Saturday, April 5, 2014

Spoke too soon...leg tremors increase in frequency

So, over the last month, Charles has had about 5 days of leg tremors since our dr. apt that was at the end of February.  So, I called the Dr. at Children's and she recommended we try a daily medicine to prevent them (or to minimize them), For lack of a better method, I'm including the medicine dosage the nurse sent me in an email.  I haven't looked into it yet, and I haven't picked up the medicine from the pharmacy yet (just got the script 2 days ago)...because I'm of course reluctant to start him on meds again.  They could make him sleepy and he finally got some energy a year ago when we stopped meds.  Its Spring Break this week and we're watching General Conference today, so I thought it was a good day to update his blog.  He had a fun week of temple walks, swimming, museum trip, zoo outing, etc.  I'll share some pics that are NOT at the hospital. :-)

The blood work he had done last month to see if he had the gene that could cause PKD is not back yet...gene results from blood work can be up to 2 months to get the results, I'll post when we get the results back.







Medication: Trileptal 300mg/5ml

 
AM Dose
PM Dose
Now
0
0
Week 1
0.75 ml
0.75 ml
Week 2
1.5 ml
1.5 ml
Week 3 & on
2.5 ml
2.5 ml

Trileptal Possible Side Effects: rash, stomach upset, sleepiness, less likely irritability

Goals of tone management: decrease dystonia enough to improve motor control without causing worsening secretions, further impaired swallowing, increased weakness or excessive sedation

Our goal in this drug titration is to relieve symptoms and not cause side effects. This titration schedule is my initial suggestion for a dose which is likely to relieve symptoms. That being said, every child responds in their own way to medications:

If at any point along the titration schedule, there are side effects, please call and we can make adjustments in the medication or would consider discontinuing it altogether.

If the symptoms are significantly relieved before you reach the goal dose in the schedule, you can hold it at the point where you feel the symptoms are well treated.

If the symptoms are well managed, but then worsen as you increase the dose per the schedule, I would recommend reducing it back to the previously well-tolerated dose.

If no side effects at the goal dose, and it is not effective enough to control the abnormal movements, then we can increase slowly to a higher dose with a max goal of 60 mg/kg/day which is 10 ml twice per day.

Wednesday, March 5, 2014

New Diagnosis? PKD Maybe?


I haven't blogged in a long time.  I'm waiting for lab work to see if he has the gene, but we went to a new dr.  (Abigail Collins) at Children's Hospital last week who is a movement disorder neurologist (instead of his normal epilepsy neurology dr.) because he and I both thought Charles probably doesn't have a typical epilepsy diagnosis.  Anyway, long story short, he was diagnosed in the exam as potentially having PKD (paroxysmal kinesigenic dyskinesia).  Just this past year, there became a link for kids with the PRRT2 gene mutation with PKD...but not having the gene, doesn't mean it's not PKD.


Anyway, it's a very interesting fit...it better describes his experiences. He would NOT be medicated for it at this point, because his leg tremors aren't often enough. YAY! you can google it, but the article the dr. printed for us is the official case study (i only have in print form) and you have to have a dr/membership to download it. anyway, i will share more later, but wanted you to have an update (still no FORMAL answer, but this is a possibility).





Paroxysmal kinesigenic dyskinesia (PKD) is a rare disorder characterized by short episodes of involuntary movement attacks triggered by sudden voluntary movements.

Thursday, April 25, 2013

2 Months No Seizures, 1 Week of Seizures, OFF MEDS

In early 2013, I felt inspired to take Charles off his daily seizure meds.  They weren't helping anyway, and I don't know what harm they could do if he doesn't necessarily need them if their not helping! So, with the blessing of his neurologist, we weened him off over a month period.  He had NO seizures for 2 months, so I thought maybe we turned a corner.   Then, he got sick and the seizures returned for about 4-5 days - each day he had 1 tonic seizure, in addition, he also had these leg tremors I've described in the past.  We video taped them and sent them to the neurologist and he said those aren't seizures (which we knew), but maybe a side affect to the actual seizures, the medicine he take when he's actively having a seizure (clonazapam), or the illness (cold).  We met with his neurologist on April 1st and he agreed to keep staying off the daily medicine and only give him clonazapam when he gets ill and they return.  Well, in mid April (about 10 days ago), he got another cold and I was like "okay, we should see some seizures any hour or day now"...but we didn't! I believe this was the first time he's ever gotten sick where he didn't also get a seizure to accompany it, or as a result of it (minor fever also).  So, in 3 months, he's had 1 bad week...not bad considering he's not being medicated on a daily basis anymore, and he had been for 2 1/2 years.

His birthday is this weekend.  For his first and second birthdays, we kept it REALLY low key since he doesn't tolerate too much commotion.  I think we'll do that again this year.  Cupcakes at 5pm type of thing - come when you can, not all at once.  I do feel like he's handling life a little better since coming off his daily meds - he does NOT spend 5-6 waking hours a day in my bed anymore.  Only about 1 hour.  He is starting to sleep in his own bed at night better (not a ton, but we'll take what we can get).  He's still kind of a "wreck" when he's tired or frustrated (or not getting what he wants), or doesn't have his "po-po" - which his his polka dot pillow (his favorite thing in the world).  He still isn't going to Nursery at church very well and doesn't last through all 3 hours, almost ever.  But, he's not medicated, and I'm SOOO happy about that. 

