Age: 0.58
Sex: U
Vaccine: DTAP, HIBV
Symptoms: Grand mal convulsion, Liver function test normal, Nuclear magnetic resonance imaging brain normal, Postictal state, Urine analysis normal
Clinical narrative: Information has been received from a author of a published literature article, titled as stated above concerning a 7 month old child who on an unspecified date was vaccinated with a dose of PedvaxHIB. Concomitant suspect therapy included Thuja. Concomitant therapy included DTaP. Subsequently the patient experienced eight generalized tonic clonic seizures over 3 weeks periods. The child was placed on maintenance Phenobarbital (5mg/kg/day) for 4 weeks, beginning at the initial neurologic consultation four weeks after the seizures begun. No further seizures were witnessed during Phenobarbital treatment or in the six months since its discontinuation. A developmental follow up at age twelve months produced normal results. The patient's case was reported as follows: "Our patient was a previously healthy, normally developing 7-month-old child presented with a total of eight generalized tonic-clonic seizures over a 3-week period. The duration of each seizure was <90 seconds; each seizure was followed by brief postical tiredness. The parents described no recent illness, injury, or metabolic derangement. The child took no medications regularly, but on detailed inquiry, had received a 4-week course of treatment from a homeopathic practitioner consisting of thuja, an essential oil derived from the wormwood plant (Artemisia absinthium). The stated indication for thuja was to provide a calming effect on the baby around time of immunizations. The child received a single DTaP vaccination 1 month before seizure onset, and a HIB 3 days before the first seizure; the family had declined all other immunizations. There were no complications of the vaccinations such as fever, encephalopathy, irritability, or local skin reactions. The child was born vaginally at term weighing 3033 grams after a normal pregnancy with no bleeding, trauma, infection, or hypertension. There were no perinatal complications, and no resuscitation or supplemental oxygen was required. Apgar score were 9 at both 1 and 5 minutes. The child was breast-fed exclusively; the mother is healthy and takes no medications. There is no history of febrile seizures in the child or any other family members. The thuja prepation was formulated by diluting the essential oil in a 1:99 dilution, and repeating this dilution 30 times. According to homeopathic therapy, there should be no molecules of the original thuja remaining after all of these dilutions. The final solution was dripped into lactose carrier seeds (no. 10 pellets, the size of poppy seeds), and the child was prescribed one eighth of a teaspoon (about 30 seeds) three times daily for 3 days, beginning just before the PedvaxHIB immunization. Because of the occurrence of seizures, it was advised to continue giving the thuja, which was administered almost daily for the next month. In addition, the child received an herbal chest rub containing sage, eucalyptus, wintergreen, peppermint, and camphor (which also contains thujone) several times in the weeks before and after the onset of seizures. One seizures occurred within minutes of application of the chest salve. On detailed examination, the child appeared normal, with age-appropriate cognitive and developmental skills. A routine electroencephalogram in the sleep and awake states, performed on the day after the first seizure, produced normal results. A subsequent 2-hour video-electroencephalogram performed 7 weeks after the first seizure produced normal results, with no focal or epileptiform abnormalities. During this electroencephalogram, the child received an application of the chest salve as a productive test, but no electroencephalogram changes or seizures occurred in response to the salve. A magnetic resonance imaging scan of the brain produced normal results. Serum electrolytes, liver transaminases, serum amino acids, and urine organic acids were at normal levels. The child was placed on maintenance phenobarbital (5 mg/kg/day) for 4 weeks, beginning at the initial neurologic consultation 4 weeks after seizures began. No further seizures were witnessed during Phenobarbital treatment or in the 6 months since its discontinuation. A developmental follow-up at age 12 months produced normal results." The author discussed; in the case presented here that it cannot be proven that the herbal products caused seizures, but the epileptogenic potential of these compounds, the temporal relationship of administration to seizure onset, and the cessation of seizures after discontinuation of the compounds raise reasonable suspicion about an association. Thuja (a word meaning "energy of the plant") is an essential oil of the arborvitae (wormwood) plant of the cedar family. Thujone is a major component of absinthe, and the properties of that liqueur have been attributed to thujone. Similar to camphor, thuja is a well-recognized convulsant in humans and experimental animals. Ingestion of certain essential oils by either the oral or transcutaneous route can lead to seizures. Nevertheless, in conjunction with exposure to similar potentially epileptogenic compounds in the chest salve (e.g., camphor and sage), a reasonable hypothesis is that the balance between neuronal excitation and inhibition in this child's brain was altered sufficiently for seizures to occur. The possibility that the seizures were triggered by the PedvaxHIB immunization is unlikely, but cannot be fully excluded. Therefore, it is most likely that this child developed reactive seizures in response to one or more convulsant components of herbal remedies. Upon internal review, convulsions was considered to be other important medical event (OME). No further information is available. A copy of a published literature article is attached as further documentation of the patient's experience.