Best of PediaCast: Food Ingredients, Vaccine War, Seizures in Kids – PediaCast 500

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Show Notes

Description

• PediaCast celebrates our 500^th episode with a special “best of” edition of the podcast. Tune in as we dig into the archive and bring you interviews on food ingredients, the vaccine war and seizures in kids. We hope you can join us!

Topics

• Food Ingredients
• The Vaccine War
• Seizures in Kids

Guests

• Daniel J Scherzer, MD
• Amber Patterson, MD
• Seth Mnookin
• Sara Albert, DO

Links

• Food Ingredients – PediaCast 227
• Froot Loops Comparison: UK vs USA
• Definition of Artificial and Natural Flavors

• The Vaccine War – PediaCast 329
• The Panic Virus: The True Story Behind the Vaccine-Autism Controversy
• Secrets of the MMR Scare: How the Case Against the MMR Vaccine was Fixed
• Secrets of the MMR Scare: How the Vaccine Crisis was Meant to Make Money

• Seizure Action Plan! – PediaCast 372
• All About Seizures & Epilepsy – PediaCast 256
• Infantile Spasms – PediaCast 281
• Febrile Seizures – PediaCast 312
• Creating a Seizure Action Plan – Epilepsy Foundation

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio.

It's Episode 500 for August 25th, 2021. We're calling this one "Best of PediaCast: Food Ingredients, Vaccine War, and Seizures in Kids". I want to welcome all of you to the program.

So, we have arrived at a significant milestone on PediaCast and that milestone is our 500th episode.

[Applause]

0:01:10

Dr. Mike Patrick: Okay, yeah, yeah, that's enough. And as I sit here in August of 2021 and look back toward the beginning of our podcast in July of 2006, I have to say it has been a privilege and a very satisfying 15 years, bringing evidence-based child health and wellness information to all of you, which includes moms and dads from across the United States and around the world.

Our previous 499 episodes have been listened to by literally millions of fellow parents and pediatric providers. And honestly, I am humbled and incredibly appreciative to have had the support of all of you throughout the last decade and a half.

And I'm also thankful to Nationwide Children's Hospital for taking our little podcast under its wing. And they really did that back in the very early days of this podcast and have provided us with time and support and a multitude of guests who have shared their incredible wealth of information on all things related to child health and parenting.

0:02:22

So, it's a lot to be thankful for. And so, to celebrate our 500 episodes, I wanted to mark the occasion by pausing and considering the past before we embark on the road forward to our next big milestone. And I thought a great way to do that would be to share a few favorite interviews from the past.

Of course, they would need to be timeless conversations, ones that are as important in 2021 as they were in the years in which they were recoded. Important topics, ones that resonate with parents now, despite being recorded a few years ago.

0:03:01

And so, with that goal in mind, I begin looking back through 499 episodes. And it really was a trip down memory lane. Of course, it's a trip you can take yourself if you like because our entire archive of past programs remain available at pediacast.org. But it was a difficult choice, selecting three interviews from the past 15 years. But at the end of the day, I feel like I picked the right ones and I'm hopeful that you will agree.

Now, all of these interviews, all three of them were about an hour long on their own. And so, I have condensed them down to about 20 minutes each for today's episode. However, if you are particularly glued in and want to continue listening to one or more of these interviews, I will have links to each one's original episode in the show notes over at pediacast.org.

The first interview was from September 19th, 2012 and that's when Dr. DJ Scherzer and Dr. Amber Patterson joined us for a conversation on food ingredients. We considered many things found in food that we feed our families such as high-fructose corn syrup, food colorings, and dyes.

0:04:12

And those are the two topics covered in today's segment. We explored others in the full interview including natural and artificial flavors, fatty acids, aluminum and growth hormone and antibiotics given to cows and how those impact the milk we drink.

It was a fun and enlightening conversation. Again, you can listen to the full unedited original interview by heading to the show notes and looking for the link.

The second interview was recorded three years later on October 14th, 2015. And that is when New York Times bestselling author and investigative journalist, Seth Mnookin stopped by the studio for a history lesson and a very practical and useful perspective on the anti-vax movement known as the Vaccine War.

When did vaccines become suspect and controversial? How did we go from folks lining up for polio and measles shots to the hesitancy and caution we see in many families today? What exactly happened?

0:05:11

Well, it's an interesting story and I am eager to share it again with you. You'll hear a portion of my interview with Seth today. But again, you can find a link to the full-length version in the show notes.

And then, to round out the show today, we fast-forward another couple of years to March 29th, 2017. And that is when Dr. Dara Albert stopped by to talk about seizures.

And so, we have a very special sort of triple episode for you this week, as we celebrate our 500th edition of PediaCast.

Before we open the archive and relive history, let's run through our usual quick reminders. Don't forget, you can find PediaCast wherever podcasts are found. We are in the Apple and Google Podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music and most other podcast apps for iOS and Android. If you like what you hear, please remember to subscribe to our show so you don't miss an episode.

0:06:02

And please consider leaving a review wherever you listen to podcasts, so that others who come along looking for evidence-based child health and parenting information will know what to expect.

We're also on social media and we love connecting with you there. You'll find us on Facebook, Twitter, LinkedIn, and Instagram. Simply search for PediaCast.

There's also that Contact link over at pediacast.org if you would like to suggest a future topic for the program.

Also, I want to remind you the information presented in each and every episode of our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.

So, let's take a quick break. We'll get our interview queued up on food ingredients, the vaccine war, and seizures on kids. All three topics coming up right after this.

[Music]

0:07:29

Dr. Mike Patrick: I've decided to call our group today "The Foodies" and actually we had so much fun putting this show together that I've already asked if they would be willing to come back in a few months to answer some of your questions about food. So, as we go along, if a particular question pops into your head or a different food ingredient comes to mind, just write it down, send it in and we'll try to get the answer the next time we meet.

So, who are The Foodies? Dr. DJ Scherzer is an attending physician with the section of Emergency Medicine at Nationwide Children's Hospital and an associate professor of pediatrics at the Ohio State University College of Medicine. Dr. Scherzer is no stranger to PediaCast. He joined us in the studio back in Episode 178 to talk about anaphylaxis, just a life-threatening allergic reaction.

So welcome back to PediaCast, Dr. Scherzer.

0:08:13

Dr. DJ Scherzer: Hey, thanks, Dr. Mike.

Dr. Mike Patrick: We really appreciate you stopping by.

Also joining me in the studio is first-time PediaCast guest, Dr. Amber Patterson. Dr. Patterson is an assistant professor of Pediatrics at the Ohio State University College of Medicine and an attending physician with the section of Allergy and Immunology here at Nationwide Children's Hospital. So, let's offer a warm PediaCast welcome to Dr. Patterson.

Dr. Amber Patterson: Hi, thank you for inviting me.

