The problem with Hypsarrhythmia, the tell tale electrical activity present in an EEG which signifies Infantile Spasms, and can cause brain damage is that it’s transient; it comes and goes. It’s most frequent during tired periods before or after sleep, but it could happen at any time. The spasms we associate with the condition are just the physical side effect of what is going on in Mattie’s brain, they can be subtle and hard to detect. For months now we had been treating Mattie’s condition with the only indication of success being the lack of a spasm. Getting some hard data – a physical measurement via the EEG that the drugs are working is what both Emma and I were waiting for. If clear it would give us confidence that the electrical activity had returned to normal, and we’d not just missed another spasm.
In the two weeks following the EEG we’d called the hospital twice to try to get some feedback on what it showed. When we didn’t hear anything we assumed that, since Mattie was doing so well, “no news was good news”.
It felt like it took forever and a day, but eventually Emma got the call from the hospital and relayed the news to me. The EEG did not show any signs of Hypsarrhythmia! Success! This was fantastic news! But there was a “slow background”, which we were told was common in babies with Infantile Spasms.
I think it’s fair to say that between Emma and I, Emma is the more optimistic; I immediately focused on the slow background news, and couldn’t relax until I found out what it actually means. The truth is overall this was good news, but I just had a nagging feeling, an itch which needed to be scratched, what did this slow background mean?
The EEG’s Slow Background
After talking to David if there is one thing that stuck with me, was not to take things at face value. So I started a mini-research project into the EEG’s “slow background”. What did this really mean?
An initial search turned up an article which suggested that the slow background was a result of a brain injury, or other physical issue – something we’ve been told Mattie doesn’t have:
Following a seizure (ie, during the postictal period) the EEG background may be slow. However, interictal background EEG frequencies that are slower than normal for age usually suggest a symptomatic epilepsy (ie, epilepsy secondary to brain insult). Normal background suggests primary epilepsy (ie, idiopathic or possibly genetic epilepsy). Thus, EEG background offers important prognostic[Christine1] and classification information.
So how could this be? Was there something more significantly wrong? We were about to call the hospital back when Emma read an article from another parent on the Infantile Spasms Facebook group, it was asking roughly the same question. One of the answers offered was that a doctor has informed one of the parents that slow background can be a side effect of the medication. I’d not heard of this before so checked it out.
The only EEG modifications induced by GVG monotherapy were a more pronounced slowing of the background activity at rest with EC [Eyes Closed] and a reduced responsiveness to BR [Blocking Reaction].
This research paper suggested that the medication Mattie is on could produce a slowing of some of the background waves. What did this mean in the real world? – According to the same article it could induce a mild “sedative” action on attentive tasks rather than on cognitive function. I imagine that while the folks in the study could still complete a mental task, it look them a little longer than expected to get it done. – Which is a good approximation to what the doctors had told us to expect.
Mattie is doing well. In the run up to Christmas he started suffering from normal everyday baby problems, conjunctivitis, and a cold. Emma and I would take this rather than more IS. He’s now 9 months old and has just about got the sitting up straight bit down… Well for good 10 minutes before he gives up. Mentally we think his doing really well; he’s turned into an octopus, hands everywhere, grabbing everything.
Emma’s employer organises a children’s Christmas party in their staff canteen. We took Mattie and Ben down, Mattie fell in love with the balloon sword he had been given, and with a little help from daddy enjoyed whacking his older brother and mother with it. Enjoyed it so much we couldn’t get the balloon of him until, in the middle of the party he fell fast asleep, normally, without any spasms.
We know this is something we’ll need to keep an eye on, but for now at least, we’ve got just what we wanted for Christmas.
Thank you all so much, for your kind words and support, it has made the world of a difference, Merry Christmas everyone – I hope you all have a fantastic Christmas break.
It was about a week after Mattie’s last check-up. I was back home, my travelling temporarily suspended. We were in the middle of bath time, and Ben was still splashing about in the water. Mattie had already been been picked up and dried off. I was sheltering from a storm of splashing about when Emma poked her head into the bathroom, she had Mattie in her arms. “I just saw another one” she said. That is when we knew that the spasms had returned.
We’d had such a good check-up, to have them return so soon was upsetting. Just seeing one spasm isn’t so bad – they are hard to spot at the moment, and the guidance we got from the hospital had been to keep an eye out for spasms which cluster, and particularly so around tired times – waking up, or just about to sleep.
We left it a few days, watching and waiting and hoping that we wouldn’t see any more, but we did. Within two days of originally spotting the spasm Emma had called the hospital.
Matthew’s medication is calculated based on a formula, he is given x milligrams of Sabril (Vigabatrin) per kilogram of his body weight. Emma and I came to the conclusion that when Mattie grows, which all babies do, his dosage effectively reduces; he gets the same x milligrams of Sabril (Vigabatrin), but his body weight has increased. So it is necessary to keep an eye on the medication and to make adjustments as he grows. Given Mattie’s recent, very successful check-up we believed that it couldn’t be anything too worrying. But still it is hard to tell.
Mattie has not had an EEG in months.
The spasms Mattie suffers from are just a side effect of the increased electrical activity in his brain. The plan, as described to us by the doctor, is to treat the symptom in the hope that should it go away, the underlying condition, the electrical activity will also have reduced. You really wouldn’t think of using this in an engineering world and it seems odd to both Emma and I. It is even more odd when you realised that the spasms can be so subtle that they are hard to determine.
We felt that getting an EEG would help. It would give us some confidence that the medication was working, or if the spasms had returned, some measure of how ineffective the medication had become.
