Two years ago, we faced the possibility that Schuyler was beginning to have absence seizures. This was tough, but not unexpected; the majority of kids with polymicrogyria, as many as 85-90% of them, develop seizures. Over the next couple of months, we went trough the whole process of EEG evaluation, including a fun test where Schuyler had wires glued to her head for a whole weekend. That test was ultimately inconclusive. It didn't record any outright seizures, but it did show a "significant neurological event" occurring periodically on the left side of her brain while she slept. Her neurologist had no idea what it was, only what it wasn't. No seizures, not yet, but maybe... something.
I hate writing about something that might embarrass Schuyler one day, but it's kind of hard to avoid at this point, so I apologize in advance. A few weeks ago, out of the blue, Schuyler had an accident. She peed her pants. A few days later, it happened again. Both times she said she tried to get to the bathroom in time, but didn't make it. She explained, as best as she could, that it just happened. One minute she didn't have to go, and the next, it was too late.
Last night, at the house of a friend, it happened again, catching her completely by surprise. And then tonight, after we got home from school, one minute she was sitting down with her Happy Meal, and the next, she was running to the bathroom, in vain. Another accident.
On none of these occasions was anyone actively observing her in the exact moment. But we know the warning signs; we've known them for years, always kept them in the back of our minds.
Typical absence seizures are primary generalized seizures characterized by brief staring episodes, lasting two to 15 seconds (generally less than 10 seconds), with impaired consciousness and responsiveness. They begin without warning (no aura) and end suddenly, leaving the person alert and without postictal confusion. Often, the person will resume preattack activities, as if nothing had happened. Simple absence seizures are characterized by staring spells alone. In complex absence seizures, which are more common, staring is accompanied by automatisms, such as eye blinks or lip smacking; they may include mild clonic, atonic, or autonomic components involving the facial muscles. There may also be a slight nod of the head or semi-purposeful movements of the mouth or hands. The automatisms tend to be stereotyped, with the same behaviors occurring during each seizure. Penry et al observed automatisms in 63% of all absence seizures. However, the automatisms are less elaborate than those observed with complex partial seizures. There may also be autonomic manifestations, such as pupil dilation, flushing, tachycardia, piloerection, salivation, or urinary incontinence.
"Absence Seizures and Syndromes: An Overview", from Perspectives in Pediatric Neurology
So again we brace ourselves, not for that often-imagined moment when Schuyler falls to the floor in a grand mal seizure and suddenly It Has Come, but rather for the suspicion, the realization that something may already be happening, that the odds may have caught up with her at last. Last time, we wondered because Schuyler had been spacing out from time to time. This time, the signs are even more compelling. And again, we'll put Schuyler in the hands and the sensors of a neurology team in the hopes that they may have their crown of wires attached to her at an opportune moment so that we can finally know if this is beginning in earnest.
Schuyler is eleven now, and we believe that she's old enough for a little more adult conversation about this. She's known about her condition for a while. A number of people have written to me over the years, afraid that words like "broken" and "monster" were going to scar her somehow, but the fact is that we've had some version of this conversation going with her all along. People afraid of how Schuyler might feel if she read my words one day are missing the point. She's been hearing the words, she's been soaking up the concept. Hiding her reality from her would be wrong, and it would be pointless. She faces the big truths in her own way; she processes them in her own time.
She was feeling humiliated by her accident tonight, as she had the night before, so I sat down with her and explained that these accidents might not be her fault. I told her that the same thing in her brain that makes it hard for her to speak clearly, the thing that causes her to drool sometimes and keeps her from eating some foods, that thing might also be causing her to pee her pants every now and then. I explained how our brains run on electricity (which she thought was pretty cool), and that some brains use too much electricity sometimes, which causes them to overload. Those overloads are called seizures, I told her. Some of them are brief and small, so small that the person doesn't know that they had them, while others are bigger.
I told her that we will have to see a doctor again to be sure, but that she might be having those little seizures, and if she is, that might be causing her to pee her pants. I told her that these seizures were cause by the thing in her brain that made her different.
"What's it called?" she asked.
"What's what called?"
She pointed to her head. "The little monster in my brain."
It occurred to me that I might not have ever actually told her this part. "It's got a long name, it's called polymicrogyria."
She thought about that for a moment, and then laughed. "That's a funny name," she said.
"Do you want to call it something else?" I asked.
"What's it called?" she asked.
She laughed. "I know, I know!" (She says "I know, I know!" a lot when she gets excited.) "It's Polly the Monster!"
I see a monster that may finally be giving my little girl seizures, might be delivering on the ugly promise we'd been made when Schuyler was diagnosed almost eight years ago, and I feel my heart drop again.
Schuyler sees that monster, and she nicknames it Polly.
As we drove to pick up Julie at work, Schuyler sat quietly in the passenger seat, processing. Finally she turned to me.
"Daddy? I don't want a little monster in my brain."
She said it seriously but not somberly, sad but not crushed. I told her that I didn't want her to have it, either, but there was nothing we could do but make the very best of it, the same as we always had.
She shrugged a little and said, "I know."
Later, she asked Julie if she was sad. She said it with concern for her mother, but I didn't get the sense that she was terribly sad herself. I mean, she wasn't thrilled by this new situation, but she was processing it already, moving faster than we were, perhaps sensing that some very hard stuff may be waiting in the near future but already impatient with the sad.
"I know." She knows.