Dr. Mike Patrick: Thanks for stopping by. Really, really appreciate both of you taking time out of your busy schedules to talk about food. So, here's how it's going to work, each of us researched two common and potentially controversial food-related items. And we're going to take turns asking each other questions about the topics we selected.

So, first stop is me asking Amber. And we're going to dispense with the doctor titles for this particular show. I mean, if we're going to be The Foodies, it just feels right to go less formal. You know what I mean?

Dr. Amber Patterson: Yeah, I agree.

0:09:08

Dr. Mike Patrick: So, I'm going to ask Amber about high-fructose corn syrup. I guess a good place to start is what exactly is high-fructose corn syrup?

Dr. Amber Patterson: Sure. Good question. High-fructose corn syrup is a liquid sweetener made from highly processed field corn. In some countries, it's called glucose-fructose syrup, description of the mix of sugar contained in the syrup.

And there are three varieties of high-fructose corn syrup named by the percent fructose that it contains. There's high-fructose corn syrup 90, which is 90% fructose, 10% glucose. There's high-fructose corn syrup 42, which is 42% fructose, 53% glucose. And then there's high-fructose corn syrup 55, which is 55% fructose and 42% glucose.

Now that 55 and 42 are the ones that are used as sweeteners and preservatives to prolong shelf life in many processed products, drinks, breads, cereals, breakfast bars, lunch meats, you name it.

0:10:07

Dr. Mike Patrick: So, once we get then to high-fructose corn syrup, they put it in the foods, why do they do that? Why do we go to the trouble to make sweetener from corn? Why not just use cane sugar?

Dr. Amber Patterson: The bottom line is money and politics. High-fructose corn syrup has really enjoyed being the darling of the processed food industry over the last 40 years. And here is how the story went down.

So back in '57 there were two guys, Marshall and Coy, who first kind of invented high-fructose corn syrup. But they didn't really have what it took to get it mass produced. So, it wasn't until the late 60s, almost a decade later, that the Japanese were able to do it. And by 1975, high-fructose corn syrup was beginning to be rapidly introduced into many processed foods and soft drinks in the United States.

Now, watch the timeline here closely. In 1975, that's when high-fructose corn syrup was introduced into our industrial production. Then two years later, in 1977, the United States imposed the system of sugar tariffs and sugar quotas that significantly increased the cost of imported sugar. And United States producers wanted a cheaper sweetener.

0:11:19

On top of that, corn costs were kept low because the government employed subsidies to pay the corn growers. So, between the sugar tariffs doubling the price of sugar and corn subsidies ultimately lowering the price of high-fructose corn syrup, high-fructose corn syrup sidestepped sugar as the more economical choice.

And then, because of that, what we've seen in time is consumption of fructose has paralleled the rise in obesity and metabolic syndrome, especially in kids. And recent NHIN's data tells us that about 15% of Americans taken in over a quarter of their energy in the form of added sugar. And that doesn't count the natural sugars consumed in unprocessed foods.

Then when you look at adolescents alone, they're the highest ingestures of sugar, period. But 20% of them consume more than a quarter of their total calories from fructose since the majority of products use that sweetener.

0:12:10

Dr. Mike Patrick: So, we know what's in high-fructose corn syrup, how does that differ from just granulated cane sugar?

Dr. Amber Patterson: Now I have to say, Mike, when I looked into this, I was actually surprised that there are probably more similarities between the two than differences.

The main difference is that high-fructose corn syrup is much more highly processed than table sugar. So, there's the possibility for more exposure to enzymes and reagents used in that processing.

But similarities abound. They both come from grasses. Table sugar is made from the cane sugar plant, which is a type of grass. And high-fructose corn syrup is made from corn, which interestingly is also a grass. Both are processed from their natural state resulting in sweet crystals in the case of table sugar, and syrup in the case of high-fructose corn syrup.

0:13:01

Chemically speaking, they have similar compositions as well. Table sugar is sucrose. And sucrose is fructose plus glucose and it's about half fructose. And the sugar in high-fructose corn syrup is also fructose and glucose, with either 42% or 55% fructose. So really, both contain around 50% fructose.

Sucrose, that table sugar and high-fructose corn syrup 55 are about the same sweetness. 42 is a little less sweet. 90 is much sweeter. And they both have similar endocrine and metabolic effects.

Now, where we do see differences in how our bodies metabolize sugar is between fructose and glucose. But again, both of these products contain both sugars.

Dr. Mike Patrick: So, they're really similar, it just takes more processing to get high-fructose corn syrup.

Dr. Amber Patterson: Yes.

Dr. Mike Patrick: I guess then the next question is, if they're so similar, is there any harm in eating it?

Dr. Amber Patterson: I guess that depends on who you ask, because if you ask the Corn Refiners Association, they believe their product is safe and the FDA supports that. You'll find others who disagree.

0:14:09

And I guess this is where it gets good, folks, because let's start with genetically modified foods. Most field corns are grown from a genetically modified seed developed by a company called Monsanto. And this company single-handedly spearheaded the development of genetically modified seeds.

The majority of field corn grown in this country is genetically modified. So, you can virtually guarantee that all high-fructose corn syrup is made from genetically modified corn.

Now, on top of that, two of the enzymes used in the production of high-fructose corn syrup are also genetically modified. Alpha-amylase and glucose isomerase are genetically modified enzymes.

Now, let's move on to mercury exposure. Several studies have come out over the last decade finding detectable mercury, a known neurotoxin, in products containing high amounts of high-fructose corn syrup. Indicating that maybe it's not just the high-fructose corn syrup or the fructose itself that's only harmful but maybe there are some reagents used in making the syrup that are also to blame.

0:15:09

Now, the manufacturing plants that make high-fructose corn syrup are called chlor-alkali manufacturing plants. Historically, they used mercury cells for production of caustic soda and other acids involved in production of high-fructose corn syrup. And this may give some explanation from where this mercury may be coming from.

Now, industry representatives will argue all day long that mercury cells are outdated technology and industry doesn't even use these methods anymore because there are mercury-free alternatives that are more energy efficient. But one study done under the direction of the FDA doesn't quite agree with that.

They sampled high-fructose corn syrup 55 and 42 from three different US manufacturers and the study that they published in the Journal of Environmental Health in 2009 shows us that they found almost half of the 20 samples that they collected from the manufacturing plants contain detectable levels of mercury.

0:16:06

And then, another study published in the same journal by Dr. Wallinga and colleagues, they tested products right off the shelves of a grocery store. They sampled only products where high-fructose corn syrup was the number one or number two ingredient. And they included a variety of different commonly purchased products from cereal bars and yogurt to barbecue sauce and ketchup.

They tested 55 samples. And they found detectable mercury in 31% of them. Now, many of the companies that were targeted in the study responded to note that their foods contain well below the EPA's safe exposure level. So, you have to take that into consideration as well.

