WHAT IS EPILEPSY?
Epilepsy is a condition where a person has unprovoked recurrent seizures or ‘fits’. A seizure results from a sudden excessive discharge of electrical activity from the brain. A seizure has also been likened to an “electrical storm” within the brain.
HOW COMMON IS EPILEPSY?
About one per cent of the world’s population has epilepsy.
WHAT ARE THE CAUSES OF EPILEPSY?
Some children are born with a tendency to have recurrent seizures. This may be due either to a genetic or hereditary condition or to an insult to the developing brain during pregnancy.
Other children may develop epilepsy as a result of an insult to the brain during the process of birth or in early childhood. Brain insults include
- physical injury
- poor delivery of blood to the brain
- deficiency of substances essential for brain function (e.g. oxygen; glucose)
HOW IS EPILEPSY DIAGNOSED?
Diagnosis is made by taking a thorough medical history, performing a complete physical examination and by doing appropriate laboratory tests. Laboratory tests may include:
- blood tests
- an electroencephalogram (EEG)
- brain imaging (CT; MRI)
In many instances however, a specific structural or biochemical cause for the seizures cannot be identified
WHAT DOES A SEIZURE LOOK LIKE?
The way in which a seizure expresses itself depends on the area of the brain from which the burst of electrical activity arises and on the maturity of the brain cells and their connections. In almost all instances there is usually some alteration of awareness or consciousness and some sort of motor disturbance such as falling, stiffness (tonic seizure), limpness (atonic seizure), or jerking (clonic; myoclonic). Some seizures may be preceded by an aura e.g. abdominal pain, strange feelings or a peculiar smell. Many seizures are followed by a prolonged period of deep sleep.
MANAGEMENT OF EPILEPSY
WHAT SHOULD YOU DO WHEN YOUR CHILD HAS A SEIZURE
- Remain calm
- If your child falls unconscious, roll her over to one side to allow saliva to drain from the mouth and to prevent the tongue from falling back and blocking the passageway for breathing
- Do not insert any objects into the mouth. Insertion of a spoon or similar object will not prevent tongue-biting and may cause more harm than good
- Wait for the seizure to stop (usually within a few minutes) and talk to your child when he comes around, reassuring him that everything is alright. Allow him to sleep if he wishes to do so
- If the seizure consists only of loss of awareness with or without automatic movements, do not restrain her if she begins to move about, but stay with her, direct her to a safe place and speak in a reassuring manner until full consciousness returns
- If a seizure lasts for more than 5 minutes, take the child to the nearest hospital emergency department. A seizure that lasts for more than 30 minutes may cause further brain damage. In addition, the longer a seizure lasts, the more difficult it will be to stop with the drugs that are available
CAN EPILEPSY BE TREATED?
Epileptic seizures can be controlled by taking anti-epileptic drugs. A large number of these drugs are now available and many of these are tailored to treat certain types of seizure. Most children with epilepsy will need to take only one drug for control of seizures. Occasionally a combination of drugs is necessary.
A child who has persistent seizures in spite of adequate doses of appropriate medication should undergo detailed investigation to exclude a biochemical or structural defect. Some structural defects are amenable to brain surgery. In many instances medication can be slowly and safely discontinued after two years’ freedom from seizures.
WHAT PRECAUTIONS SHOULD YOU TAKE WITH A CHILD WHO HAS EPILEPSY?
- Keep your child well away from open fires
- Swimming should always be supervised by an adult who is a competent swimmer
- Young children taking a bath should always be supervised
- Protective gear (helmet, elbow pads, knee pads) should always be worn when riding a bicycle
- The door should never be locked when your child is using the bathroom
- Your child should not be allowed to climb trees or other high places
CONDITIONS THAT MAY ACCOMPANY EPILEPSY
- Intellectual disability
- Learning disability
- Cerebral palsy
- Behavioural disorder
CLASSIFICATION OF SEIZURES
1. GENERALIZED SEIZURES
A generalized seizure arises simultaneously from both sides of the brain and may manifest in a number of ways.
In a tonic clonic seizure (previously called grand mal) there is loss of consciousness with falling, upward rolling of the eyes, clenching of the jaw, frothing at the mouth, noisy irregular breathing and sometimes emptying of the bladder &/or bowel.
In a tonic seizure, there is generalized stiffening of the body but no jerking.
In an absence seizure (previously called petit mal) there is sudden loss of awareness with a fixed stare for 10-15 seconds and then an abrupt return of consciousness. An absence seizure is sometimes accompanied by automatic movements such as smacking of the lips or blinking of the eyes.
In an atonic seizure, the whole body becomes suddenly limp and the child collapses to the ground.
A myoclonic seizure consists of a momentary jerk or multiple jerks of limbs or trunk.
2. PARTIAL OR FOCAL SEIZURES
A simple partial seizure arises from one side of the brain and results in some form of localized activity e.g. turning of the head and eyes to one side; stiffness or jerking of a limb or limbs on one side.
If there is loss of awareness the seizure is referred to as a complex partial seizure.
A partial seizure may also be accompanied by automatic movements.
A simple or complex partial seizure may sometimes extend to involve the other side (secondary generalization)
FURTHER TIPS FOR MANAGEMENT
Keep a seizure diary. Note the date, time, description and duration of the seizure as well as the events that precede and follow them. Take the diary along with you when you visit the clinic or doctor
Regularize the child’s activities of daily living (meals, bedtime, homework, play). Avoid boredom and over-excitement
Take careful note of the name, dosage, timing and side effects of the anti-epileptic drug and whether it should be taken before, with or after meals
Take the anti-epileptic drug on a regular basis. Do not stop the drug unless advised to do so by the doctor or clinic
Do not give a double dose the next time to make up for a dose that has been missed
Do not give an extra dose of the drug if and when a seizure occurs
Renew the prescription when supplies of the drug are getting low
Take the prescription &/or the remainder of the prescribed drug along with you at the time of clinic or doctor’s appointment
MYTHS ABOUT EPILEPSY
- Epilepsy is due to possession by evil spirits or demons
- Epilepsy is a form of madness
- Epilepsy is a contagious disease
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