Study guide week 10 epilepsy

Discuss outcomes for children with seizures in terms of 1) intelligence, 2) Prognosis,3) psychosocial issues and impirments in memory/learning 4) and seizure control

1) Most children with seizure disorders have typical intelligence scores.Repeated IQ tests have not shown a decline in intellectual abilities, unless the child is overmedicated, is exposed to ceratin AEDs that carry hgher risk of cognitive impairment, or has had a very prolonged episode of status epilepticus 2)Prognosis mostly depends on the seizure type and the underlying brain pathology For example, the average IQ score for children with absence seizures is in the normal range, whereas children with Lennox-Gastaut syndrome have intellectual disability. Prognosis depends not solely on intellignce but also on how the child and family handle this chronic illness. If the seizues prove resistant to treatment and fdrug side effects are many, these stresses may interfere with the functioning of both the child and family.3) Psychosocial issues and subtle impairments in memory and learning are approached in an effective manner, the prognosis is generally good. As most seizures remit during childhood, it is critical to encourage each child to achieve his or her maximal potential. For those whose epilepsy is but one feature of a multiple disability disrder the eventual outcome is more commonly a function of the other disabilities than of the seizures 4) About 70%-80% of children with epilepsy achieve control of their seizures withthe first for second AEDtried 2/3 remain seizure free during a 5-yr follow-up period, and almost the same % can be successfully weaned from their AED after 2 yrs of being seizure free. these generalizations are somewhat misleading because they may not include all of the childhood seizure syndromes. Finally , epilepsy is not a homogeneous disorder; even within families with a genetic form of epilepsy, there is variability of seizure expression.

Psychosocial issues related to epilepsy in terms

1)Impact to child and family The uncertainty of when the seizure will strike next may be what causes such distress The child with epilepsy must be educated about the cause of the seizures. Even if sizues beome rare after achieving proper medicaiton dosage, full discussion is appropriate. 2) The soical stigma attched to epilepsy may need to be addressed witht he child and family. Surveys find that the self-perception of a person with epilepsy is far worse that how others see this person.3) Some children with epilepsy have low self esteem and depression, leading to absenteeismin school and overdependene on their parents. Unfortunately, thes self esteem concerns and parental overprotecton can lead to social isolation. Combined with memory or learning impairments school gilure may result. Although the seizues themselves or the social reaction to them are major concerns for families, it is actually the associated brain dysfuncion-cognitive, behavioral and motor impairment-that is more problematic. Unlikea seizure, which is a time limited episode, thes deficits are persistient and affect daily functioning.

Discuss the side effects of AED in terms of 1. most common side effects 2. effects on learning 3. cognitive impairment 4. other body organs 5. hormonal/metabolic and finally 6. dosage

1.)The most common side effects of AEDs involve motor and cognitive aspect of brain function They include sleepiness, decreased attention and memory, dysphasia (difficulty producing speech), ataxia (unstable gait), and diplopia ( double vision).

Single vs multiple therapy

AEDs are probably best utilized as single therapy. Use of multiple drugs carries the potential for biochemical interactions One drug may increase or decrease the metabolism of the other in the childs body or brain, possibly decreasing efficacy and or increasing side effects. Drug interactions also can occur with medications taken for other conditions, and certain food (eg. grapefuit) can affect the metabolism of some drugs. In sever epilepsy that is unresponsive to a single medication, and additional drug may be required

Discuss medical treatment with AED's in terms of Optimal AED prevention and the definition of successful seizure control

AEDs manipulate neurotransmitter activity and ionic channels, influencing seizure activity. The first consideratio is making a correct diagnosis. Diagnostic studies may assist in clarifying the nature of the spell and the recurrence risk. Ultimate decision to treat or not depends on the parents' and physician's assessment. Treatment is usually institued only after The optimal AED should prevent all seizures from occurring without producing side effects. Unfrtunately, present therapies do not meet these criteria. As a rule, multiple doses of medicaiton are required to keep peak blook AED levels from becoming too high and producing toxic effects wihile keeping trough levels high enough to prevent seizues from occurring.