We will continue to watch over the next 3 months and if he does well, we will keep off meds, and if he doesn't, we will try a 4th kind of daily.  I'm hoping for the first, of course.  I was so frustrated in March, that I started researching neurologists in the country who could figure out what was wrong with him...there just isn't an answer.  There are some good neurologists at Primary Children's Hospital in SLC, but for now, we'll hold off.  In the meantime though, I also researched the reasons children can have leg tremors - there were 49 reasons, I narrowed them down to 7 based on all of his symptoms, and went through the list with the Dr. and he addressed them all.  The only one I think may still be a small possibility is high thyroid numbers.  I insisted he get blood work done for them, and sure enough they did come back a little high - but the range for children is so huge that it appears he's in the "normal" range, but some people just can't tolerate a higher number than others.  His TSH is 3.269 (range for adults is .5 to 5 and for kids its .5 to 7.5).  I'm going to have this retested in 12 months to see if it changes.

David (Charles' big brother) came with me to his last appointment (It was Spring Break).  He was SOOOOO helpful!  Charles did SO well waiting for an hour for the Dr, and David played with him tons.  But, by the time he finally came in, he had had ENOUGH.  He just wanted his "po-po".  Unfortnately, I was with the Dr. and the pillow was in the car, which I had valet'd - we always valet at Children's (free, convenient, simple, most patients do).  But, I knew if he didn't have the pillow he would be screaming and crying the WHOLE time and the Dr. appt would be a disaster and non-productive.  So, I made a crazy decision.  I would SEND MY 9 YEAR OLD (David) to retrieve the pillow from the valet service.  I gave him the valet slip, no cell phone, told him which floor we were on to come back (Children's Hospital is HUGE), which department we were in, the Drs' name, and what to explain to the Valet.  The neurologist looked at me like I was the craziest mom in the world - how could he do that? and why would I possibly send him? and is it safe? and why can't the 2 year old live with out it for 20 minutes? and everything else you're thinking now too.  But, David can be SO incredibly responsible and smart, when he sees the need and feels like he's being given an opportunity to do something amazing.  So, I sent him off.  Charles calmed down immediately when he saw someone in progress headed off to get his "po-po" and save him from the wrath of no pillow!!! aaaahhh!! halelujuah!  The discussion with the Dr. continued.  And, about 7 minutes later, David was back with the pillow - talk about the HERO OF THE DAY.  I was SOO proud of him and Charles was SOO happy!! And the Dr. was SOOOO impressed with David - he gave him permission to come to ALL of Charles' neuro appointments, even if he was in school, that Mom would just have to take him out.  I concur.  It was wonderful to have his help.   Here are some pics of playtime while we waited for an hour.  Its our tradition to take pictures at all of Charles' appointments, hospital visits, etc. for records and this blog, and to remind me of his experiences, so I can help remind the drs of his history.  One day I hope to look back on this and not remember the hard times, only the fact that I have been given the opportunity to have LOTS of quality one on one time with Charles.  Thanks to Grandma Dianne (and Auntie Sheila too) for making that always a possibility - she gets the other 3 kids when we have to care for Charles. 

Here's hoping for a seizure-free, fun-filled summer!  If you're looking for us, we'll be at the pool, lovin' life!

Friday, January 18, 2013

What?! Poor Charles only had 2-3 weeks with no seizures! They're back!


After Christmas, we assumed he would have a few months off again until his next episode. That was not the case. It's Friday, January 18th today. Last Saturday night (the 12th), we had the missionaries over for dinner. An hour later, Charles has 8 seizures. Sunday he had like 150 tremors in his legs. We took him Skyridge to get an IV dose of Keppra (per his on-call neurologist). We thought that would eliminate all seizures as it has in the past (he's had the IV dose of Keppra once before). Alas, it did not. The experience at Skyridge was awful too. They had to poke him 3 times till they get the IV going, he was SO upset about it. In addition, we forgot to bring the Cars DVD with us and/or pre-download it to the Kindle, so he was devastated until it finally downloaded. I know, that sounds trivial, but when the poor kid only wants 1 thing while he's going through such an awful experience, we like to try to accommodate :-) Anyway, the next day, Monday morning, it all started again - including a tonic seizure, several small seizures and many many leg tremors that make him lose balance. So, we decided this time, to take him back to Children's Hospital since they have better and more experience with kids. After 2 hours there, we got no-where, other than the recommendation to add a morning dosage of his daily medicine. Before, he was on 5 MG of Clobazam, and now they changed it to 5MG at night and 2.5 in the morning. Tuesday was not much different...he had 35-40 leg tremors while we were at Sam's Club shopping. Poor kid. It scares him no matter how many times he's experienced it. It wiped him out and he had a LONG nap. Wednesday was a little better, and Thursday was even better (yesterday). We had a scheduled neurology check-up with Dr. Levisohn (his primary neurologist) at 3:15. We discussed MANY things...

