Mens Health Blog. Medical Blog » Epilepsy

EPILEPSY AS A PSYCHO-SOCIAL DISEASE: HOW COMMON ARE PSYCHO-SOCIAL PROBLEMS? GUIDANCE AND COUNSELING

admin — Wed, 23 Feb 2011 17:03:23 +0000

Guidance and counseling, commonly used as synonymous terms, have somewhat different connotations to us. Guidance is something one person provides to another. It implies, to us at least, something actively given and passively received. Counseling, on the other hand, implies something done together and requires active participation by both parties. We believe this distinction is important.
Physicians often speak of patients as compliant or non-compliant, meaning they have or haven’t followed their instructions. Implied in the word compliant is a sense of submissiveness. We often assume that a person with seizures should do exactly what we tell them to. We forget that it is the patient who experiences the seizures, who is encumbered by the stigma of epilepsy, and who may experience side effects from medication we prescribe. We forget that the disorder is the patient’s and, therefore, that the patient must ultimately exercise his own control. However, in a more positive sense, compliance is not submissiveness but reflects a partnership in which the patient agrees with a therapy we recommend and will follow it.
If the patient or, in the case of young children, the family is to exercise the control, then they must be educated to become active partners in the decision-making processes. They must be informed about their condition or their child’s condition and about the likely future. The patient— or the parents of a young child—must assume the responsibility for that future. They must determine their own goals and aspirations. Some use terms like “owning your own disease” or “empowering the consumer.”
We prefer to talk in terms of a partnership and counseling. Then the physician and his team are in the more appropriate position of teachers, counselors, and supporters on this road to seizure control and to medical as well as psycho-social well-being.
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CHILDREN WITH EPILEPSY: PRACTICAL SAFETY TIPS

admin — Wed, 26 Jan 2011 17:00:38 +0000

Get an engaged notice to hang on the outside of bathroom and lavatory doors instead of locking them.
Baths are a potential hazard for anyone who has seizures. Showers are safer. When baths are taken, always run in cold water first, then add hot, so that the water never reaches a dangerously hot temperature. Bathwater should be kept shallow: about six inches is safest.
A regular routine with regular meals and plenty of sleep is important for any child, but especially so for the child who has epilepsy.
Do not leave your child alone after a seizure. They may be confused and need comfort and reassurance. If the seizure seems worse or different from usual, contact your doctor immediately.
Make sure the child always carries something (a Medic-Alert bracelet, for example) with their name and address and the information that they have epilepsy.
FEBRILE CONVULSIONS
Children’s brains are more excitable, and therefore more seizure-prone than adults. Between three and six per cent of children sometimes have convulsions when running a high temperature. These febrile convulsions tend to run in families. They usually last only a few seconds or, at the most, a minute or two, and take the form of a grand mal seizure. Febrile convulsions are nearly always harmless for the child, though frightening to watch. Most children grow out of them by the time they are two or three years old.
However, children run a greater risk than adults of developing status epilepticus (prolonged or repeated convulsions) during a fit. This is dangerous, and may cause permanent brain damage and even, occasionally, be fatal. About five per cent of children who have febrile convulsions go on to develop epilepsy later in life. This is probably because during severe febrile convulsions the brain has been damaged through a partial deprivation of oxygen. The damaged area is usually the temporal lobe, which is the part of the brain most vulnerable to lack of oxygen. There is some recent evidence to suggest that a few children are born with an abnormality in this part of the brain which causes them to have severe febrile convulsions. But whatever the cause, the result is that after a severe febrile convulsion these children are left with an area of damage in the temporal lobe which later acts as a focus for seizures.
It is therefore important that febrile convulsions should be treated quickly; always call your doctor or an ambulance if your child develops a convulsion during a fever. Once your child has had one febrile convulsion, your GP will want to take steps to ensure they do not have another. Some years ago most doctors believed that children who have a tendency to febrile convulsions should be given regular anticonvulsant medication, usually Epilim (sodium valproate), to prevent fits until they have outgrown the tendency. The view now is more flexible, and practice varies quite widely. It is most likely that your doctor will not give regular medication after a first febrile convulsion unless it was very prolonged and led to the child being kept in hospital for a day or two. Some doctors will not even give medication after a second or third febrile convulsion, but wait for a trend to be established before giving regular anticonvulsants.
When your doctor makes the decision, one of the most important guiding factors will be whether there is a strong family history of febrile convulsions which have not led to the development of epilepsy. A strong family history is usually seen as a sign of a child being likely to outgrow the convulsions without permanent damage, and so the need for medication is less.
In addition, your doctor will probably suggest that if your child has had a fit in the past, you should give them paracetamol whenever they start to run a temperature, and sponge them with tepid water to help bring the temperature down. The fact that your child has a tendency to have febrile convulsions and may even have to take an anticonvulsant drug does not mean that they have epilepsy; the treatment is just to prevent further convulsions which might eventually cause epilepsy.
A few children may have a short-lived paralysis down one side of the body after a severe febrile convulsion. If this happens, it is worthwhile noting and remembering which side of the body is affected. Some of these children may later go on to develop temporal lobe epilepsy; if they do, and if it is thought they might benefit from surgery, it can be very helpful to the doctor to know which side was paralysed at the time of that early seizure. The side of the paralysis is a very good indication of the side of the brain in which the seizure focus is likely to lie.
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HOW LONG DO SEIZURES NEED TO BE TREATED? WHAT IS THE WORST THAT CAN HAPPEN IF MY CHILD CONTINUES TAKING THE MEDICATION? WHAT IS THE WORST THAT CAN HAPPEN IF WE DECIDE TO DISCONTINUE MY CHILD’S MEDICINE?