We were told that EEGs are only carried out when it is felt that it will answer a question. The original plan had been to not do another EEG until next year. But given our concern, we really wanted one. So when Emma called the hospital she explained our request, and the reasons why. Consequently, we were able to get Mattie booked in for one in just a couple of days time. At the same time we all agreed to up Matthew’s dosage of Sabril (Vigabatrin).
That evening we increased Mattie’s dosage from 800mg of Vigabatrin to 1000mg per day. It normally takes a couple of days for the impact of any changes in dosage to be visible, and sure enough, after a couple of days Mattie’s spasms vanished. As a precaution we planned to up his dosage to 1400mg per day.
News from the Crèche
A couple of days after we initially increased his dosage, Emma arrived home with the two boys from crèche and said “The carers in the crèche seem really happy with Mattie. I even got a comment that ‘he really seems to have come alive’”. It was great to have a third party confirm what we had noticed at home. With the increase in dosage Mattie really seemed to be a bit more alert, and he was into everything, picking things up and throwing them about. It really seemed like the increase dosage had taken effect in such a great way.
I really haven’t had that many work trips this year, however two seem to come almost back to back. As a result, I was out of the country during Mattie’s appointment.
In addition to the hastily arranged EEG Mattie had an appointment with the physiotherapy and occupational therapy nurses. Starting at 8am it was going to be a very busy day.
Mattie was up early. Emma woke him at 5 am for the trip into hospital. The EEG is conducted when Mattie is asleep. The hospital is about 40 minutes from our house and Mattie was bound to sleep in the car, then wake all ‘bright eyed and bushy tailed’. But Emma had a most cunning plan; to arrive in early and wake him in the car, give him a bottle and play with him, basically try to knacker him out before his appointment. The plan worked. One very tired baby fell fast asleep during his EEG. Unusually towards the end of the EEG, when Mattie was awake and still hooked up to the sensors the nurse administering it started shining lights into Mattie’s eyes. It didn’t seem to phase him. We didn’t hear why they were doing this, but I assume it wa s because for some children the spasms can be triggered by flashing lights.
Unfortunately we wouldn’t hear more for another two to three weeks, until the results of the EEG were shared with us.
Occupational Therapist & Physiotherapist Update
In contrast with the wait for the EEG results, we got the results from the Physiotherapist and the Occupational Therapist instantly: Great Progress.
In stark contrast to the last time Matthew visited he was now almost sitting up by himself – he was able to do it for a couple of minutes before getting tired. His “tummy time” work had also improved considerable.
The Occupational Therapist was impressed by his new found motor skills – he picked up a Cheerio with no trouble, he was passing things between hands, pinching and grasping everything within sight, all the things they were looking for at his first appointment.
Community Health Worker Check-up
I’m sure many parents who have two children do the same thing; compare how the youngest is doing with how the eldest developed. Of course you try not to, because every baby is different, but it is almost impossible not to and particularly when the youngest baby has a condition which might affect their development. So it was extremely reassuring when the community health worker came to visit.
In Ireland a community health worker will frequently check up on new born children and their families, they help provide some initial contact for parents. The community health workers also measure and track babies development, and during our latest visit Mattie was weighed, measured and recorded. At 80 cm in length (about 31 & 1/2 inches) Mattie charted at over the 100 percentile for babies his age. I think he’s going to be a tall chap. The community health worker also provided us with some feedback on how Mattie is doing. She told us not to worry too much about the fact that Mattie wasn’t sitting up by himself all the time, many babies his age can’t do that.
Its Tuesday morning, this is a big morning. Mattie is due for his 2 week EEG. We’re hoping for good news but suspecting Mattie will need some more help to kick his Infantile Spasms to touch. It’s a disappointing thought considering all the great progress Mattie has made during his first week back home from hospital. We are worried too as from what we’ve read the next line of drugs can be particularly nasty.
The first two to three days back from hospital were hard, we had a teething and tired baby, Mattie didn’t seem much better. But towards the end of the week we saw a dramatic improvement – we suspect that it’s not quite enough to prevent further treatment.
Chart of the total number of Infantile Spasms Mattie has had since hospital. The last two days are highlighted red and green. – Is there a pattern forming.
We’ve been recording and charting Mattie’s spasms, noting everything from a lurch through to a definitive “jerk”. It was towards the end of the week, from Wednesday onwards as the spasms seemed to slow, that we saw the best improvement and the biggest leap.
Mattie’s drugs for the day – Steroids and a Tummy stabiliser
It was harder than expected to get Mattie’s dosage right. On two occasions Matthew spat up part of his steroids. The first time he did this we thought we’d let it lie – there was no way to know how much had had taken, and how much was still left to go. However when on Tuesday night, for the second night in a row he spat up we thought we should do something about it. Mattie had managed to spit up at least half of his dose; it covered his bib, so we called the hospital and asked for some advice.
We got through to the doctor on call for Neurology. The doctor advised us that we could give him another half dose. The doc also suggested mixing the diluted steroid tablets with a little flat 7-UP to take the bitterness away. The doc explained “Don’t you know, flat 7-UP is an Irish cure for everything!” Unfortunately we didn’t have 7-UP to hand, so we substituted dilatable juice. It worked wonders! – Medication delivered!
If Wednesday saw the first noticeable drop in spasms and clusters, then it was Thursday when we saw Mattie’s first big leap.
