base…quite a little ballplayer. Needless to say, Jake did not have ADD.