Dear parent,
Thank you for your query at DoctorSpring.com

I can understand your concerns. There are number of things that need clarification before I can help your child. A good pediatrician is one who elicits a detailed history, does a thorough clinical examination and uses investigations (MRI) only in the very end. We cannot start with MRI and forget about the child. Kindly answer the following questions:
1. Describe the seizure in as much detail as possible... What was he doing at that time? Who witnessed it? How did it start? Was the child febrile at the time of seizures? Which limb or limbs were involved? How long did it last? Did it start from one limb and progress to involve the others? Did the child have involuntary passage of urine or stools at that time? Was there any frothing from mouth or tongue bite? Was there and uprolling of eyeballs? How long did the child remain unconscious? Did the child have any vomiting, abnormal behavior or any limb weakness after seizures stopped? Did the child require hospitalisation for seizure control? Was he started on any anti seizure drugs?
2. You mention that there is previous history of same. What was the seizure type on those two occasions? Were they accompanied by fever? Were those two episodes similar to this one? Describe the two other episodes also in detail, if anything was different.
3. Kindly give a detailed developmental history.. When did your child attain various milestones such as neck holding, sitting, standing, walking, running, riding a tricycle, speaking ma and pa, speaking in sentences, obey commands, speak so that others can understand fully? Compared to his age group boys, what do you think he s able to do? What is he not able to do?
4. Is there any family history of seizures, seizures with fever, mental retardation? Ask your parents about any such history for any of the family members during childhood...
5. What about his growth? Height, weight and head circumference?
6. Were there any significant problems in the antenatal period or around his birth? How and where was he born? Did he cry immediately after birth? Did he have any jaundice in the first few weeks of life?
Are there any other significant details that you want to share?
Regards

Dear parent,
I really appreciate your having replied in detail. This has helped me understand the situation much better. Thank you for your patience.
Analyzing his history, the first two episodes seem to fit into a febrile seizure that is common in children of that age group. The last two seizures, however, do not fit into that spectrum.
It is also clear that there is a developmental delay, especially in the language sector. The delay is there in both perceptive (understanding) and expressive (speech) language. The child's height and weight seems to be normal, but measurement of head circumference is important and cannot be under-emphasised.
With the significant family history of febrile seizures, this could be part of a GEFS+ spectrum. The MRI report is however, nonspecific. Firstly, there is a lot of variability and heterogeneity in how MRI films are reported by radiologists. It is always better to personally look at the films and interpret them. Assuming that the above report is accurate, the changes could be part of a focal cortical dysplasia or just due to the seizures.
As of now, I would advise the following things:
1. Continue anti-epileptic drugs (levepril)
2. Personally visit a pediatric neurologist. The history that you have given me is adequate, but a thorough physical examination could provide vital clues to the underlying neurological disease. The neurologist would also measure the head circumference.
3. Consider getting an EEG, a repeat MRI and a TMS/GCMS after one on one discussion with a pediatric neurologist.
Regards

Hello,
Unfortunately, this consult is over a month old, and hence will be closed by the system.
You need to initiate a new consult for continuing with this conversation.