Looking back to Thursday 5th September
What a day, I worked from home today while Emma and Mattie hung out down stairs. Emma has in good spirits and with good reason too. Although Mattie had still had some spasms today he, it was as if he had a complete miracle week in a day! He was alert and bright and giggling with fun. About mid-morning I came down to the kitchen for a coffee to find Emma and Mattie both laughing away. Mattie was in his jumperoo and was bouncing! A first!
In the past we’d pop him in and he’d last 60 seconds max – before the crying would start. Now as I acted like a Muppet and was jumped up and down myself Mattie would giggle at me, then kicked his legs and start to copy my actions. It was so very good to see.
He didn’t seem to have many spasms at all today – this looks good.
Emma: Thursday was the day that I noticed the biggest change in Matthew. LOTS of smiles and giggles! He found his voice….oh my goodness the ?oohs? and the ?aahhs? and the cooing coming from him was absolutely unbelievable! In addition he actually played in his jumperoo!!! Something he has NEVER really done, he happily played in it for about 30 minutes!! He also sat very sturdily and robustly in his bumbo – again something he had never done.
Looking back to Friday 6th September
Mattie was tired and cranky today, and I think he had more spasms today than he had yesterday. Yesterday Mattie appeared to make such a leap, but today his progress seemed to have been slowed a little, and depressingly the spasms are still with him. Emma and I are pretty much living in a state of constant hope; perhaps this will be “the day” – the day when the spasms stop and we don’t see any at all. Then there is the crushing feeling when they do hit, especially after the good bit of progress he appeared to make yesterday. Objectively it is perhaps not that Mattie had a bad day, it was still better than when in the hospital, but that he didn’t make it throughout the day without a spasm – that was something I think Emma and I were both hoping for after yesterday.
There is still cause for more hope. Emma’s father came back down to visit today. It was great to see him, and it was good to get his opinion of Mattie after his break away from him. Emma’s dad commented on how much more alert and with it Mattie seemed, and he still wasn’t jumping at the sound of his voice, something he had done before being admitted to hospital – all good news.
After the disappointment of more spasms, today did manage to end on a really fantastic note. Emma has taken to reading Mattie a bed time story (when he’s able for it). Tonight the story was Love Monster. He loves this book! – This story combined with his newly found voice, made for so much noise that Emma actually recorded it on her phone. I’d highly recommend a listen.
Tuesday September 10th – The EEG
Emma giving Mattie a bottle during his 2nd EEG
I sit, watching Emma give Mattie a bottle. The room is cool and dark, all the ingredients for a good nap, which is exactly what Mattie needs right now. He’s been all go this morning and the room is a welcome relief. The Neurology department is brimming with children and parents; a far cry from last week when we arrived to find a deserted department.
Preparing for today
Last night we started to prep for the EEG, just trying to read up on stuff before talking to the consultant about any further treatment, and wanting to quiz the doctors on the off chance that the EEG is OK, but the spasms remain – which is something that has been known to happen.
Emma has done a bucket load of fantastic research which she has started to catalogue and share. We’ve noticed a couple of things, first off each country appears to treat infantile spasms differently.
US v UK and Ireland
The treatment in both the US and the UK is to give steroids initially. However the types differ. In the USA they use ACTH which is injected into the child. In the UK and Ireland they use an orally administered synthetic steroid prednisolone. The latest research seems to show that the UK and Irish method is just as effective, if not more so, without the risks associated with injecting something. Emma’s recent research indicates that the US is progressing toward the UK / Irish norm for first line treatment.
Ireland (or maybe just Mattie) v UK
There are differences between the treatment Mattie is receiving at the treatment recommended in the British Medical Journal. Basically the BMJ suggests that after 7 days the steroid dosage is reviewed; if the spasms are continuing or an EEG shows no marked improvement, then the steroid dose is increased to its maximum for the remaining week, before tapering it off. – Mattie didn’t get this; instead he had a single flat level of steroids.
We’ve also started looking at potential second line drugs. Wow are those things strong, and wow to they have some potentially nasty side effects. One of the things Emma and I are keen to explore is, if the EEG isn’t back to 100% normal (which it shouldn’t be – given our observations) can we revisit the hormonal treatment, rather than moving on to the more aggressive and harder second line drugs?
Tuesday September 10th – EEG Progress
Removing Mathews “Digital Dreadlocks” after his EEG
Back at the EEG, Mattie has still fast asleep when the EEG Operator who had been silent speaks:
The EEG Operator: How many spasms did he have yesterday?
The EEG Operator: Is that the most he’s had since starting his medication?
Emma: No, the least.
The EEG operator opens the blinds, letting the mid-morning sun shine into the room:
The EEG Operator: Let’s wake up him, it will be good to see if anything unusual happens then.
Looking back to Monday 9th of September
I was in a meeting at work when the text arrived:
Bad News – More Infantile Spasms on Monday
I had been hoping, so hoping that today would be the day. That he’d have one day without a spasm. But it doesn’t look like it – and that’s hard. Mattie got so lucky during his stay in hospital, he’s in the rare 30% bucket with good prognosis, there is nothing else wrong with him, we appear to have caught it early. On top of this he’s made such fantastic progress today.. everything was pointing in the right direction. It’s pretty upsetting.
Mattie has been teething like mad today too. With some tiredness and crankiness which is probably a triple combination of teething, drugs and his Infantile Spasms.
