Death by febrile seizure?

As the lawyers for Joaquin Rams began to build their case Wednesday that his toddler son suffered a fatal seizure, and wasn’t drowned by his father, a pediatric neurologist testified that febrile seizures could be fatal but admitted he’d never had a patient who died of one.

Then the judge in the murder trial took over.

Circuit Court Judge Randy I. Bellows displayed his deep knowledge of the case, and his experience as a prosecutor and public defender, citing events and documents that haven’t even been discussed in Rams’s murder trial yet. He quizzed the expert witness for more than a half-hour, finally drilling down to one of the most vital questions of the case: Could 15-month-old Prince McLeod Rams have had a fever that caused his father to exclaim “he’s really hot!” in the background of the 911 tape reporting the boy’s collapse, and then be cold to the touch when paramedics arrived five minutes later?...

“That’s exactly right,” said Joseph Scheller, a former pediatric neurologist at Children’s Hospital in Washington now in private practice. “When the body feels something drastic is going on, it shunts blood away from the hands and feet to the main organs. so that may have been going on as well…To me, the fact that Prince feels cold to the touch means there has been a really significant brain injury.”

Bellows asked, “How far back would the brain injury have to occur” to cause a drastic temperature drop?

“If the child’s not breathing,” Scheller said, “it could take only a few minutes.”…

Bellows is deciding a capital murder charge against Rams without a jury, and so may have felt that when neither side asked the questions he wanted answered, he asked them himself, as he has throughout the trial. Prosecutors allege that Rams, 44, drowned Prince in October 2012 in order to collect $524,000 in life insurance policies he’d taken out on the boy shortly after he was born in 2011. The judge’s questions were crucial because the medical examiner ruled Prince had drowned, and she testified that she disregarded the possibility of a febrile seizure because the boy was cold when paramedics arrived, meaning he couldn’t have had a fever as Rams told police.

So Bellows took the trial’s first deep dive into Prince’s medical history, particularly a series of seven febrile seizures starting in June 2012, citing doctors’ and paramedics’ notes which pointed out that the boy sometimes stopped breathing during a seizure and that his mother also had febrile seizures growing up…

Scheller was the first of several defense witnesses who will attempt to refute the prosecution’s case that Prince drowned. He started off by explaining that when electrical impulses in the brain are disrupted, they cause seizures, which can be minor and not particularly noticeable, or major and result in prolonged convulsions. Febrile seizures, caused by a fever and occurring only in small children, are typically benign and not usually indicative of epilepsy or a serious brain condition.

But they’re not always benign, Scheller said. “At least several times a month, there was a child with febrile seizures who was intubated in the emergency room” during his time at Children’s Hospital, Scheller said. “Probably a few times a month, a child with febrile seizures was admitted into intensive care. The official term for it is benign febrile seizures. Like anything that’s benign, it can turn sour and cause very very serious problems or even death.”…

Scheller noted on cross-examination by Chief Deputy Commonwealth’s Attorney James Willett that he no longer practices at Children’s Hospital and spends 60 percent of his time consulting and testifying in child brain injury cases. Scheller said he had treated hundreds of children with febrile seizures. But, Willett noted, “you can’t say with medical certainty that you’ve ever treated a child that died from a febrile seizure?” Scheller replied, “I can’t say I recall specifically.”…

On Oct. 20, 2012, Prince was on a visit to his father’s home in Manassas City, Va., when he was put down for a nap. Records show he had suffered his seventh febrile seizure two days before, and that he was “apneic” during a previous seizure in September. “If a child has a history of being apneic,” 

Bellows asked, “is it more likely if he has another febrile seizure he will also become apneic?”

“Yes,” Scheller said.

“Do you see this of any relevance to whether febrile seizures were a factor in his death?” the judge asked. “Is that relevant to your analysis?”

“Yes,” Scheller said, “because there are infants that have seizures that manifest only during sleep with apnea.”

“Could it be seizures not visible to the naked eye with anything other than apnea?” Bellows asked.

“That is possible,” Scheller answered.

Bellows noted that Prince’s blood was found on his crib sheet in his father’s home on Oct. 20, after Rams swept into his room, claimed he saw the boy seizing and rushed him to the bathtub and began splashing water on him to cool him down. He also observed that in Prince’s seizure on Oct. 18, medical records showed “blood came out from [Prince’s] mouth.” Scheller said blood in the mouth was “very common” after a febrile seizure, and more likely to be caused by blood leaking from capillaries as the body reacts to lack of oxygen, rather than someone biting their tongue. “I believe it’s a hypoxic event,” Scheller said of the blood found on Oct. 20…

Bellows referred to the 911 call and asked, “As a result of a febrile seizure, could an individual go from a parent indicating he’s really hot to medical personnel indicating he’s cold to the touch in a period of about five to seven minutes?” Scheller said he thought the observation that Prince was cold showed he had suffered a brain injury, and “the inability of the brain to regulate temperature. I’m not at all surprised by that.” He said the intensity of Prince’s previous seizures did not show a trend, but six seizures in six weeks was “a lot of seizures in a short time.”

When the judge was finished, both sides sat stunned. He asked if they had follow-up questions. Robin only asked one, if blood in Prince’s nose — noted by the paramedics — made it likely to be a “hypoxic event” involving lack of oxygen to the brain. Scheller said yes. Willett stood and asked Scheller, “Drowning is a hypoxic event, is it not?” Scheller said yes. “As well as suffocation?” Willett added. “Yes,” Scheller said.

https://www.washingtonpost.com/news/true-crime/wp/2017/03/22/rams-trial-day-6-judge-questions-witness-at-length-on-deceased-boys-febrile-seizures/?utm_term=.1d7cb70dc46b