And then finally, fructose. High-fructose corn syrup is about half fructose. And we know that liver breakdown of fructose results in sustained elevations of triglyceride levels after meals.

We also know that increased fructose consumption, especially when we're talking about sugar-sweetened drinks, which in this country are mostly sweetened with high-fructose corn syrup, has been implicated in promoting weight gain, visceral adiposity, dyslipidemia, insulin resistance and glucose intolerance and fatty liver.

0:17:14

Dr. Mike Patrick: That doesn't sound good.

[Laughter]

Dr. Amber Patterson: It doesn't sound good.

Dr. Mike Patrick: But some of those things, there is also fructose in table sugar.

Dr. Amber Patterson: Exactly.

Dr. Mike Patrick: So, some of those risks are there with table sugar, just not the possibility of mercury exposure kind of thing.

Dr. Amber Patterson: Exactly.

Dr. Mike Patrick: So how do parents know if a product contains high-fructose corn syrup?

Dr. Amber Patterson: You have to be a good label reader. You can look for high-fructose corn syrup in the ingredients. And in this country, it should say high-fructose corn syrup. But sometimes it will masquerade in the abbreviated form, so it might just have the initials HFCS or it might say HFCS solids. Sometimes, it will say fructose syrup or fructose solids.

Now, there was a push a couple of years back to switch the name of high-fructose corn syrup to corn sugar. You may have heard about this. The Corn Refiners Association felt that it would better represent their product and kind of rescue them from some public discontent about high-fructose corn syrup.

0:18:13

So, in 2010, they applied to the FDA to formally make this name change. And after 20 long months, this summer, the FDA finally released their decision and they rejected the application.

So, thank you, FDA. They felt it would be misleading to change the name and they required that they continue to promote the product as high-fructose corn syrup.

Dr. Mike Patrick: Very good. Kudos to the FDA.

Dr. Amber Patterson: Exactly. Now, you can also look for foods that advertise that they're non-GMO of non-genetically modified because like I said earlier, most field corns used to make high-fructose corn syrup is genetically modified. So, if the product is claiming that they don't contain genetically modified ingredients, then it would assure that there was no high-fructose corn syrup.

Dr. Mike Patrick:  All right, we're going to move to colorings and dyes in food. So, I've seen like dye-free products out there, especially like children's medicines, so acetaminophen, ibuprofen, Benadryl, out on the shelves. What's the concern with dyes?

0:19:15

Dr. DJ Scherzer: A lot of people are concerned that these dyes, which were originally made from coal tar and now from petroleum, can be carcinogenic. And I think an even more popular concern is that they may facilitate or contribute to problems with attention deficit disorder or other behavioral difficulties.

Actually, in the 1970s, there was an allergist named Dr. Feingold who found that when he eliminated some food colorings from some children's diet that their behavior actually improved. And there have been quite a number of studies since then trying to either confirm or deny these suspicions.

Dr. Mike Patrick: So, you said petroleum-based, so food colorings are made of petroleum?

0:20:00

Dr. DJ Scherzer: Well, food coloring can come from vegetables, minerals, animals, predictably certain insects, and also from petroleum. The petroleum-based products are the ones that the FDA certifies and names with a number like red 40, yellow 5, yellow 6.

Dr. Mike Patrick: So, petroleum, like what you use to make gasoline with?

Dr. DJ Scherzer: Yeah. You can color your food, or you can degrease your engine.

Dr. Mike Patrick: So why do we color food in the first place? Why not just let it be its natural color?

Dr. DJ Scherzer: Well, essentially just to make something look better than it really is. We're naturally attracted to colors, maybe it's even instinctual, maybe it's part of how we identify nutrient-rich foods. But food colorings are kind of fun, they're rich. They're bright, they're vibrant and they sell well.

Dr. Mike Patrick: So, are there any studies to support real concern with food coloring?

Dr. DJ Scherzer: There are a lot of studies, and it's a difficult thing to study. For the most part, the evidence is pretty weak but there's something there.

0:21:02

Recently, relatively recently, in 2007, The Lancet, which is a very well-known medical journal, it's known now worldwide, published a study in which about 260 kids were studied over a period of several weeks. And these kids had been given three different concoctions of fruit drinks. They were indistinguishable from each other by appearance or by taste.

And all of the children kind of rotated through which drink they got. One of the drinks was a placebo, it was actually pure fruit juice. And their behaviors were rated using a standardized scale by parents and teachers. And this was a double-blinded trial. In other words, nobody knew who was getting what drink.

And in the end, when the results were decoded, when they found out which child was drinking what and correlated them with what their test scores were at that time, they found that there actually was a significant difference in children's behaviors. As a group, wasn't for every child, but for a group of children.

0:22:06

There was a significance difference in how children were rated on hyperactivity scales when they were drinking the concoction with the highest amount of food coloring versus the one with the medium amount and the one with none. And the high amount was still within the realm of what kids might typically eat.

Dr. Mike Patrick: So, with studies like that out there, have regulatory agencies responded?

Dr. DJ Scherzer: Yes. So, in England and Europe, this has actually been a really big deal. Actually, all the countries called for a ban on these colorings and a few of them actually outright banned them. The European as a whole actually had required as of 2010 that foods with these colorings on them have a warning label saying that these particular petroleum-based dyes are associated with hyperactivity.

There are a number of American multinational food companies that have big business in Europe and England. They don't want these labels on their products which can scare away consumers. And interestingly, they actually did change their ingredients.

0:23:10

So, Kraft, Kellogg's, McDonald's, Nestle's, Mars, the company that makes M&M's, they actually make their products with vegetable-based food colorings in Europe and in England because of this. That has all occurred in the last few years.

Dr. Mike Patrick: So that may be coming here. Possible.

Dr. DJ Scherzer: Maybe. Maybe. The FDA's stand, and just to paraphrase them, is that findings from relevant clinical trials indicate that the effects on behavior appear to be due to unique individual intolerances rather than any inherent neurotoxic properties of these substances. That has been their stand. There are some indications that they're going to look at this a bit differently, but we'll see.

Dr. Mike Patrick: So, it may not be that the FDA rules against it, but maybe the consumer if we start looking at "Does it have those numbers?" so they are the petroleum-based ones. I mean if the consumer push maybe away from that possibly.

0:24:09

Dr. DJ Scherzer: Yeah. It's an interesting issue. One can make a very reasonable argument that the evidence is weak, or weak to moderate. But everything we do is a matter of benefit versus risk. So perhaps the evidence for risk is weak, but on the other hand, the benefits are also weak. So, if there's something that has a high benefit, you’re willing to accept the high risk. If something has little or no benefit, you should probably accept no risk.