Over all during the week he’s made some amazing progress: Emma: Something else that is VERY noticeable. We now have regular nap times again!! 🙂 Mattie will take about a 2-2.5hr nap in the mornings and a 1hr nap in the afternoon. But in between these naps he is awake and interacting! (also sometimes grouchy but thats ok). This is a HUGE difference, prior to his diagnosis even when up from naps he was dosing in his chair and his level of interaction was low. This is massively heartening to see 🙂
Tuesday September 10th – The EEG Results
After the EEG we get taken in to see the head of neurology. Sitting in his office we get the EEG results. If it was an exam we needed an “A”; we got a “C”.
Emma and I were worried that the EEG would be all clear. We’ve seen and felt Mattie continue to have spasms and a clean EEG would mean that the doctors were not getting the same picture as us. The EEG wasn’t clear.
The EEG showed a good improvement, perhaps as much as 60%/70%. But the hypsarrhythmia pattern remained present. This aligns with the spasm pattern Emma and I have witnessed.
Infantile Spasms, by very definition, only happens in babies. The problem is that small changes to the brain now have huge impacts later on in life. The continuing hypsarrhythmia can have a huge impact. In terms of Mattie that impact can range from a slight learning problem – through to inability to sit unaided, the inability to read or do basic mathematics.
Today Emma and I have the chance to review Matthew’s progress. He had tracked the developmental milestones for his age group up until 2 weeks before his hospital admission. During these two weeks his development slowed. Last week he made huge leaps and we feel he has caught up, but just not all the way.
The Head of Neurology’s Office
We asked the head of Neurology what the outlook was for his Infantile Spasms. The conclusion was, without doing something it will not get better. It may plateau at this point, or it may reoccur. However all the time the spasms and hypsarrhythmia continues – and continues to alter his brain.
Sitting in the doctor’s office, and working with the head of Neurology we reviewed the options available to us. Importantly in the field of Infantile Spasms there is not enough data to answer many of the questions we had; in particular Emma and I had wanted to know if the steroids would work completely if we increased the dosage? The head of neurology: There is no evidence that they would. The head of neurology recalled being an conferences where, at the same conference one person had stood on stage and said that the steroid dosage should be upped after the first week, and another had stood up to say if the steroids don’t work after the first week – forget them and move on, don’t waste the time “testing” theories.
The head of Neurology told us about Vigabatrin (also known by the brand name – Sabril), a second line drug which is used to treat Infantile Spasms. This drug has some long term, non-reversible side effects – it can be pretty nasty. In 30%-40% it causes permanent vision loss. The doctor explained that he had seen some cases without vision loss, and some who were unable to drive a car because of the vision loss. The risks to vision loss increase along with the dosage of the drug.
If Vigabatrin is prescribed and if it works Mattie will be on it for a year. Initially the dosage of Vigabatrin is low, and increases each week for four weeks until one dosage level is found which works, stopping the spasms. If no dosage level works, then we’ll drop the drug and reassess the best way forward.
I asked about Vitamin B6, “What’s with the Japanese prescribing B6?”
Well according to the doctor there are a wide range of epilepsy syndromes which benefit hugely from the introduction of B6. There however is no data to suggest that Infantile Spasms are one of them. As a vitamin supplement B6 has no significant side effects.
We distilled the options available to us:
Increase the dosage of steroids
Move to a second line drug Vigabatrin (Sabril)
Introduce Vitamin B6
What we know:
Time is ticking and with every delay Mattie’s outlook deteriorates.
Staying on the steroids is unlikely to help.
Vigabatrin has the next best chance of helping – but with a significant risk.
Vitamin B6 has no known side effects.
This left us evaluating the outcome of Infantile Spasms with and without Vigabatrin . – With and without the benefits, and the risks. In the end we decided, along with the doctor that having Mattie on Vigabatrin – stopping the spasms was the better way to go. The potential benefits – spasm free, and reduced learning difficulties outweighed the risk to his eye sight.
It was, and still feels like a very difficult decision to make. It makes it worse knowing that we’re doing so in a field which is largely unknown, with limited concrete data to go on.
We also decided that since there is no risk to using Vitamin B6, that we should go head and use it.
Mattie’s Drug Cocktail
Cocktail of Drugs: Matthew’s new perscription
Mattie is now ramping down on his steroids, ramping up on Vigabatrin, starting B6 and continuing his other drug to control the impact of his steroids on his tummy. The cocktail of drugs he’s on appears to be pretty hard to come by. We ended up trying 5 pharmacies before eventually getting a pharmacy which didn’t have what we needed, but could get it couriered to them before Mattie’s next scheduled dose of drugs.
Emma asked about physical exercises we could do to help Mattie. There is a physiotherapy clinic in Temple Street. The head of neurology explained that they don’t normally refer at this stage, but he’d be happy to – and effectively start Mattie early on this.
There are lots to be positive about. Mattie has responded well, just not well enough to the steroids. He was in a good place developmentally to start with, and we appear to have caught it early. As the consultant said, Mattie is a member of a group of people who suffer from Infantile Spasms. As such the average prognosis is not good. There is a subset of this group which do better – Mattie is in that group, but at the same time it is still a high risk group.
Fingers crossed the new drugs will work early at a low dose…
I spent Thursday night in the hospital with Mattie, and Emma eventually got some rest at home – but not until she’d spent hours sending photos of Mattie to friends and family from her phone.
The ward was quiet on Thursday night, even so, Mattie has a restless night. He woke and had a cluster of spasms at midnight, 1am, 3am and then was awake and in great form playing from about 3:30 until 4am. He woke again at 5am, and eventually at 5:30am I gave in and gave him a bottle of milk. He was in great form in the morning and I got some wonderful smiles from him. He had breakfast and at 8:30 he had another set of spasms. Mattie got sleepy, as he does after a cluster of spasms and started to dose in my arm.
