13 September 1999
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physician who knows you and cares about you.
Dr. Warren
He is up to 8 cc of valproic acid three times daily for treatment. Although we have noticed a decrease in minor seizure activity, he still has one to two major "clusters" (extension spasms involving arms, legs, head, and eyes at about 8 to 10 extensions per seizure) a day. The treating doctor is going to return to steroid treatment (which was administered when the spasms were first discovered) in conjunction with the valproic acid.
There is no evidence of post-natal or pre-natal injury or infection that would serve as a source for the seizure activity. There has been no diagnosis of brain damage or retardation. Psycho-motor skills are slightly delayed (one to three months), but therapists believe this is acceptable given the medication.
Although the treating physician has been very helpful in terms of treatment, he really has not been responsive regarding expectations for recovery. We realize that no definitive answers can be given, but what are the percentages regarding full recovery if the spasms have continued past steroid treatment and into his first year? Further, what has been the general experience of families faced with similar diagnosis? Finally, any general information you can provide regarding this condition would be greatly appreciated.
-T
Dear T: I have not treated any patients with infantile spasms, so I cannot speak to you from personal experience.
The following information is from Nelson's Textbook of Pediatrics: Those children who have underlying neurological conditions or developmental delays at the time of diagnosis have a poor prognosis. Those who develop their spasms at a later age (after 6 months), have had normal development, and have no underlying neurological disorder have a better prognosis, but significant numbers do not retain normal intellectual development. The spasms generally resolve spontaneously by 4 years of age but may be replaced by other seizures.
Since I can't offer you a personal perspective on the subject of infantile spasms I found three up to date, reliable Web sites I suggest you look at. They are:
Sincerely,
Dr. Warren
-Eric
Dear Eric: From your description, I am unable to tell if your son has started puberty. The first sign of puberty in boys is enlargement of the testicles. Following that, boys develop pubic hair. If your son has testicular enlargement and hair around his genitals he has started puberty and it is highly likely that he will continue to progress through it at his own rate. If he just started puberty, you would not expect him to have facial hair or a changed voice yet. While 16 years old is late to start puberty, it is within the normal range. If your son has not yet started any pubertal changes, he should have further evaluation. The specialist who deals with this kind of problem is an endocrinologist, but before seeking the advice of a specialist, it would be most appropriate for your son to have a complete physical by a family doctor or pediatrician since other factors influencing health can contribute to delays in body development.
Sincerely,
Dr. Warren
Will this be with her for the rest of her life? And if you can help in one very difficult area. What can she eat that won't bother her or upset her more?
-Very Worried Parents
Dear Very Worried Parents: Since you describe your daughter's situation as existing as long as you can remember, it is likely that her colitis is chronic and may be a lifelong affliction. Such conditions can be managed medically, but should be under the care of a specialist. Your daughter should have her symptoms managed by a Pediatric Gastroenterologist.
You need a definitive diagnosis in order to receive appropriate treatment. Even dietary advice may be difficult without a diagnosis. Therefore I urge you to see a gastroenterologist. In general, most patients with intestinal problems tolerate bland diets with starches; however, if your daughter is sensitive to gluten, some starches may cause her symptoms, so you see why a thorough evaluation is essential.
Sincerely,
Dr. Warren
-Mr. & Mrs. M
Dear Mr. & Mrs. M: Thrush is a yeast infection in the mouth. It is common in infants and not at all serious. It is generally treated with an antifungal called Nystatin which works locally on the membranes and is not absorbed into the body. Difficult to eradicate cases can be treated with Diflucan which is absorbed and works systemically rather than locally.
Thrush could be self limiting, but generally requires treatment to eradicate. The yeast is everywhere and likes to grow in moist warm areas. Infants are more prone to thrush because their immune systems are not fully developed.
Sincerely,
Dr. Warren
-VH
Dear VH: It is common for newborns to secrete milk from their breasts as a result of stimulation from their mother's hormones. This can even happen to newborn boys. The milk should not be expressed from the breasts. Expressing milk from the breasts would stimulate the breasts to produce more milk.
Sincerely,
Dr. Warren
Thank you.
-MM
Dear MM: Blood at the end of urination usually comes from the bladder. Your doctor's assessment of the situation possibly representing a spontaneous bleed from the bladder may be correct. If the blood continues, your son will need further evaluation by a urologist which could include an ultrasound study of the kidneys and bladder, an x-ray dye study of the bladder (voiding cystourethrogram), or cystoscopy (a look inside the bladder with a special scope).
Sincerely,
Dr. Warren
Thanks in advance,
-SD
Dear SD: Complete information about immunizations and medications recommended for travel to India can be found at the CDC's Travel Information Web Site at http://www.cdc.gov/travel/indianrg.htm.
Sincerely,
Dr. Warren
I don't know what's causing it. It's seems to happen when he's tired (before his morning nap or before his bed time) but other times we'll be sitting down relaxing watching his favorite tv shows. And then he starts.
Do you have idea or suggestion on how I can monitor this, to help me determine what could be wrong if anything?
Thank You.
-HC
Dear HC: From your description, your son's movements may be a habit or a mannerism. He may find the movements soothing and therefore respond to physical or emotional stress with these movements. If your sense is that the movements are not voluntary, your son needs evaluation by a pediatric neurologist to rule out a tic disorder, movement disorder, or seizure disorder.
Sincerely,
Dr. Warren
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