Discuss mechanisms, selection and use of AED's in terms of the older AEDs, the newer AEDs, other AEDs, single versus multiple theray.

AEDs work by interfering with the physiological mechanisms that lead to seizures. There are numerous channels on neurons that allow the flow of ions (e.g. calcium, potassium, sodium) into and out of cells. These channels are opened and closed by excitatory (glutamate) and inhibitory (gamma aminobutyric acid, or GABA) neurotransmitters that are released from nearby cells. The older AEDs (e.g phenytoin(dilantin), carbamazepine (Tegretol) block the high frequenc voltage dependent sodium channels. Several newer AEDs (e.g felbamate (Felbatol), lamotrigine) block this channel but also inhibit excitatory neurotransmission. Other AEDs (e.g. valporate (Depakene, Depakote), topiramate) have even a wider range of potential mechanisms Valproate blocks voltage dependent sodium channels and calcium currents while also infuencing GABA transmission Topiramate blocks sodium channels, opens chloride channels, and interferes with glutmate transmission Other AEDs (eg barbiturates (phenobarbitol), benzodiazepines (Valium), vigabatrin (Sabril), tiagabine (Gabitril), gabapentin (Neurontin) primarily increase inhibitory mechanisms mediated by the neurotransmitter GABA. The mechchanism of action of some drugs (eg levetiracetam (Keppra ) is not full understood,.This raises the possibiltiy that additional mechanisms of action of AEDs are yet to be discovered.

What are absence seizures

Absence seizures (previously called petit mal seizures) are among the most benign seizure types. They appear to arise simutaneously in broad regions of the brain and are mediated through the thalamus. The onset is usually between 3 and 12 yrs of age. They are characterized by a brief(usually less than 30 sec) behavioral arrest with impaired consciousness. During this time a characteristic 3-hertz spike and wave discharge occurs on EEG. Unlike most other seizures, there is no postictal (time immediately following a seizure) period of confusion proir to the restoration of full awareness. They can not be interrupted by verbal or tactile stimulation. They can effect learning and can be a physical hazard. Absence epilepsy may evolve to include generalized tonic-clonic seizures especially in adolescence.

Febrile Seizures

Are most commonly witnessed seizures during childhood. Because they are provoked by fever, they are not considered an epilepsy syndrome. They occur in approximately 5% of all children who are between the ages of 6 mos and 5 yrs. Febrile convulsions are generally seen with temp elevations abouve 39 degrees Celsius(102 degrees Fahrenheit). Thos seizures that occur with lower temps are associated with an increased risk of subsequent febrile seizures. Upper respiratory illnesses, middle-ear infectons, gastroenteritis, immunizations, and viruses associated with skin rashes (e.g., roseola are known precipitants. Greater than 80% of all febrile seizures are brief, summetic tonic or clonic-tonic events that occure once during an illness. These are called simple febrile seizures in contrast, complex febrile seizures are prolonged, focal and/or recurrent during a single illness. COMPLEX febrile seizures are frequently of unknown cause, but a more aggressive evaluation than simple febrile may be undertaken to exclude a chronic encephalopthy or an acute CNS infection(eg meningitis, encephalitis). After the first fever provoked seizure the risk of subsequent F-S is 30%-50%, depending upon the child's age, family history of febrile convulsions, and the intensity of the fever. The risk of developing epilepsy (recurrent seizures) by school age in s typically developing child is 1% followins simple febrile seizures and 2%-3% following complex berile seizures. the risk of developing epilepsy by adulthood is somewhat higher. The risk of future epilepsy is increased in a child with pre-existing developmental disability; ceregral pallsy, or with a familyh history of epilepsy. As many as 30%-50% of adults with intractable epilepsy resulting from mesial temporal sclerosis have a history of FS Although medicaitons may prevent subsequent febrile seizures AEDs do not prevent the development of future epilepsy.

Partial seizures

Are the most common type of seizure disorder in childhood, accounting for almost 60% of all cases. They may arise in the motor control centers of the brain but also in areas involved in sensory, behavioral, an cognitive functions. These seizures often start with and aura and /or an abrupt and unprovoked alteration in behavior.