It was just a waiting game now until we got called for the optometry appointment.
The consultant who had admitted Mattie on Monday came down to visit. The consultant was in a great mood and was checking that Mattie was now firmly in the hands of the Neurology team. The consultant explained that there was much to be pleased with, Mattie had given some good results so far. The MRI showed no physical cause – this means that Mattie has “Crytogenic Infantile Spasms“, the rare form, but the form which as the better prognosis. – Mattie got lucky!!
The Long Lost Smiles are Back!
The Consultant asked how Mattie seemed. I explained that we’ve got something we didn’t know we’d missed… smiles. I had got some great smiles in the morning and Emma had the day before, and it’s crazy because even though Emma had told me, it was when I saw Mattie smile that it struck me that we hadn’t got many of those over the last couple of weeks. What a joy it was to seem them, it was like Mattie had had a little “wonder week” all to himself.
After the consultant left Mattie woke and was grumpy. I have him another bottle of milk and he settled again and fell asleep. He slept most of the morning until a doctor from neurology came down to visit.
A doctor from the Neurology team came down to see us next. The Doc asked how I felt about taking Mattie home today – it was impossible to hide a smile, “delighted”. I asked about the side effects of the steroids. Mattie’s course of steroids overlap with Emma’s expected return to work, and her (currently) scheduled Jury Service. I explained that this would mean Mattie going to crèche before the end of his steroids. The Doctor said we should avoid that if at all possible. Following Doc’s advice Emma has been working out the best way of extending her Maternity leave. She’s going to call her boss and explain the situation to him next week.
The Doctor asked how Mattie was getting on, I replied with the same update I’d given the consultant but added that Mattie had been asleep a lot this morning. The Doc looked a little concerned, but didn’t say anything about it.
Mattie was now asleep in his hospital cot and the nurse appeared to take his blood pressure, wrapping the cuff around his leg rather woke him up and he cried. The nurse explained that Mattie’s blood pressure was high, but it could be because he was upset and she’d come back later to check. Mattie settled and slept on for another hour or so. The nurse returned and as he woke I picked him up and had him in my arms, she checked his blood pressure and again it was high, perhaps it was the wrong sized cuff, she replaced the cuff and we tried again. No mistaking it now, Mattie’s blood pressure is up.
Still asleep I returned him to his cot. He slept on.
I started chatting to the nurses and in the course of the conversation I explained that Emma was heading to Ikea this morning for a new cot. Both Emma and I had noticed that Mattie as enjoying “star-fishing” in his hospital cot. The crib he was sleeping in at home was just too narrow for him now. We’d been hoping that Ben would have transition to his toddler bed, but he isn’t quite there yet. So it’s definitely time to replace Matthew’s cib, and nothing for it but purchasing him his very own new cot.
The nurse commented that, in a few months that this would leave us with both an empty cot and an empty crib.
“There is only one thing for that now” she said, “you’ll have to have another baby to fill the empty beds!”
“Ha!” I replied, “I’ve mentioned a 3rd baby to Emma before, you should see the panicked expression on her face!”
Getting late and Getting Worried
Chris and Mattie in Hospital on the last morning – trying hard to get some smiles from a tired baby
It was getting late, going on for 12:30 and Mattie had been asleep from 8:30, he was sleeping through all the hustle and bustle of a busy ward’s morning routine and hadn’t really woken. He should be getting hungry as he was late for his normal lunch time. I picked him up and tried to coax him awake, after 10 minutes he looked at me, his head lolled forward and his eyes rolled – he feel back asleep. With this plus his high blood pressure I started getting worried.
Am I being an anxious parent, or is this something serious? – Well I didn’t think the jerks we saw before Monday were anything to worry about, and I couldn’t have been more wrong. After calling Emma and double checking his lunch time, I grabbed a nurse and explained. The doctor was called.
As I returned from the nurses’ station Mattie woke up – and was starving…. little cute bugger, but after his bottle he fell back asleep.
I’ve started telling other people about Mattie’s condition, when I explain that he has epilepsy I get a “Oh, ok” response. But when I explain what I’ve learnt this week, and how it can impact on a babies development then their reaction changes. When I first heard of Mattie’s diagnosis I thought about the “fits” that you hear about, and occasionally seen portrayed on TV shows. But an infantile spasm is not like that at all. It’s quite subtle, but it’s what’s going on that we can’t see which is quiet frightening.
The Optometry Appointment
Just as Emma arrived in the early afternoon we were called for our optometry appointment. We all exited the ward via a secluded entrance at what we thought was a dead end of the ward; Temple Street really is like Hogwarts, or at least the house from “Cludo” with all of its hidden passages and shortcuts.
Mattie as given the once over by the optometrist and then given eye drops to dilate his pupils. We now had a 30 minute wait before the examination started in earnest. Mattie started to have a few single spasms, but seemed ok.
After the long night I was struggling so I took the opportunity to head home and freshen up. Just as I pulled up outside the house my phone rang it was Emma.
“You have to come back for us, we’re going home!”
The optimist had found two perfect eyes with all nerve endings intact and functional. There was nothing wrong. Shortly after this Emma had met with a doctor from neurology who gave us the update from the MRI, the final written update has said Mattie was normal; we were free to take Mattie home!
Thank You Temple Street!
Emma had got the nurses on the ward some fresh baked goods and a thank you card – as I mentioned in a previous post they were simply amazing. The staff at Temple Street are brilliant, there is so much care and thoughtfulness from everyone, consultants, doctors, nurses, even other members of staff that I bumped into in the hallways. So it was so very nice to say thank you in some way.