[Music]

0:25:07

Dr. Mike Patrick: We are back. It is an honor and a pleasure having Seth Mnookin in the PediaCast studio today. Seth serves as co-director of MIT's Graduate Program in Science Writing and is an accomplished author and journalist. His work has appeared in Newsweek, The New Yorker, Wired, Vanity Fair, The New York Times, The Washington Post, The Boston Globe. I could name many more.

He's also The New York Times bestselling author of Feeding the Monster: How Money, Smarts, and Nerves Took a Team to the Top, which chronicles the challenges and triumphs of the John Henry-Tom Werner ownership group of the Boston Red Sox.

More recently, his writing has turned toward science, which has resulted in recognition by the National Association of Science Writers with their Science in Society Award in 2012, and by the New England Chapter of the American Medical Association with a Will Solimene Award for Excellence.

The FDA has also taken notice, including Seth as a member of the Expert Working Group on Medical Countermeasure Emergency Communication Strategies. His most recent book is The Panic Virus: The True Story Behind the Vaccine-Autism Controversy.

0:26:08

That's what we're talking about today. So, let's give a warm PediaCast welcome to Seth Mnookin. Thanks for joining us.

Seth Mnookin: Thank you for having me.

Dr. Mike Patrick: Really appreciate you stopping by. So your book came out in 2012, but it's just as relevant today as it was then, probably more so, given the Disneyland measles outbreak, last month's GOP presidential debate with assertions that again, vaccines are linked to autism, kids get too many vaccines, we should be giving lower doses, none of which is based on evidence. So, it's a great time to be talking about these things and for parents to be reading your book.

Seth Mnookin: Yeah, the hard copy actually came out even earlier, in 2011. The paperback, which is slightly revised, came out in 2012. I remember, actually, at both publication dates thinking because of recent events in the news, "Okay, well, this is sort of a done deal. No one's going to be talking about this anymore."

0:27:03

When the hard cover came out, that was not long after Andrew Wakefield lost his medical license, the doctor who is the original proponent of the idea that the measles-mumps-rubella vaccine cause autism. His paper had been retracted by The Lancet. I figured, all right, well, we're done here, and that has obviously not ended up in the case.

Dr. Mike Patrick: Yeah, unfortunately. Fortunately for you, I guess. Unfortunately for kids.

[Laughter]

Seth Mnookin: I'd be happy if it disappeared.

Dr. Mike Patrick: Now, how does a journalist, and you written a book about the Boston Red Sox, how do you become interested in writing about science?

Seth Mnookin: Well, my undergraduate degree was in History in Science. Right after I left school, I started a career in journalism. There were a couple of different points over the next decade, or decade and a half, where I try to get back into science writing. And for one reason or another, it didn't work out.

0:28:03

My book about the Red Sox did fairly well through no fault of my own. But my publisher, I think, probably misinterpreted its success as having to do with me and not the team. And so, I'd some more freedom and latitude to choose the topic of my next book. This was a subject that I had noticed was coming up a lot in discussions with my peers.

When I started working on it, my wife and I were not parents and we're not expectant parents, but a lot of our friends were. And again, and again and again, in conversations at dinner parties or over brunch, these issues of vaccine safety and efficacy would come up.

What got me interested in it, initially, was that when I asked my friends, "How is it that you're making this decision? This is one of the most fundamental decisions you're going to need to make about your young child's life." I didn't get answers like, "Well, I'm reading the relevant literature" or even, "I'm talking to my doctor."

0:29:15

People tended much more to say, "Well, it feels to me as if kids today are getting too many shots too soon." Or, "It seems like it couldn't be that bad to skip extra Y vaccine".

And at that time, I had no idea it was possible that their intuition was true. I had no idea. It wasn't something I would look into. But I was surprised that my friends were making decisions about a scientific issue based on instinct. I think I sort of snobbishly associated that with people who ignored climate science or maybe people who didn't believe in evolution.

0:30:04

So, I thought that surely none of my group of lawyers and computer programmers, and scientist, and journalists are making decisions in a similar way, based on instinct and intuition as supposed to looking at the evidence.

So that was what really started this whole investigation and this whole process. And then, it became much more about this specific issue than that sort of philosophical question of how do we, as a society and as individuals, decide what counts as truth?

Dr. Mike Patrick: When I was early in my career as a physician, it was before the whole Andrew Wakefield fiasco took place, you'd have a few people that would question it. And they were really far between one another that you'd encounter these folks. And it really was around 1998, when we just started to see more and more parents sort of be aware of this and start questioning.

So, I really do think that the vaccine issue now really did start with Dr. Andrew Wakefield. Let's frame a little bit. Who was he and what did he have to do with all these?

0:31:16

Seth Mnookin: That's a great question. But just before, I want to go back a little bit more. So, I think you're definitely right. I don't know when your medical career started, but there was also a moment in the mid and both the late 70s and early 80s, where there was similar fears, not exactly the same but similar, surrounding the DPT vaccine. Those fears are actually one of the big reasons why the pertussis vaccine went from being whole cell to acellular.

There is a sort of similar parent-led movement of parents who were convinced that their children had been harmed by the pertussis vaccine. One of the main leaders of that movement, a woman named Barbara Loe Fisher, continuous to be active to this day. But there was a period of about a decade where this type of issues running vaccines were really weren't in the news a lot. It wasn't a huge issue on people's minds.

0:32:24

And then, in 1998, Andrew Wakefield, who is a British gastroenterologist, published or was the lead author on a paper that appeared on The Lancet, a very respected medical journal, that posited a connection between the measles component of the MMR vaccine and a new gut disorder, and then that gut disorder and autism.

So, the paper itself was careful to say that there wasn't any mechanism that they had identified. This was essentially hypothesis that needed to be studied and tested. It was nothing more than that.

0:33:09

But Wakefield, when he then had interviews about this paper and actually held a press conference, he went way way off the reservation and essentially acted as if he had proven there was a connection, told parents not to give their children the MMR vaccine. That really started this period that we're still living in, where there is all this concern about that.

One of the things, when I went back and looked at it, that was so interesting to me is it's easy to posit Andrew Wakefield as being the culprit here. Certainly, I think he was a bad actor in this controversy, but anyone can say anything at any point. The problem with what happened with him is the UK press took what this one person was saying and treated it as in "on the one hand, on the other hand" debate.

0:34:08

So even though from the word go, other pediatricians, the head of his medical school, some of the other authors were all saying, "Wait a minute, we don't have any evidence that indicates that people should change their behavior. At best, this is something that deserves to be looked at more." In the press, it started to be treated as "This guy thinks this. This guy thinks this." Who knows what the real answer is?

Again, and again, I think we've seen that treating a tiny minority of viewpoints as essentially being worth and worthy of a more serious examination in the media. And so, I think that my colleagues and my peers actually bear an enormous kind of responsibility for what has happened since then.