Discuss those AEDs commonly used before 1933 and since 1933

Before 1993 the most commonly used AEDs were phenobarbital, phentoin, carbamazepine, ethosuximide (Zarontin), and valproate. Since 1993, nine new AEDs have been approved by the FDA (but not all bave been studied in children, and fewer have been tested in infants): flebamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine (Trileptal), tiagabine, topiramate, zonisamide (Aonegran), and pregabalin (Lyrica) In addition new sustained release formulations of two older drugs have decreased their toxicity: carbamazepine(Tegretol XR, Carbatrol) and velproate (Depakote ER). Intravenous drugs used to treat status epilepticus have undergone reformulation (eg fosphyenytoin (Cerebyx), which is closely related to phenytoin), and there is now a rectal gel preparation of diazepam (Diastat) These newer meds have increased both the options and the complexity of AED therapy The major advantage of the new drugs is that they may be more specific in their action. As a result they can theoretically be more effective at a lower dosage and have fewer side effects

Why is there confusion in classifying epilepsy?

Confusion may arise in classifying epilepsy for a number of reasons: 1) the onset of the seizure is often not observed or remembered; 2) the seizure spread is rapid, and the focal signs may be so overwhelmed by the experience that they do not recognize the subtleties of the seizure presentation. Fortunately, the nature of the seizure onset can often be inferred by the interictal. (between- seizure) EEG pattern.

What does Batshaw say about epilepsy in terms of cognitive development, medical disordered, and behavioral issues?

Epilepsy is a common medical condition that occurs with increased frequency in children with developmental disabilities. In these circumstances, epilepsy is another manifestation of a brain abnormality and may complicate the care and needs of the child.

What is the definition of epilepsy?

Epilepsy is defined as a condition involving 2 unprovoked seizures separated by 24 hrs. The term does not define severity or prognosis.

Epilepsy syndromes

Epilepsy syndromes are seizure disorders characterized by specific clinical features and characteristic EEG findings. A group of signs, symptoms, diagnostic tests, and historic info defines an epilepsy syndrome. These include 1) age 2) neurological signs and symptoms 3) clinical course,a dn 4) chacteristic EEG findings and may involve 5) a genetic component.

Vitamins & minerals

For the child with zeiuzres, supplementatio wit h a multiv itamin containing calcium may be useful in preventing osteoporois For females of child bearing age who are taking valproate, folate supplementation is also recommended. Megadoses of the Band E vitamins or supplemental carnitine are not indicated for the typical with epilepsy. In fact high dosages of supplemental vitamins and minerals maybe harmfu, except in rare cases of pyridoxine diependency/deficiency, which rquire moderated dosages of vitamin B6 Certain rare inborn errors of mealbolism that are associated with seizure disorders are treated with a combination of vitamins and nutritional supplements

2. AED effects on learning and 3. cognitive impairment

Have an adverse effect on learning that may persist long after the drug has been dicontinued. This issue was raised by a study of phenobarbital in children with febrile seizures, in which children were found to have cognitive impairments that persisted for 6 mos after drug cessation Topiramate and zonisimide may also lead to impaired cognition Virtually all AEDs , especially at high dosages, have the potentioa to cause cognitive impairment during treatmen, but lon term effect have not been studied to date.

Aura

If the event is merely sensory in nature it is caalled an aura. They are unusual sensations origlinating from the mesial temporal lobe, abnormal motor activity, such as jerking of fingers, or hand, involving the primary motor cortex of the frontal lobe, or abnomoral posture, progation of through the basal ganglia.

Complex partial seizure

If the secizure spreads and alters consciousness, it is called a complex seizure, previously called paychomotor seizure. This type of seizure may occur with or without subsequent secondary gereralization into a tonic-clonic motor sezure. Signs and symptoms of complex partial seizures are the result of the brain's impaired ability to rapidly plan motor activities and process environmental stimuli;these signs also provide clues to the region of seizure onset. Buring a comple partial seizure the abnormal electrical disturbance in the brain causes the chil's movements to become purposeless and slowed. Frequently this is accompanied by motor automatisms including eye blinking, lip smacking, facial grimacing, groaning, chewing, and unbuttoning and buttoning of clothing. The child may appear agitated. These seizures tend to occur during sleep and can be misinterpreted as night terrors. When they happen during the day, the child may strike out at someone who comes to close during the seizure or postictal period.