admin — Tue, 11 Jan 2011 16:58:29 +0000

“What is the worst that can happen if my child continues taking the medication?”
If your child has been free of seizures for two years and is tolerating his medication well, then probably not much will happen if he continues to take medication. However, if he continues to take medicines for a long time, chronic effects occur that vary with the medicine. In addition, if your child is a girl, eventually she may want to have children. While the risks of any medication on the fetus are small, they are many times greater than no medication at all. If a woman doesn’t need medication to control seizures, the baby will be better off not being exposed to these drugs. Also, you’ll never know how much better your child will function without medication unless your physician discontinues it.
“What is the worst that can happen if we decide to discontinue my child’s medicine?”
Medication should never be stopped suddenly since this could cause status epilepticus. It should only be stopped under your physician’s direction. When the medication is decreased slowly, the worst thing that can happen is that your child will have another seizure. The consequences of another seizure vary with the individual’s age and circumstances. You and your child will have to determine how much weight to give this matter. When people stop taking medication under their doctor’s direction, they tend to worry about having another seizure. In our experience, this concern diminishes over time and is usually negligible after about a year.
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DRUGS USED IN THE TREATMENT OF EPILEPSY

admin — Thu, 03 Jun 2010 10:12:42 +0000

Carbamazepine

Carbamazepine is available in 200 mg and 100 mg tablets as well as a suspension (100 mg/5 ml). The drug does not last very long in the body and so needs to be taken two or three times a day.

Side effects with carbamazepine are few but include sleepiness and double vision; this usually means that you are taking too much medicine. A rash, like measles, may occur during the first month of treatment. If it does, you are sensitive to the drug and should probably stop taking it after discussion with your doctor.

Patients on carbamazepine should avoid taking the antibiotic, erythromycin, as it may make the blood level of carbamazepine rise and produce toxicity. The same applies to Verapamil which is occasionally used in the treatment of epilepsy.

Clobazam

Clobazam is available as a 10 mg tablet.

It is not a drug that can be used on its own; it needs to be used with another anticonvulsant (adjunct therapy). It can be taken twice daily. Side effects are few, but include some drowsiness, weight gain and, occasionally, depression.

As for clonazepam, tolerance may occur.

Clonazepam

Clonazepam is available in 0.5 mg and 2.0 mg tablets and as a liquid (2.5 mg/ml).

Clonazepam generally needs to be taken two or three times a day. Side effects are quite frequent, more so in children than adults. The side effects include hyperactivity, an increase in weight, drowsiness, slurred speech and an unsteady walk (as if drunk). There may also be increased salivation.

In some patients, tolerance occurs. This means that they ‘get used’ to the drug. In these patients, seizures may recur, usually one to six months after treatment was begun.

Ethosuximide

Ethosuximide is available as a 250 mg capsule and a syrup (250 mg/5 ml).

It lasts a long time in the body and so may be taken once a day although it is usually given twice daily.

Side effects are few and include a decrease in appetite, tiredness, headache and an unsteady walk.

Nitrazepam

Nitrazepam is available as a 5 mg tablet and is usually given twice daily. Side effects are similar to those described for clonazepam, but to a lesser extent.

Phenobarbitone

Phenobarbitone is available in 15 mg, 30 mg, 60 mg and 100 mg tablets and as a 15 mg/5 ml syrup.

Phenobarbitone lasts a long time in the body and can be given once a day although it is usually given twice a day. It has been used for many years as an anticonvulsant, but tends to make patients rather drowsy. Children and elderly people may behave the opposite way and become hyperactive. These behaviour changes have made phenobarbitone less popular than it was ten years ago.

Patients on phenobarbitone should not take warfarin (to thin the blood), phenylbutazone (for arthritis), prednisone (for arthritis or asthma) or doxycycline (for infections) without careful medical supervision.

Phenytoin

Phenytoin is available in 30 mg capsules, 50 mg tablets (chewable), 100 mg capsules and two suspensions (30 mg/5 ml and 100 mg/5 ml).

Phenytoin is retained in the body for a long time and can be used once daily.

It has rather a lot of side effects, although many patients are well controlled on this drug with minimal side effects. Drowsiness, unsteady walk and slurred speech suggest that the patient has been taking too much of the drug and should contact his doctor. Other side effects include swelling of the gums, rashes, acne and an increase in body hair.