1. Is it possible he doesn't have epilepsy, but something else (since his symptoms are so un-like any other patient)?

2. It is possible if we took him off all meds completely, we he be any worse off than he already is?

The Dr. agreed that maybe it's not epilepsy but rather a movement disorder. He recommend I go home and log all seizures on a calendar, including dates/times and TYPEs (tonic, myclonic, and just leg tremors) AND to try to capture them on video - that will be very difficult obviously I don't have a video camera ALWAYS on me and when they are happening, I just want to comfort the poor kid. The Dr. also said we could try weaning him from his meds.

So that night, since he had been doing well, we all went to the Gym as a family. Right after we checked them into the kids club, he went down to the ground. The care taker there said oh he's just playing...I said maybe but I better check. Sure enough, the seizures were back AGAIN. We promptly left.

NOW TODAY...So this morning his leg tremors were back again. Then, as I was taking the kids to school, he had a big 15-20 second seizure in the car in his car seat. He was shaking, bent over to the side, couldn't speak, etc. I pulled over and tried to video it but just caught the very end where he's just weak and limp and exhausted. He's napping now and has been for 2 hours...between the seizures and the meds, he's exhausted during the day, then stays up late at night. Its a vicious cycle that's also probably not good for him, but HOW DO I FIX IT??!! I was able to capture the leg tremor in the kitchen this morning and will try to upload that.

I LOVE THIS LITTLE BOY SO MUCH, he's just so cute and sweet I can't understand why this is happening and how and why the doctors don't know what to do for him. My job in life is to keep him safe and make him a priority. I want so desperately for him to at least get relief from medicine, but it's not happening, it's getting worse! Tomorrow would be a full week of seizures. The Dr. recommended a 3-day stay at the hospital which sounds atrocious, but I would do it except it would probably be the 3 days he's seizure free and they would get NO helpful information out of it. The Dr. put the orders in for it, but it can take quite of a bit of time to actually get it scheduled, etc.


He fell asleep on the way to this appointment as well.
 


Thursday, December 27, 2012

Christmas Seizures

We were so excited about Christmas time, but as soon as Christmas break started for the kids, the illnesses started. I (Amelia) was sick with an aweful head cold, then Ken got it 2 weeks later.  Annelise got the fever and throwing up from about Dec. 22 to Dec. 26.  Liesl was ill also during that time, but not as bad. David got it right after Christmas and had it for a week - probably the FLU.  He wanted a re-do on his Christmas break.  But, as we've discovered, if Charles gets ill, that usually leads to seizures.  Sure enough, right after cooking all day Christmas Eve, and heading  to Grandma's house for dinner, it became clear we would have a quiet dinner alone.  Ken and I and Annelise and Charles stayed home, but Liesl and David went to family dinner at Grandma's house.  Charles had a fever and seizures, including a "tonic" seizure - only his second to date.  We went to Walgreens on Christmas Day to get more of his "emergency" medicine - Clonazapam (same family as new daily Clobazam) but more fast acting.  Grandma Dianne Greaves gave Charles new pajamas that she MADE him for Christmas...that was a highlight that day for sure!  Here's a picture of him on Christmas Eve in his new jammies.  At one point, we had planned to drive to Utah for a week after Christmas, and are SO glad we had already cancelled that trip - with ALL the illness and poor little Charles' episodes.

Friday, December 21, 2012

Medicine #2 was shortlived...We're on medicine #3 now

So, after a disasterous 1 month on Topamax, Dr. Levisohn switched Charles over to Clobazam in the hopes that his side affects (weakness and tremors in his legs) would stop and in general, he would have fewer seizures and issues.  Well, that worked for 3 months and we thought a miracle drug was in place, so much that our first line in our Christmas card talked about how thrilled we were about how he was doing.  We should have knocked on wood. More to come...this picture is from his Dr. appt. at Children's Hospital the first week of December with Dr. Levisohn.  He likes to fall asleep on the way to this appointment, many times.  Cute kid - he stays asleep from the valet guy to the stroller to the department.

Friday, October 12, 2012

24 Hour EEG

The day after David's 9th birthday and 2 days after Annelise and I got back from our Florida trip, Charles and I check into Children's Hospital for his 24 hour EEG stay, where neurologists view him on video in his room all day and night to see any brain activity and actually get to see him and what things look like when he's having a seizure or tremor or general weakness.  It was a LONG 24 hours, but Charles did great.  The floor has books and activities and movies for the kids that the nurses and volunteers bring to his room.  In addition, a friend of mine (Courtney Clark -- Marianne and Heather's sister from Willow Creek Ward) was there with her son and they had been there for 6 weeks, so I really couldn't complain.  It was nice to see a friendly face.  Charles had a couple of seizures but they did not show up in his brain on the EEG as a "typical seizure" so once again, Charles is a MYSTERY. 















I took lots of pictures, he was so cute the whole time!!!