0:35:01

Dr. Mike Patrick: I think you make a good point that you can't necessarily take these as being having equal evidence. And so, if we dig down just a little bit deeper on what exactly it is that he thought and then what he did to show what was his evidence, all scientific studies start, as you mentioned, with the hypothesis. His hypothesis was that the MMR vaccine, which does have a live attenuated virus or there is the live measles virus that, again, this is his hypothesis, that that leads to a chronic infection with that measles virus. Which leads to a type of inflammatory bowel disease, which leads to toxins entering the body, which leads to brain damage which leads to autism. So that was kind of his hypothesis.

And then the study that he was talking about with his press conference just involved 12 children.

Seth Mnookin: Right. And that's a crucial point. I talked to some of the reporters who wrote those initial stories in the UK. One argument that they made was it's not their place to evaluate evidence.

0:36:08

I don't really buy that as an excuse for running these stories for a couple of the reasons that you just pointed out. A case series is never under any circumstances the basis for a conclusion. It's the basis for a hypothesis. It's the basis for "this deserves further study."

There are all sorts of examples that I give. Oftentimes, when I'm giving talks, I'll point to the first 12 people sitting in the audience and say based on that case series, 80% of the population is female, and 90% of the population is over the age of 30, based on whatever the characteristics those 12 people have. So, drawing any conclusions from that small study is crazy.

And anyone who's writing about science and writing about medicine and writing about issues that have the potential to really significantly impact the health of the population, I think, needs to understand that at the very minimum.

0:37:09

Then, the second point he made, he wasn't saying that, "Oh, I think A leads to B." He was saying, "I think, A leads to B, which leads to C, which leads to D, which leads to E," and there is no evidence of any of those steps. It was all hypothesis. Parts of those hypotheses were based on theories that had already been discredited. One of the theories was the opioid theory of autism which had been discredited decade earlier.

So, you didn't need to have a sophisticated understanding of immunology or gastroenterology, or really any branch of science, to know that this is not the study that you should be drawing broad-based conclusions from.

0:38:00

Dr. Mike Patrick: Now, once this came out, it didn't take long for there to be immediate backlash, where investigators really around the world was like, "Look we're talking about a study of 12 kids." And then they started to look a little bit deeper into this and found that it wasn't only skewed and maybe coming up with saying prematurely that there was an association. It was fraudulent.

Seth Mnookin: Yeah. The revelations that have come out since the initial publication are shocking. If you wrote a screenplay or something based on this, you would say, "You can't have all that because you're stacking the deck. It's too much." So, it turned out that Wakefield had been receiving money from a lawyer who was preparing a case against vaccine manufacturers, who was working with parents who believed that their children had been injured by vaccines.

His patients, which he claimed had been consecutively referred, so in other words, it just happened to be 12 random patients one after another who came in to his clinic, were actually sent specifically to him, some of them, by this lawyer who's trying to prepare a case against vaccine manufacturers.

0:39:10

He declared no conflicts of interests in the study. What he did not declare was that shortly before the paper came out , he had taken out a patent for a measles vaccine that would exist on its own, which would be precisely what parents would want if they thought that something about combining the measles-mumps-rubella vaccine was what made it dangerous, which was what he was arguing.

And then, as if that was not enough, it turned out that some of the results were likely fraudulent as well. So, anyone of those things would have been enough to discredit the study. But again, the point that I make with the journalists is even if none of those things have been true, it's crazy to take 12 kids and say, "This is what parents should do based on this."

But the string of revelations about Wakefield, it's not even ethical corners that he cut. Its completely unethical behavior is really astounding.

0:40:12

Dr. Mike Patrick: There was another investigative journalist by the name of Brian Deer in the United Kingdom who also investigated this. He wrote a two-part series that was published in the British Medical Journal that was really well done. I'll have links to that in the show notes as well so for folks who are interested more about it. It ended up none of them even had inflammatory bowel disease. In follow-up testing, they were all negative for any kind of chronic measles infection.

Seth Mnookin: He also talked to some of the parents. And some other things that he uncovered was the fact that a lot of Wakefield's conclusions were based on parents' after-the-fact recollections, which are notoriously unreliable. We could get into a whole discussion to why that is, but it's incredibly unreliable to take a parent's or anyone's memories about a potentially traumatic event and assume that represents what actually happened.

0:41:14

But one of the things he uncovered was it turns out that these traumatic events that they had remembered actually were not what they had told him in some cases, anyway. So again, it's just every single step along the way.

Brian Deer is someone who did a lot of the initial work uncovering all the problems of Wakefield's study. While it's true that after his investigation started coming out in the early 2000s, then more critical examination was paid to Wakefield, there really was a couple of years where no one dug into what was going on there. It took Brian Deer to come, this incredibly dogged investigative reporter, and say, "Wait a minute, what is going on here?"

0:42:04

Dr. Mike Patrick: So, we really need people like you and him who look into these things and can uncover it and present it in a way that folks can understand, so that we can see what's really happening.

Seth Mnookin: Right. Well, thank you. He probably gets more credit than I do in that regard but thank you.

Dr. Mike Patrick: Now, one question that comes up is how is it that a doctor, a researcher can get collaborators on to a study like this? So, Wakefield wasn't the only name on this research. There's other people who basically their names are on it as well. How was he able to convince them that this was a good idea?

Seth Mnookin: So, I think that highlights something about how scientific research is conducted, that a lot of people don't understand. And the reason they don't understand it is because it intuitively doesn't really make sense. But, when you see a paper with 10 or 12 or 15 authors, co-authors on it, they each could have contributed one piece of data. But because they have one piece of data that's included in this, they get credit as co-author.

0:43:11

That's why there's always a lot of jockeying as to what position you are, if you're the first lead author. The last author is also an important spot.

But there is just another example not that long ago of the case of the study about changing people's minds that was based on canvassing about gay marriage. There was a study that claimed that when gay canvassers went in California and canvas people who were opposed to gay marriage and spent 20 minutes with them talking about why it was important to them to get married, et cetera, they could change people's minds.

And this was the study that the lead author ended up being a very prominent scientist from Columbia University. It turned out the grad student who had submitted those results had made them up. So that paper was retracted.

0:44:11

Now, there's criticism that the lead author should've had more oversight, and that's probably true. But I think what that illustrates is the scientific process is based on trust. And if you're going to collaborate with other people, you need to assume that when they say, "I found this," that they really found it.

In that way, it's very similar to journalism. You couldn't ever put out a daily newspaper if you have to go and re-report every single thing in the newspaper before it was published. The assumption is that most people are doing this in good faith. And when it turns out that someone is not, that's when it becomes an issue.

So, there has been criticism of his co-authors and some of his co-authors have held on to this more tightly than others, but most of them have disavowed his work.

0:45:04

[Music]

Dr. Mike Patrick: Dr. Dara Albert is a pediatric neurologist at Nationwide Children's Hospital and an assistant professor of pediatrics and neurology at the Ohio State University College of Medicine. Dr. Albert is passionate about helping kids who suffer from epilepsy and the education of families and caregivers regarding best practices for preventing and treating seizures.