Patients on phenytoin should not take rifampicin (for tuberculosis), chloramphenicol (for infections), phenylbutazone (for arthritis), dicoumarol (to thin the blood) or cimetidine (for stomach ulcers) without careful medical supervision.

Primidone

Primidone is available as a 250 mg tablet. The drug is broken down to phenobarbitone in the body.

Sodium valproate

Sodium valproate is available as a 100 mg crushable tablet, a 200 mg and 500 mg enteric coated tablet, a syrup (200 mg/ 5 ml) and a sugar free liquid (200 mg/5 ml).

Sodium valproate stays in the body for quite a long time and may be given once daily. It is more usual to give it twice daily.

The side effects of sodium valproate are relatively few and include slight drowsiness, an increase in weight, hair loss (which is usually temporary) and very rarely jaundice (turning yellow). This last complication (jaundice) is serious and immediate medical attention should be sought. It occurs very rarely and is due to liver damage caused by the drug. If a patient taking this medication feels generally unwell, unduly tired or drowsy and has an increase in seizure frequency, a doctor should be consulted immediately. It may be necessary to do regular blood tests, called liver function tests, to see how the liver is working during the first six months of treatment.

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Epilepsy

EPILEPSY: FAST FACTS

admin — Thu, 03 Jun 2010 10:12:03 +0000

The management of epilepsy has improved considerably over the past two decades but, despite this, a number of problems remain. They have already been alluded to in this text, but it may be of use to summarise them.

Polypharmacy (more than one anticonvulsant). It is worth repeating that the majority of people with epilepsy can be well controlled on one drug only (monotherapy). Naturally there are people with severe or complicated seizures who will need more than one medication. However, it is desirable to be on as little medication as possible.

Blood level monitoring. This has been a very useful advance in the management of epilepsy. There is a risk that doing a blood level may become an end in itself. If you feel that you are having too many blood levels done, ask your doctor what is being achieved. Do not let blood level results become a substitute for conversation and asking questions.

Non-compliance. If you are not taking your medication, be honest and tell your doctor. In a condition like epilepsy there is always a reason for people not taking their medication. It may be that you cannot see the value of taking medication because you have very few fits or perhaps because you have not understood the importance of taking the drugs regularly. If you are honest and tell your doctor that you are not taking your medication and you get a hostile reception, it is probable that he or she does not understand how you see things. A change of doctor may be desirable.

Should all seizures be eradicated? It is the right of epileptics, provided they are not in an occupation where harm might come to others, to decide on the degree of seizure control which they find acceptable. It is not, in my view, the prerogative of the doctor to insist on complete seizure eradication. This is a matter of consensus between patient and doctor which should be reached intelligently. To achieve this takes time and communication with your doctor.

Education. There is an ongoing need for education about epilepsy amongst people with epilepsy, the medical profession and the general public. It is for this reason that Epilepsy Associations exist. By joining your Association you will be helping yourself and very importantly helping the epilepsy cause in general. If you don’t stand up and be counted, the epilepsy movement will remain static, the prejudice and stigma will persist and you will have contributed to this ongoing state of affairs.

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Epilepsy

THE FIRST SEIZURE AND THE DIAGNOSIS OF EPILEPSY

admin — Tue, 28 Apr 2009 12:32:44 +0000

A common story is for parents to be woken by the stertorous breathing or grunting of a child in the next bedroom. They go to him, thinking usually that he is having a bad dream, and find him staring, unresponsive, convulsing, and perhaps blue. Few if any parents can cope calmly with such a scene. It is usual for the family doctor to be telephoned at once, and, if there is any delay in his arrival, for an ambulance to be summoned as well. Many parents subsequently confess that they thought their child was dying, so they are acting in an entirely rational way. Almost invariably, however, by the time the family doctor or ambulance has arrived, the seizure is over, the child is sleeping peacefully, and the adults are making tea. But they will not sleep again that night. Many—though not all—are immediately aware of the nature of what they have just seen.

Although the first seizure can occur anywhere and at any time, another common scenario is for the first seizure to occur in a young woman in the company of her friends or at work. In this case, the lack of ready access to the family doctor, whose name and telephone number is unlikely to be known to the bystanders, results in an ambulance being almost invariably called, and the unfortunate young woman being rushed off to hospital. She will recover consciousness either in the ambulance or in the Accident and Emergency Department of the hospital. To the confusion invariably consequent to the generalized seizure must be added the feeling of ‘What on earth has happened to me, and how have I finished up here on a stretcher with strangers peering at me?’ Obviously, therefore, although ambulance services are rather prickly on this point, a friend should accompany her to hospital—not only to provide moral support when recovery of consciousness occurs but also to give an accurate account of events to the hospital staff. In this case, the diagnosis of a tonic-clonic seizure is clear, but in others matters are not so straightforward. It is important to distinguish between an epileptic seizure and some other event which may initially seem to be one. Patients may speak in terms of a ‘black-out’, ‘funny turn’, or ‘blank spell’, and we have to do our best to analyse the cause.

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