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more about Epilepsy

Convulsion, seizure, epilepsy does not apply to febrile seizures (seizures that occur with fever).

  • Epilepsy -- is a medical word meaning "recurrent Seizures."  The word is upsetting to some people; therefore, many doctors refer to this condition as "recurrent Seizures" or "recurrent convulsions" until the family becomes comfortable with the medical term (if the Seizures are recurrent).
  • This is a brain disorder in which an abnormal spread of electrical activity (from one area of the brain to another) causes a sudden altered state of consciousness.
  • Muscle twitching, stiffening, muscle weakness or loss of consciousness, occurs in some types of Seizure.
  • Not all Seizures have the generalized twitching and loss of consciousness that many people expect with a Seizure.

  • To follow are examples of 4 Seizure types:
    1. Grand mal Seizure (generalized Seizure): usually with no warning, there is loss of consciousness, falling to the ground, eye-rolling, muscle contractions with jerking of the arms and legs; possibly cyanosis is seen (blue lips).  After the muscles start out with a single prolonged contraction, there is repetitive jerking.  During the single prolonged contraction, the patient does not breathe.  This can create cyanosis.  After the Seizure, there is drowsiness or confusion.
    2. Focal motor Seizure: part of the body will twitch and the eyes deviate to one side.  The child might not lose consciousness.  If he does, the Seizure might become more generalized. 
    3. Temporal lobe Seizure (psychomotor Seizure): a feeling of ill health (aura) comes shortly before the Seizure.  The child or parent may then realize a Seizure is coming.  The child may act as though in a trance or act awake with odd movements, or might twitch, and is generally drowsy afterward. 
    4. Petit mal Seizure: staring spells happen many times per day, usually lasting 15-30 seconds each time.  Usually the child will not fall.  There is no aura and the child is not drowsy afterward.  Petit mal usually resolves by adolescence.

  • Normally, each area of brain tissue spreads a tiny burst of electricity to a few neighboring areas of brain, and that particular burst ends.  In a Seizure, an area of brain tissue is abnormal (either in its anatomy, or its chemical reactions) and becomes an "irritable focus" that can suddenly spread an electrical burst to areas of the brain outside the local region, or perhaps to wide areas of the brain.

  • Besides the symptoms and possibly the family history of Seizures, a recording of the brain's electrical activity (especially during sleep) shows abnormal patterns when a person has a Seizure tendency.  This usually is an abnormal spike on a recording that normally looks like small jiggles or ocean waves.  The recording is called an EEG (electroencephalogram).
  • Some difficulties are: (1) the spikes might not show up between Seizures (but should show up during a Seizure).  (2) If the irritable focus is several inches deep in the brain, it may be too deep to show up on the EEG between Seizures.  (3) Normal children sometimes have a Seizure pattern on the EEG.
  • A lumbar puncture (spinal tap) is often done when a child has a first Seizure to see if the Seizure is the first sign of Meningitis (infection in the lining around the brain).  A CAT scan or MRI scan (3-D picture of the brain) might be performed to see if brain swelling or Brain Tumor is present, or to determine if it is safe to perform the lumbar puncture.
  • Blood tests are often done, to look for infection, abnormal levels of blood sugar, calcium, sodium, magnesium, and other abnormalities.

  • During the Seizure, it is important to follow the ABC approach, which is to make sure the airway is open, make sure the patient is breathing effectively, and make sure the blood is circulating (basic CPR is often needed).  Oxygen is usually given, if available.
  • If the physician or paramedic sees the child during the Seizure, medicine is often given by injection to stop the Seizure.
  • If medication is then given on a daily basis afterward, it is usually by mouth.  To follow are some examples of medications that might be used daily:
  • Grand mal Seizures or focal motor Seizures: phenobarbital, Dilantin, Tegretol, or valproic acid
  • Temporal lobe Seizures: Dilantin, Tegretol, primidone
  • Petit mal Seizures: Zarontin, valproic acid
  • Febrile Seizures: as upsetting as a Febrile Seizure is, a child with a rare Febrile Seizure is not usually placed on long-term anticonvulsants to suppress Seizures, because the medicines often cause a daily problem of drowsiness or behavior problems.
  • If a child has Febrile Seizures, doctors usually advise treating the fever vigorously when it occurs (with acetaminophen and tepid baths, for example).  Children with more than occasional Febrile Seizures that need preventative treatment are usually given either (1) short-term treatment with an anticonvulsant such as diazepam -- at the start of each fever and then daily until the febrile illness resolves, or (2) long-term treatment with anticonvulsants, but they all have side effects, as mentioned.
  • Generally, with a few exceptions, patients with recurrent Seizures need to avoid contact sports, unprotected heights, swimming, and other activities where falling (or less than full alertness) would be dangerous.  Some children need to wear a helmet if they fall frequently.
  • Referring to adolescents, they generally have restrictions on driving, and cannot drink alcohol.

  • Referring to epilepsy, damage might occur to any part of the brain during the Seizure, resulting in loss of that particular brain function.  Brain damage might occur due to oxygen-lack during the Seizure.
  • Brain swelling
  • Mental retardation
  • Recurrent Seizures might occur, even after medication has controlled the Seizures, if doses of medication are missed.  Some patients need multiple medications to control Seizures that used to be controlled on 1 medication.
  • Liver damage (known to occur with valproic acid or Depakote or Depakene) or bone marrow damage (known to occur with carbamazepine or Tegretol) might occur as a side effect of some medications.

  • Loss of consciousness, twitching, falling spells, cyanosis, all become medical emergencies.  Protect the child from falling or gently lower the child to the ground.  Call 911.  Follow the ABC plan of CPR.  Give oxygen if available.  Transport the child to a hospital or emergency facility as soon as possible!
  • In the known case of Seizures, where the doctor has already given detailed instructions, follow the doctor's advice in the event of a Seizure.

  • Febrile Seizures (Seizures during a fever) occur either with a very high fever, or a rapidly rising temperature.  Usually a Febrile Seizure does not go on to cause recurrent Seizures in the absence of fever (epilepsy).  Many children do, however, have recurrent Febrile Seizures.  These are usually short (a few minutes, but may last 10-15 minutes) and usually have a normal EEG when the febrile episode is over.  It is thought that in the usual case of Febrile Seizures, and even in multiple Febrile Seizures, that this does not cause any brain damage or impaired intellect.  A Febrile Seizure patient who has a family history of epilepsy has an increased risk of having recurrent Seizures (epilepsy).
  • Children sometimes have repetitive movements that end abruptly, but are not Seizures.  These should have a normal EEG pattern during the event.

more about Epilepsy

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