As it turns out, a very helpful tool in the management of epilepsy is the seizure action plan. That's what Dr. Albert's here to talk about today, seizures and action plans.

So, let's give a warm PediaCast welcome to Dr. Dara Albert. Thanks so much for stopping by.

0:46:08

Dr. Dara Albert: Hi, Dr. Mike. Thanks so much for having me. It's a real pleasure.

Dr. Mike Patrick: Yeah. Really appreciate taking time to help us all understand this a little better.

Dr. Dara Albert: Absolutely.

Dr. Mike Patrick: So, let's talk first, just a reminder, what is a seizure?

Dr. Dara Albert: So, neurologically, a seizure is an episode of excessive discharges coming from the brain. And clinically, it can look like all different kinds of symptoms. So, someone might become unconscious. They might fall to the ground. They might have shaking. They might just be staring and unresponsive.

And it typically occurs in paroxysmal episodes, meaning that the patient is normal in between, and then they have this episode. And then, they're normal afterwards. 

Dr. Mike Patrick: So, the brain really just starts firing neurons randomly. And depending on which neurons fire, then that will determine what symptoms that you see in terms of if it's motor neurons. Then, you're going to see muscle movement.

Dr. Dara Albert: You got it.

Dr. Mike Patrick: And then sensory neuron, then someone may have hallucinations or smell something, any of those kinds of things.

Dr. Dara Albert: Yep, you got it.

Dr. Mike Patrick: Then, at what point do we say a child has epilepsy?

0:47:13

Dr. Dara Albert: So if someone has had two or more seizures that are unprovoked. So, someone who has a seizure with a fever that we call febrile seizures, that's doesn't count. But someone who has had two or more seizures that are unprovoked, we consider epilepsy.

Or if someone has had one unprovoked seizure and a risk factor for a second one, such as a tumor or a stroke or something, lesion in the brain or abnormalities on EEG that tell us that they're at high risk for having another seizure.

Dr. Mike Patrick: Then we would call that epilepsy. Or seizure disorder would be another name for it.

Dr. Dara Albert: Right.

Dr. Mike Patrick: And then, there's certain patterns of seizure that we can see so that we can then begin to characterize seizure types. What are some of the types of seizures that kids can have or adults, too?

0:48:02

Dr. Dara Albert: There are two kind of broad categories, one being generalized, meaning that it's coming from the whole brain at once. And this is a distinction that we can make both by the EEG and clinically. But by definition, if someone's having a generalized seizure, they're going to be unconscious. So, the whole brain is affected at once. They're going to lose consciousness.

As opposed to a partial seizure, which is a seizure that originates from one part of the brain. Some other words that we use might be focal or localization-related, meaning that the seizure is coming from one particular part of the brain. And those are the seizures that you might see that affect maybe one side of the body.

The patient might be awake. They might be awake but somewhat altered, like seem a little bit confused or dazed and not really responding normally, but they could still potentially be conscious.

So, those are kind of two broad categories of the way we group or classify seizures. And then, we can further categorize based on the characteristics. So, as you mentioned before, if the muscles are involved, motor movements, we would call that motor seizures. You could have a generalized motor seizure or a focal motor seizure.

0:49:13

And then, we kind of describe what the movements are. The classic one that everybody always seen at least in the movies is what we called the generalized tonic-clonic seizure or it used to be called grand mal. So, patient is unconscious, again, because it's generalized. And then, they have tonic stiffening of the body followed by clonic jerks which are jerking movements. And so, that's kind of word we used to describe generalized tonic-clonic.

Dr. Mike Patrick: And then when you talk about that old term, grand mal, and then there was another term petit mal or absence seizure, tell us what those are.

Dr. Dara Albert: The terminology for petit mal was to refer to smaller seizures. 'Small bad' being the literal translation, right? And that terminology was used for a bunch of different seizures, not just absence.

0:50:03

So, absence are very specific type of seizure that are staring spells where the child will suddenly become unresponsive and stare and may have eyelid fluttering. Sometimes, they have lips smacking and those kinds of movements. But it correlates with a very specific EEG pattern, that's a generalized pattern.

Versus there are other kind of seizures where someone might stare off and be unresponsive. That could be focal or partial seizures, such as someone with a temporal lobe epilepsy that might just have staring spells.

Dr. Mike Patrick: So, seizures can really come in all sorts of varieties.

Dr. Dara Albert: Yeah, many different flavors.

Dr. Mike Patrick: If parents are concerned that their child may have had a seizure, really just want your child to be seen, describe what you saw. If you can capture it on, everybody's got a smartphone now, it can show you exactly what it look like.

Dr. Dara Albert: Yes.

Dr. Mike Patrick: Because there are things that really are going to be seizures and others that aren't. So, if you have a concerned, talk to your doctor about it and let them know what's going on.

0:50:59

Dr. Dara Albert: Yeah, absolutely. The most important features of seizures are typically what we call stereotype, meaning that they look the same every time. So if a child is having an event that happens a few times and it's paroxysmal, meaning that like I said before the child is normal beforehand, and then they have this event and then it goes away, and then they have it again, and it looks exactly the same as the first one, that would be concerning and would warrant further evaluation.

Dr. Mike Patrick: For folks who are interested in lots more information about seizure disorders, I just want to mention a couple of past shows that we have done. And I'm going to put links to these shows in the show notes for this episode, 372, over at pediacast.org. Dr. Anup Patel, another pediatric neurologist here at Nationwide Children's, back in episode 256, talked all about seizures and epilepsy. And that one will really go into the science of seizures and what causes them.

And so, if you're interested especially in those generalized tonic-clonic to the grand mal of seizures that folks are most familiar with, you'd want to listen to that episode.

0:52:04

There's another kind of seizure that affects babies called infantile spasms. And those are really important to recognize and treat early because there can be a problem with normal development if those aren't recognized and treated. And so, on Episode 281, Dr. John Mytinger was here to talk about infantile spasms.

And then, PediaCast Episode 312, we talked in pretty much detail about febrile seizures or seizures that happen in young children with fevers. And so, folks may want to listen to that episode. Again, I'll put all the links to all of these so you can find it easily.

As we continue along, how common are seizures?

Dr. Dara Albert: Epilepsy affects about 1% of the population. So, anyone of us have a 1% chance that we might develop seizures at some point in our life.

Dr. Mike Patrick: Do you see any difference between boys and girls? Or is it pretty much equally distributed among the sexes?

Dr. Dara Albert: It's pretty equally distributed. There are some epilepsies, like you brought up infantile spasms, that do seem to have a little bit higher predominance in males. We think because there's some X-linked genes maybe that contribute to that. But overall epilepsy is equal between the sexes.

0:53:15

Dr. Mike Patrick: You do see family clusters, though. Epilepsy tends to run in families, right?