Emma drove us all home and during the drive she told me about a conversation she had with one of the nurses on the ward.
“I hear your buying a new cot today” the nurse had said to Emma
“Yes, Matthew’s been star fishing in his hospital cot – definitely time to upgrade”
“Oh there is nothing for it then – you’ll have start working on two more babies to fill the empty cots that that will leave behind!” said the nurse.
“I must have given her a funny look” Emma said “because she looked at me for a second, then said ‘Yes, your husband said you’d have that expression’”.
Emma’s sister had collected Ben from crèche. Ben has known something was wrong, he’s been great though – but very, very clingy; hugging legs, not wanting us out of line of sight etc. He has known something was up. Ben was very surprised when I turned up at my sister in law’s front door, quickly followed by Mattie and Emma!
We grabbed a quick cup of tea at as it gave us time to give Mattie his dinner and fill Emma’s sister and brother in law in on the days updates. Unfortunately Mattie has another cluster of spasms as Emma was trying to feed him.
We got home, and Emma hit the Ikea flat packs with force. I hung out with the two boys, Mattie falling asleep on top of me, and Ben sitting with treats watching “Despicable Me” on TV.
One of our neighbours popped over with a little bag with a gift and a get well card for Mattie in it. It was a lovely gesture.
After 45 minutes Emma was done with her handy work and Mattie was safely ensconced in his new bed.
Myself and Ben took this as an opportunity to hit the local Pharmacies to pick up Mattie’s prescription, it was getting late and the first Pharmacy we called to didn’t have the drugs in stock. Luckily the pharmacist was able to call around the other pharmacies in the town and we got one with all we needed.
We’re out of the woods, but we’ve a valley to traverse
We are now all set, we’ve just got to wait until September the 10th for Mattie’s next EEG. So far we’ve got lucky. From the initial shock and confusion of Monday through the battery of tests, and trying hard to get up to speed on something you know nothing about, and about which the doctors seem reluctant to explain to now. It is like stumbling out of a thicket of trees into the open. We can now see a path in front of us. It’s across a valley, we can see the track for the next 10 days, but after that it vanishes.
Saturday Morning – 31st of August
I don’t think Ben knew what hit him – breakfast with the entire family around the table. It was great to have everyone back at home. Ben was all smiles, I think the last week has been tough on him too. It must have been weird for him. I know it was weird for us too.
Home at last! – Emma, Ben and Mattie enjoying breakfast together for the first time since Mattie was admitted to hospital.
Emma and I have our fingers crossed that the steroids will kick in work well for Mattie, but as the doctors explained this is very subjective and each individual has a different reaction. We won’t know until the EEG. There is a correlation between the EEG and the spasms, so we’re still recording everyone he has – he had a big cluster tonight around bed time. I understand why the doctors are reluctant to explain the details to us; when the clusters hit they can be frightening for Mattie, but knowing what they are and their repercussions it also scares the crap out Emma and I.
Mattie has done great so far, as long as he stays well on the steroids his next battle is seeing how they have affected his EEG. And we won’t know that until September 10th.
As we’re now entering a longer stretch – fingers crossed we will not have anything major to report until the next EEG, I’ll reduce the volume of emails for now. I’ll be back in touch to let you know how the EEG goes, and Emma and I are still logging Mattie’s spasms.
A Very Big Thank You
Emma and I have been so very grateful to you all. Writing these notes has given us a way of structuring so much information, and so many things have happened that – at times it’s been extremely confusing and to be frank, very frightening.
Your responses and encouragement have helped hugely. Emma and I are really very thankful to have such a great bunch of family and friends. Emma and I hope that any other parents dealing with Infantile Spasms who read these notes will get as much comfort from them as we did from you guys.
Thank you all!
Emma and I will set up an Infantile Spasms Crib Sheet on this blog with details on useful links and publications, other web sites, stories and information. We’ll try to add to this as we go along.
I am trying to translate all my notes and recollections from last week into readable blog posts for you all as quickly as possible.
Everyone likes to hope for the best, but a recent experience, which I don’t feel I can share publically here, made Emma and I vow to each other to not count our chickens before they hatch, no matter what result we get from a test, we’ll wait to see the final report.
Thursday 29th August 2013
It is late on the ward. I’m taking the night watch, and Emma should be asleep at home and recovering from doing three nights back to back. She isn’t. I know this as my phone is buzzing with images and SMSs – I even got an SMS which said “I’m off to bed”. Two minutes later it’s followed by a photo of Mattie Emma taken earlier in the day. We’re both tentatively relieved by the news we received today.
Thursday 29th August – 9am
I spoke to our crèche today. Mattie was due to start with the crèche at the end of September as Emma is due to return to work. This unfortunately overlaps with his steroid treatment, and assuming the best case outcome (he’ll be home and better with no spasms) he’ll be starting a little later. I needed to check if our crèche will take a baby with epilepsy, I know that not all do. Even if he’s better, there is a chance that he’ll have another spasm, and they’d need to be prepared for that.
Our crèche is also changing hands. It’s the same crèche Mattie’s brother Ben goes to, so we’ve known it now for over a year. The owner is retiring and she’s selling on the crèche. I spoke to one of the assistants at the crèche who said there was no problem with a delay in starting, but she didn’t know about taking on babies with epilepsy. We’d have to wait and speak to the new owner.
