Q. Do I have to fear if my child has seizures following a tonsillectomy?

Hello doctor,

I have a few questions about my child, who was very ill nine months back. At the beginning of his illness, he had two short seizures within 20 minutes. These two seizures did not have jerking motion, and he was not incontinent. A month later, he developed a peritonsillar abscess which was removed successfully. He had another seizure five days after the surgery that lasted a bit longer with slight twitching in his hands but was incontinent of his bladder.

He had an MRI (magnetic resonance imaging) that was normal. Two months later, EEG (electroencephalogram) EEG was found to be abnormal in the awake and asleep states due to rare right frontal spikes wave discharges (F4), placing the patient at risk for focal and secondarily generalized seizures. During sleep, these appeared to be bifrontal with synchrony, so it cannot completely exclude a fragmentation of primary generalized epilepsy.

The tests for CMV (Cytomegalovirus) and EBV (Epstein Barr virus) were negative.

1. Do you suspect juvenile onset epilepsy in my child? If so, is the EEG confirming the condition?
2. Do you suspect that he had seizures as he was sick, and it is not epilepsy?
3. Would you recommend putting him on medication?
4. What is the probability of him having another seizure, and when?
5. Is SUDEP (sudden unexpected death in epilepsy) a concern in his case?
6. Is it better or worse to get epilepsy at this age?
7. Are the results of this EEG severe or mild?
8. Would you recommend having a more extended EEG?

Below is a timeline of events:

• My child was diagnosed with Charcot Marie tooth through a genetic test. He was under medication tablet Amoxicillin 825 mg twice daily, tablet Tylenol 600 mg, and two extra-strength Tylenol PRN for pain nine months after peritonsillar abscess removal.
• Five days later, he had symptoms of the illness and requested to stay in bed.
• The next day while taking him to urgent care, he had a seizure in the parking lot, which lasted for one minute, and he woke up confused but alert and oriented after a few minutes. He had another attack down the street to urgent care when his blood sugar and blood pressure levels were normal. The lab reports showed negative for a flu test, CT (computed tomography) scan, and Streptococcus. Slight dehydration was noted; he was given fluids intravenously and discharged the same day.
• The next day I took him to a primary care physician who identified fluid in the left ear and recommended to follow-up with a neurologist regarding the seizure activity. The doctor strongly suspects infectious mononucleosis as he had swollen lymph nodes and a sore throat and scheduled for a follow-up at the end of the week.
• A day later, he had extreme pain in his left ear with fluid running out. He was taken to the emergency unit and was tested for streptococcus and infectious mononucleosis. He was identified with a ruptured left eardrum and right ear infection. He was treated with tablet Zithromycin and ear drops and was scheduled for a follow-up with an ENT (Ear Nose Throat) specialist.
• After five days, the MRI report stated fluid in the mastoid cells. Four days later, the rupture in his eardrum was healing, and he could hear. And the ENT specialist identified that the fluid is due to a past infection, which will resolve soon.
• A Methylphenidate skin patch was recommended to reduce impulsive behavior.
• After a week, he was sick and sounded like a hot potato. There was a swelling noticed at the back of the throat. However, the tests for Streptococcus and Infectious mononucleosis were negative.The physicians put him on a steroid dose pack to help with swelling in the throat.
• The primary care provider ordered a CT scan of the neck, and the MRI result was positive for a peritonsillar abscess. The next day, a tonsillectomy was performed.
• After a week, he had a seizure attack and was not breathing, and his body turned blue. He was taken immediately to the emergency visit and was stabilized.

The EEG performed showed the results that I have attached in your mail.

Hello and thank you for your reply, doctor.

If you are counting the seizure attacks to be two, is it the first one he had 20 minutes apart from each other and the second one a month later? And he had the skin patch one month before his second seizure attack. Would your answer still be the same with this additional information? And the neurologist recommends Keppra (Levetiracetam - antiepileptic drug) as she suspects epilepsy. I would like to know if the EEG test results would be correct if he takes Keppra. And how long should I wait for the EEG and MRI to be repeated?

Hello and thank you for your reply, doctor.

I want to mention that the second seizure happened six days after the surgery, and his body was still in a state of infection, which might be the possible triggering factor. And the EEG was taken four days after the second seizure. Would that be the cause of the lousy EEG? And he had a longer duration EEG this time and waiting for the results. I hope that is normal.

Hello and thank you for the reply, doctor.

I would like you to review the EEG report as a second opinion.