Dr. Dara Albert: Absolutely, yeah. There's lots of genetic causes, some that we've identified specific genes, and then other families that we haven't necessarily identified a gene. But it does tend to run in families.

Dr. Mike Patrick: What are some of the things that can cause a seizure?

Dr. Dara Albert: You mean a provoked seizure or a person who has epilepsy that trigger a seizure?

Dr. Mike Patrick: That is a great distinction.

[Laughter]

Dr. Mike Patrick: So, let's start with what causes these neurons that kind of fire on their own to begin with? Or do we know?

Dr. Dara Albert: Well, the answer is probably different in many kids. So, we think of seizures as a symptom of a disorder, not necessarily a disorder itself. And epilepsy would be the disorder.

But seizure can be symptomatic of other things as well. For example, a high fever in a young infant, that seizure is a symptom of. Someone who has a brain injury, like he's in a bad car accident or something, might have a seizure that's symptomatic of the injury itself. So, we would call those symptomatic.

0:54:18

And someone who has epilepsy, so epilepsy is probably multi-factorial in origin. Like I mentioned, there had been some genes that we've identified so there can be some genetic disorder causing the seizures.

Sometimes, it can also be symptomatic of an old injury. So, if baby has a stroke in the perinatal period and that leads some scarring on the brain, then later on when the baby's a little bit older, might develop seizures and epilepsy.

So, there's many different causes. We cannot think of seizures as the symptom. And then, part of our workup to try and figure out why a child might be having seizures is doing some investigations to figure that out.

Dr. Mike Patrick: Yeah, to look for past injuries maybe and other structural things that could potentially cause it. But often, you don't find anything and then we go back to "It's probably genetic," and, "It just happens, and we don't understand exactly why those neurons fire like they do."

0:55:11.

And then, you mentioned, and I should have distinguished a little better, in terms of triggers, so things that can then bring about a seizure in someone who’s prone to having them, what are some of those events?

Dr. Dara Albert: So, the three most common, the three big ones are missing doses of medication for a child who’s on medicine, sleep deprivation, so not getting enough sleep, and then getting sick. So, fevers, colds, and infections.

Dr. Mike Patrick: And these things then we'd say they lower the seizure threshold. So, it just makes it easier for those folks who are prone to seizures to have a seizure if they're ill, or they're not getting enough sleep at night, or they're not taking their medicine for their seizure disorder.

Are there other medicines that kids should avoid that could provoke seizures, like over-the-counter things that parents ought to be thinking about not giving their kids who have seizures disorders? Or does it kind of just differ from one kid to another?

0:56:07

Dr. Dara Albert: Yeah. There isn't necessarily specific list. There are medications out there that kind of have that as listed as the potential side effect. But, it's not as though we tell people to avoid specific medicine, unless there's a specific case.

Dr. Mike Patrick: So, if a kid gets an antihistamine medicine and they've had seizures after having that in the past, you might want to avoid those in the future, but not necessarily, universally, avoid it for all kids.

Dr. Dara Albert: Yeah.

Dr. Mike Patrick: Great. Love that practical approach. What about flickering or flashing lights or playing video games?

Dr. Dara Albert: Yeah, good question.

Dr. Mike Patrick: Sometimes, there'll be a warning like "This can cause seizures." What's with that?

Dr. Dara Albert: So, there is a percentage of people with specific kinds of epilepsy. It's usually in the generalized epilepsy, that have what we call photosensitivity. And whenever a child gets an EEG, we always do flashing lights. We put a strobe light in their face. And we can tell based off of their brain waves whether they react to those flashing lights.

0:57:05

Maybe as high of 20% or 30% of patients with generalized epilepsy might have photic response. And those are the kiddos that we would say should avoid the disco and fast flashing lights and that sort of thing.

Dr. Mike Patrick: And that's really helpful for parents to understand, because on the one hand, you don't want to keep kids from experiences that might be fun and social with other kids, if they don't need to stay away from those. And on the other hand, if you are prone to having seizures with those, you want to know that too, so that you can avoid it.

Dr. Dara Albert: Right, yeah. I mean with that trigger specifically, we oftentimes, like I said, can tell based on the EEG. And then, an individual person might have other specific triggers. So, I've met patients who the heat when it gets really hot outside, that triggers seizures.

Other people can have really weird specific triggers like there's reading epilepsy that people might have seizures from reading. Some very very rare, but unusual, what we call reflex epilepsies.

0:58:03

Dr. Mike Patrick: Yeah, very interesting.

How do you go about then diagnosing epilepsy? And you'd mentioned the EEG and kind of doing the work up for to make sure there's nothing structural that's going on. What does that look like in terms of tests that are done?

Dr. Dara Albert: So, the first and most important part is a good history. So, as you guys say in medical school, that 85% of diagnosis is history, right? So, teasing apart the individual details of the event itself, what was the child doing beforehand? What did the event look like? The sequence of the events, what was the first symptom? How did it progress? And then, what does the child look like afterwards?

There's a lot of funny, unusual spells that kids do that are not seizures but might look like a seizure to an unexperienced person, like a parent or caregiver or something. So, the first part is really making sure that it is actually a seizure.

Dr. Mike Patrick: Yeah, absolutely.

Dr. Dara Albert: And then the second thing we want to figure out is, is this a symptomatic seizure? So, is it a seizure caused by an infection, a fever, a head trauma, something else going on? Or is this epilepsy?

0:59:12

And, in fact, probably one of the most common cause for a first-time seizure in a kid is the beginnings of epilepsy. But we can't always tell from the first seizure.

So, then, the next step, once we've determined that the event actually was a seizure, is to get an EEG, which is the brainwave test that looks at activity. And children who have epilepsy oftentimes, but not always, will have abnormalities on their EEG that tell us that they're a person who's at increased risk for future seizures.

Dr. Mike Patrick: Is brain imaging always necessary to figure this all out? So, CT scans or MRI scans, I think a lot of times parents, "When are they get a scan?" Is that something that always happen or not always?

Dr. Dara Albert: Nope, not always. So, in children who have those generalized epilepsies, we tend to think of those as genetic and not caused by some focal abnormality in the brain. So, we don't often get an EEG. For example, one of the most common€¦

1:00:14

Dr. Mike Patrick: Or don't always get a scan.

Dr. Dara Albert: Excuse me, yes.

Dr. Mike Patrick: You always get the EEG.

Dr. Dara Albert: Always get the EEG, don't always get the scan, yeah.

So, one of more common epilepsies that we see in kids is the absence epilepsy that you brought up, which is the generalized epilepsy. So, the kids has the classic story, classic EEG, we don't need to get an MRI, because we know it's a genetic condition and there's not going to be something structural with the brain.

Dr. Mike Patrick: Yeah. And those tests have risks of their own.

Dr. Dara Albert: Exactly.