In other news, which I’ve not mentioned yet – Emma got called up for jury duty in October, the letter arrived on Monday. Epic timing. Maybe, unlike when we were burgled, we could claim for that on the home insurance?
Thursday 29th August – 10:45am
The phone rings, it’s Emma; Mattie is out of the MRI. Everything went well. Mattie was sedated for the imaging. He moved once or twice, but they got everything they needed. Now comes the big long wait to see the doctor in charge of Mattie’s case and getting the results. – I’ve nothing to report yet.
I spoke to my boss at work, who has been great. I cancelled my work trip to the UK next week. I don’t think, even if everything goes really well, that I would be giving anyone 100%.
Thursday 29th August – 3:30pm
I arrive on to the ward, just in time to see the doctor who is in charge of Mattie’s case leave. Emma quickly updates me on what was said. The MRI showed nothing which would be causing the Infantile Spasms he is experiencing. It may show something else. But we won’t know until the final results are provided. These are due at some point tomorrow I think. The good news is that we’re on track to head home tomorrow. Something we’re all looking forward to.
Mattie will be returning to the hospital every Monday for the foreseeable future for a check-up. Initially this is to gauge the impact of the steroids. It can affect blood sugar and if there is type 2 diabetes in the family (there is) it increases the risk, blood pressure and of course his immune system. The original plan had been to have the public health nurse from Balbriggan check on us at home, but they don’t have the equipment to take a babies blood pressure. So instead we’ll need to report back to the neurology department here in Temple Street. Emma was thankful for this as it also means that each week we’ll have the opportunity to check in on any developments we see with Matthew, and ask questions of the neurology team which the public health nurse wouldn’t be able to help us with.
The doctor explained that the steroid dosage he is on at the moment is very high, so high that some pharmacies would question it, even going so far as to ask about mal-practice. But this very high dosage is based on research which indicates that it helps. It also explains why the dosage is just for two weeks and then tails off with a four week ramp down. There is no guarantee it will help. The doctor explained that the process of finding the right drug combination for Matthew could take months or even years to get right. In the mean time we can only hope that he doesn’t regress.
The good news is that Mattie has a lot going for him. He is healthy, he’s developed normally up to this point. These are good portents. We’ve got more work to go, but our starting place is much better than many others.
After talking to Emma, I felt that it was obvious that the doctor had not given Mattie’s MRI a clean bill of health yet. Emma recalled that the doctor had said that (I’m obviously paraphrasing a second hand quote) … other neurologist may see that certain areas of the brain that might not be as they should be, but when I looked at it there was nothing on it which would be causing the severe spasms he is experiencing. . .
Thursday 29th August – 9:45pm
The ward is quiet, but a new baby on the ward has just woken and got scared. Her parents had just left for a bite to eat and she was alone. The nurses have called back the parents and are doing their best to settle the little one. Mattie stirs, but appears to be remaining asleep – which is good. Obviously my typing beside him isn’t waking him up. The nurse comes over and attaches the blood oxygen monitor to his toe. This too fails to wake him.
Mattie in “Good Form”
Mattie has been in good form when awake. Emma told me she got smiles and giggles from him which was fantastic. In fact the images which have just arrived on my phone show a fantastic smile from both of them:
Mattie and Emma – all smiles after the MRI
The clusters of spasms are still happening
Right now however it is good to see him sleep so well. He woke 45 minutes ago and had another cluster of spasms, which lasted about 8 minutes, but wasn’t has violent as they have been. Compared to the beginning of the week they seem to be changing. He’s having just one isolated spasm at times, and what feel like longer gaps until a full on cluster of spasms strikes. The steroids should have kicked in by now. The doctor explained that they will look at him again in two weeks. They are treating the EEG not the spasms. The changing nature of the spasms could indicate a change in the EEG pattern, but we will not know until Mattie’s next EEG – and that’s going to happen a week on Tuesday (September 10th). In the meantime all we can do is hope. Fingers crossed that over the next week the seizures wrap up – I sense that we really should be seeing something like that by now. But I don’t know. . . I’m no expert. . .
This is most definitely a marathon, not a sprint no matter how affective the drugs have been.
What we have seen today are smiles, and more smiles from Mattie in one day than we’ve seen in a long long time. That too could just be a side effect of the steroids, but it is very pleasant to see.
Sharing our learning and experiences
Both Emma and I, and you guys reading these missives have learnt so much over the last couple of days; new phrases and terminology, new friends, and other parents. We’ve had the reality checks – even if we got (or get) the most negative news, that we have ultimately been extremely lucky. We’ve come so far from the confusion and shock of Monday. I’d like in my way to do something to help other parents who will find themselves in this position too. Catching the spasms early is so very important, and they are so easy to confusion with other ailments. Perhaps we could share some of the videos of Mattie’s Spasms and the (edited) contents of our notes on line? – Anything really that others can stumble across and that will help them.
Tomorrow morning Matthew has an appointment with an optometrist. According to my own research the condition has is also linked to limited vision, or Cortical Visual Impairment. Basically there is nothing wrong with the eyes physically, an issue with the brain is impairing the comprehension and affectively the meaning of the images the eye is capturing. – This sounds like what my father; a stroke survivor is currently suffering from.
Googling “Infantile Spasms and Optometry” (I know I shouldn’t, but I avoided the crap and stayed with the academic papers on it) suggests that CVI is very common among children with Mattie’s condition, and rather depressingly the prognosis for those children’s vision is also not as good as other children. If he has CVI – then it may improve, but he’ll never have the full vision most of us enjoy. Fingers crossed…
After the optometrist appointment, assuming the official MRI results don’t show anything, and the vision tests go well, then tomorrow Mattie will be able to return home to us. Now that’s a Friday I’m really looking forward to – I just wish I could remove all the “if”s from the last sentence.
