Be informed and give a hand to a child with “Epilepsy”
View(s):Being diagnosed with epilepsy is frightening for both the parents and the child due to the poor understanding of the disease and/or the impact that will have on the child’s life and the family. A part of coping with epilepsy is researching to learn as much as possible about the condition.
What is epilepsy?
Epilepsy is the commonest neurological disease which originates from the brain. The brain is made up of billions of nerve cells (neurons) that form networks and communicate with each other through electrical and chemical signals to control the way we think, move and feel. If these signals are disrupted or too many signals are sent at once, a seizure (sometimes called a ‘fit’ or ‘attack’) occurs.
Epilepsy is the tendency to have repeated seizures; thus to be given a diagnosis of epilepsy you will usually have had two or more unprovoked seizures originating essentially from the brain.
What are the features of childhood seizures?
The clinical features are based on the maturity of the brain (age of the child) and the nerve cell network involved, so seizures can take many different forms. Sometimes it is difficult to distinguish between a seizure and an unusual behaviour in a child. We attribute any jerk to a seizure; however, all involuntary jerks are not seizures and all seizures do not go along with jerks. Therefore it is imperative to acknowledge that any pattern of behaviour that happens too often to be by chance could be a feature of childhood-epilepsy. If you have any suspicion about such happenings, always seek guidance from a qualified paediatrician / paediatric neurologist.
What can cause a seizure?
Some children’s seizures can be triggered off by stress, excitement, boredom, missed medication, starvation or lack of sleep. If you can recognize triggers, avoiding them as far as possible may help to reduce the number of seizures your child has. Keeping a diary of their seizures can help to see if there are any patterns to when seizures happen.
How do we diagnose epilepsy?
Diagnosis of epilepsy is based entirely on clinical features, thus it is crucial to document what you observe. Take a detailed note on occurrences before, during and after an event, the duration and the frequency. Capturing an attack with your mobile video-phone would be of great help, as your doctor may not witness one of your child’s events personally.
Your doctor will analyze the history, examine the child and might ask you to get some complementary investigations done. Finally he will build up a comprehensive dialogue with you prior to the diagnosis or exclusion of the disease, “epilepsy”.
What causes epilepsy?
Epilepsy is caused by a number of factors that affect the brain. It is not a psychological disorder or insanity, nor is it contagious. Neither is it a result of a demonic possession, or an influence of an evil eye as believed in the past.
The cause of epilepsy could be genetic, a structural brain lesion or a metabolic derangement. However, even now, in a majority (60 – 75%) of patients the exact cause is unknown. Some common identifiable causes include birth injury, brain trauma from accidents and infections such as meningitis or encephalitis.
Can it be treated?
Seizure medication is effective in controlling seizures in most children with epilepsy. Medicine does not cure epilepsy, but it often reduces or even stops seizures from occurring. Your doctor will select the most appropriate medication considering the age of the child, type of seizure and the side-effects of the medication.
Who should adjust the dose of medication?
Doses and drug combinations should always be adjusted by a qualified doctor. Changing your child’s medication without first talking to the doctor can be deleterious; leading seizures to start again or making seizures worse, prolonged-continuous, uncontrollable and life threatening.
The Dr. has to adjust dosages to establish optimum seizure control and to keep up with the growth of the child, thus regular check-ups are necessary.
When can we discontinue the medication?
Similar to dose adjustments, discontinuing seizure medication can cause serious complications and should only be done with a doctor’s advice and supervision. In most cases, if a child has been seizure-free for two years on seizure medication, a doctor will recommend weaning the child off the medication slowly.
What about the side-effects of medication?
Like all drugs, seizure medication can cause side-effects for some. Some side-effects go away as the body gets used to the medication, or if the dose is adjusted. Some erroneously believe children who take seizure medication will become addicted. If you have such concerns, talk to your doctor.
Why are seizure medications not working well for my child?
If seizure medications don’t help your child, your doctor may consider other ways to treat. Ketogenic diet is one such medical treatment, often started alongside seizure medications and is supervised by trained medical specialists and dieticians. All the teaching hospitals in Sri Lanka with a paediatric neurologist have the facility of offering diet treatment for a child with epilepsy.
Epilepsy surgery which involves removing or separating a part of the brain to stop or reduce the number of seizures is the other option. It may be possible for some children to have surgery depending on the type of epilepsy they have and where in the brain their seizures start.
How can I manage a seizure at home?
Although you may feel helpless, it is necessary to understand what should and should not be done during an actual episode.
When should I take the child to the hospital?
A continuous seizure state, or status epilepticus, is a life threatening condition requiring immediate medical care.
From where can I get more information on epilepsy?
You can get information direct from the www.ilae.org web site; you can e-mail your queries to us apuraepilepsy@gmail.com or call 025-2222261/62/63 ext. 619/620 between working hours.
(The writer is a Consultant Paediatric Neurologist, Teaching Hospitals Anuradhapura and Kurunegala)
| First aid management of a convulsive seizure 1. Stay calm, let the seizure take its course. 2. Whenever possible, time the length of the seizure. 3. Protect from injury. Move hard or sharp objects out of the way. |
| Immediately take your child to the closest medical facility If a convulsive seizure lasts longer than 5 minutes. If consciousness or regular breathing does not return after the seizure has ended. If seizure repeats without full recovery between seizures. If confusion after a seizure persists for more than one hour. If it is a first-time seizure, or the person is injured | |
| Features that may give a clue towards a childhood seizure Repeated jerking movements of the body, arms, or legs Momentary stiffness or floppiness of part or whole body A sudden loss of awareness, simulating day-dreaming A brief lack of response associated with memory gaps Vacant stare Rapid eye blinking Purposeless lip smacking, chewing or swallowing movements Unusual, unexplainable irritability or sleepiness Sudden falls or disturbances in usual walking pattern Sudden recurrent stomach pains, nausea or regurgitation Feeling of strange tastes, sounds, smells, scenes Sudden fear, panic, or anger without an apparent reason | |