Dr. Mike Patrick: So, with CT or CAT scans, there's radiation exposure. And MRIs can take a long time and often needs sedation which can have effects.

Dr. Dara Albert: Yeah, so we want to be choosy who gets one.

Dr. Mike Patrick:  So we really want to think risks and benefits, as you do this work up and you just want the neurologist that you trust to walk you down the path of what you need to do.

Dr. Dara Albert: Yeah.

1:01:02

Dr. Mike Patrick: And then, once you diagnose a seizure disorder, how do you go about treating it?

Dr. Dara Albert: So, treatment is medication, first line. Right now, in 2017, we have about 30 different seizure medicines.

Dr. Mike Patrick: There are a lot of them.

Dr. Dara Albert: And counting. Yes, new ones are coming out all the time. So, we try and make an educated decision based on the seizure type and the other characteristics of the patient. We try and pick the best medication that we think for that patient. And start there.

And then, about three-quarters or so, somewhere between 60%, 75% of patients are going to respond to the first medication. If they fail the first medicine because they continue to have seizures, then we have to move on to a second medicine. Chances are probably about 10% to 15% that we're going to be all get them seizure-free.

Once someone has failed two medications and failure because they continue to have seizures, not because they have side-effects, then we consider them what we call medically resistant or refractory or intractable. All these words are synonymous.

1:02:09

And that's when we start to think about other kinds of treatment such as epilepsy surgery. There is implantable devices. And there are special diets that we try.

Dr. Mike Patrick: And marijuana, one of those things. Everybody is talking about medical marijuana. We actually did a show on that in the past, too.

Dr. Dara Albert: With Dr. Patel?

Dr. Mike Patrick: Yes. Yes, with him on our PediaCast CME program, so folks want to know more about that. But those are the exception really. I mean most kids are treated well with the standard medications that are out there.

Dr. Dara Albert: Yeah, yeah, fortunately, so.

Dr. Mike Patrick: One of the things that you had mentioned was the implantable like a vagus nerve stimulator. Tell us a little bit more about that because I've actually come across, in working in urgent care, where a parent may have a seizure disorder and they have one of these with the magnet. And it's good I think for folks to know about this.

1:03:05

Dr. Dara Albert: Yeah, absolutely. This had been around for a couple of decades now. It's a small implantable device about the size of a pacemaker or so. And it's implanted usually in the chest, so similar location of where a pacemaker would be. And there's a little wire that comes up and attaches to the vagus nerve, which is a big nerve that runs through your neck and from the brain down. It sends impulses up.

And it does two things. We set a repetitive impulse throughout the day. Every couple of minutes, it sends up an impulse and we can manipulate the dose that we give.

And then, it also comes with a magnet where if a patient where to have a seizure, you take the magnet and swipe and that sends an extra impulse up the stimulator.

Dr. Mike Patrick: Which can help stop the seizure.

Dr. Dara Albert: Potentially, yeah.

Dr. Mike Patrick: We don't understand exactly how this works, right?

Dr. Dara Albert: Yeah, unfortunately, like a lot of things in medicine, we know that it works some of the time, but we don't necessarily have great mechanism of action.

Dr. Mike Patrick: That makes you wonder how the first person figured it out that this is going to something that will work, but we're glad that they did.

Dr. Dara Albert: Yeah, absolutely.

1:04:12

Dr. Mike Patrick: So, these are ways that we can prevent seizures in someone who is known to have a seizure disorder. What about a seizure itself? You mentioned swiping the magnet if you have an implantable device, but most kids who have a seizure aren't going to have one of those.

What do you do to treat a seizure that is actively occurring?

Dr. Dara Albert: So, good news is that most seizures are going to stop on their own in less than five minutes. The most important thing is first aid. Making sure that the child is safe. Lay them on the ground, make sure that there's nothing around them that they're going to bang into and hurt themselves.

We tell parents to roll them on their side. It doesn't matter which side. It's just so that way, if they have a lot of foaming and secretions, they don't swallow it into their lungs but rather it comes out.

1:05:01

And then wanting to watch the clock. So, when it's your child seizing, it's going to feel like an eternity. But in reality, like I said, most are less than five minutes. If the seizure progresses longer than five minutes, that's when we give rescue medications. And these are medications that we typically prescribe in our clinic preemptively, so that way a family would have it at home.

And there's a couple of different versions that we use. Here at Children's, we favor an intranasal medication call midazolam. It's a liquid version and then we have a little atomizer that converts it to a mist that they would spray up the nose as treatment. There's also a rectal medication that's commercially available called Diastat given for the same indication.

Dr. Mike Patrick: And these are very easy to give, just a squirt up the nose or the suppository in the rectum to give. So, you don't have to fool around with trying to get an IV in or giving a shot. And, of course, it's not practical to give something by mouth in the child who is seizing.

1:06:05

And that's one of the misconceptions too, that you have to make sure they don't swallow their tongue.

Dr. Dara Albert: Yeah, you can't swallow your tongue, it's attached.

Dr. Mike Patrick: Yes.

[Music]

Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.

And really, thanks for your long listening. We've done 500 episodes of PediaCast now and that would not be possible without you the audience. And so, really, just so appreciative of your support over the last 15 years.

1:07:11

Also, thanks to Nationwide Children's Hospital for supporting us.

And in this particular episode, thanks to Dr. DJ Scherzer, Dr. Amber Patterson for sharing their thoughts on food ingredients. Thanks to Seth Mnookin for enlightening us on the vaccine war and to Dr. Dara Albert, thanks for demystifying seizures.

Don't forget, you can listen to those interviews in their complete sense, the unedited versions of those. They are much longer, about an hour each. So, if you like to check those out, we will have links in the show notes so you can find them easily.

Don't forget, you can find PediaCast wherever podcasts are found. We are in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android. 

Our landing site is pediacast.org. You will find our entire archive of past programs there, so all 500 episodes, show notes for each of those episodes, our Terms of Use Agreement, and that handy Contact page if you would like to suggest a future topic for the program.

1:08:11

Reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show.

And we love connecting with you on social media. You'll find us on Facebook, Twitter, LinkedIn, and Instagram. Simply search for PediaCast.

Don't forget about our other podcast. It's not been around quite as long. We've been doing that one since 2015. It's called PediaCast CME. That stands for Continuing Medical Education. Similar to this program, we turn the science up a couple of notches and offer free Continuing Medical Education Credit for those who listen. That includes doctors, of course, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.

And since Nationwide Children's is jointly accredited by many professional organizations, it's likely we offer the exact credits you need to fulfill your state's Continuing Medical Education requirements. Of course, you want to be sure the content of the episode matches your scope of practice.

1:09:06

Shows and details are available at the landing site for that program, pediacastcme.org. You can also listen wherever podcasts are found. Simply search for PediaCast CME.

Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.

[Music]

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.