The ward is quiet now. The only sounds are my typing, the occasional footsteps from the nurses as they do their rounds, and of course the deep breathing coming out of Mattie as he sleeps.
This time last week our little boy, Matthew who is not yet six months old was admitted to hospital and Emma (my wife) and I were trying to come to terms with what had happened.
I remember it like yesterday, Mattie was in my hands – almost Lion King style, and the whole family was around welcoming the new arrival to the world. Mattie’s older brother was playing in the corner of the room. As I showed my new son off to the world it happened. Holding him in my hands, his smile vanished and his head dropped forward witch such force that I clutched him to my chest to prevent him from landing on the floor. Scary, and odd. I mentioned it to my wife Emma, after discussing it we decided that at his age, about 4 months it was to be expected. After all he was only a few weeks old, perhaps his little body wasn’t capable of holding his head up?
Dismissing the Fear
“Maybe it’s in my head” Emma said, “but I don’t think Mattie is doing as well, developmentally as Ben. I think I recall Ben doing more at this age.”
Mattie was now 5 months old, and perfect, how could there be anything wrong? I thought. Mattie’s head bobs had continued and Emma had become increasingly worried about them. “I’ve been Googling the head bobs, they could be some form of spasms.” Emma said, “The good news is that they are benign and should pass in a couple of months” .. Nothing to worry about I thought. Nothing at all, Emma was probably just getting worried about nothing.
“Chris, I’ve got that appointment with the doctor on Monday, can you look after Mattie that day, I’d love to go alone, it would be so much quicker.” asked Emma.
Unfortunately I had a bunch of meetings on that day and couldn’t take the time off. Instead Emma took Mattie with her to her doctor. It was after her check-up that she mentioned Mattie’s head drops to her doctor. Emma’s doctor gave us a referral to the Children’s Hospital in Temple street in Dublin, we had the appointment booked with the paediatric consultant booked for one week away.
The week did not pass normally. Emma became increasingly worried about Mattie, and what he was doing. We decided to video Mattie’s behaviour and his head bobs. Sod’s law we thought, we’d get the consultants appointment and Mattie will be perfect, no head bobs – at least this way we’d have one on record to show.
I’d let work know I would work from home on the Monday of the appointment with the consultant. I had a lot to do with a work conference scheduled in London the following week, working from home made sense. I had imagined that for Mattie’s appointment that I’d only be out of the office for a couple of hours, returning directly afterwards.
Sitting in the consultants office, with Mattie on my knee we described the head bobs to him. He didn’t seem really concerned. Then Emma offered him the video on her phone.
“They look like spasms” he said.
The consultant advised us that we needed to get an EEG to check him out. He made a phone call from his desk and found space on a ward for Matthew. He filled in the admission slip, collected together all of Matthew’s notes and made asked us to wait outside while he dictated a letter to our family GP. He came out and met us, asked us to walk around to the hospital, Mattie’s notes in our hands and go straight to the admissions office.
Temple street is like a maze. Walking from the admission office to the ward was not straight forward. Honestly if you’ve ever been in Temple Street you’ll know it makes Hogwarts look like a walk in the park. As we pondered what direction to turn, the consultant appeared. “Hello” he shouted, “This way”. He led Emma, Matthew and I to the ward. We’d nothing with us, as we were not expecting to have a hospital visit, so once we’d packed the buggy up, got the hospital tags on Matthew’s arms we were off – into the Neurology department.
With little waiting around we were whisked into a room, Matthew and Emma sat on a bed facing a camera hooked up to a PC / work station. Leads were attached to Mattie’s head and the EEG was started. Just as the EEG kicked off Matthew began spasming.
Baby Matthew having an EEG with Emma at Temple Street Children’s Hospital
“I’m sure you’ll get the results soon.” Once the EEG was complete the operator noted that “It’s very unusual, but the consultant came up in person and handed me the paper work for the EEG. They don’t normally do that.”
The speed at which everything had happened was frightening and reassuring at the same time. We still had no idea what was really wrong with Mattie.
We moved from the EEG room into a waiting room in the Neurology department. The consultant came in to see us. He explained that Matthew had “Infantile Spasms”, the EEG had shown that. He then explained that the Neurology department would be looking after Matthew from here on.
Two members of the Neurology department came in to see us and as they were explaining what was going on, Matthew had another spasm attack. It was a confusing conversation. Looking back I can’t really remember what was said – just that it was cut short with the spasms, and that they were going to start Matthew on a very high dose of steroids and would return him to the ward. He’d be staying in hospital until they could arrange an MRI.
I called Emma’s sister to ask her to collect our eldest little boy, Ben (not yet two himself) from his crèche, while Emma and I worked out who was staying with Matthew and was needed for a hospital stay.
This was to be the start of a very confusing week.
Getting ready for the night ahead
We decided that Emma would stay with Matthew that first night and that I would return home, get our other little boy ready for bed before heading back into the hospital with all the gear needed.
Ben knew something was up the minute I collected him. They say kids have a sixth sense and I do think that’s true. We got home and the house simply felt empty.. dead quiet.. and a little weird to be honest. It was hard not to feel scared when I walked into our bedroom and saw Matthew’s empty cot beside the bed.
As soon as Ben walked into the house he said “Mammy! … Baabaa?” and walked around looking for them.