Future therapeutic approaches

In animal studies reservoirs are being implanted into areas of the brain affected by seizues, permitting AEDs to be infused directly into the seizure focus.Electrical stimulators are being implanted into the thalamus to alter the pathways that lead from this organ broad regions of the cerebral cortex or over the sezure focus to abort seizures. The use of transcranial magnetic brain stimualtion is also bing tested. In the future, medical interventon is likely to hift from treating the symptom (sezures) of the brain disorder to treating the underlying abnormality. Gene therapy may allow the introduction of new genes into patients with specific mutations (eg channelopathies) that lead to epilepsy. Agents may be developed that are given immediately after brain injury to interrupt abnormal reoganization of neural networks Sem cell implantation into the brain, with the provision of appropriate growth factors, may allow the replacement of destroyed neural networks. Finally, microchip implantation may permit the creaton of a "bionic" part of the brain that assumes those functions lost in the seizure focus.

Discuss the interventions needed during a sezure event in terms: a) Type; Repeated absence seizures vs. prolonged seizures b) emergency services c) seizures with fever d) Procedures

Intervention depends on the seizure type and duration. Repeated absence seizures require no immediate action prolonged complex partial seizues require interventon after 10-15 mins. Toni-clonic seizures require simple common-sense first aid procedures. Emergency medical services need to be called only if the seizure lasts more that 5-10 mins. The Epilepsy Foundation suggests that an ambulance be called if 1) the child is not known to have had prior seizues, 2) the child has an intercurrent illness, 3)a second seizure occures or 4) consciousness is not regainded following the seizure. If the seizuere occures with fever or trauma, urgent care should be sought. Otherwise the child should be attended until fully awake and alert and then allowed to nap. The the chil should be encouraged to reume activities after recovering fully.

Landau-Kleffner syndrome or acquired epileptic aphasia

Is characterized by a progressive encephalopathy, the hallmark of which is loss of language skills. It is manifested by an auditory agnosia (inability to distinguish different sounds), language regression (or rarely, the inability to attain language skills), and ASD. Clinically evident seizures may be infrequent or absent, but when the child is asleep the EEG pattern shows continuous abnormal epileptiform activity that obscures the normal sleep pattern. Treatment is difficult. EEG normalization and seizure control seem to be nexessary for improved outcome and steroid medication may be useful. The syndrome is important as it may serve as a model for a treatable form of autism.

What can be said about epilepsy in terms of cognitive development, medical disorders, and behavioral issues?

It can contribute to impaired cognitive function, as can side effects of anti-epileptic drugs. Children with epilepsy also have a high incidence of ADHD, learning disabilities,anxiety disorders and depression. Learning and behavioral disorders are often present at the onset of epilepsy. This observation provides evidence that learning disabilities, behavioral disorders, and epilepsy are different manifestations of the same underlying brain dysfunction. .

What is the most common cause of seizures during the first year of life?

The most common cause of an isolated seizure is a fever.

6.) Dosage

Many of the medication side effects are dosage related, so dcreasing the prescribed amount of an AED can lead to elimination of adverse effects Sometimes the side effects are independent of dosage and probably reflect genetic differences in the metabloism or sensitivity of the patient to the drug In these instances, if the side effects are severe, the AED should be stopped.

4.Other body organs

Medication administration requires gastro-intestinal absorption, dissolution in the blook, and eventual exposure of other body organsto the drug. As a result, side effects of AEDs can involve many organs in additon to the brain. Tkhere can be gastrointestinal irration, bone marrow suppression(leading to low white and red blood cell counts), liver dysfunction( as revealed by elevated liver function tests), kidney stones, pancreatitis, cardiac arrhythmia or decresed heart contractility, and dermatological chges (hair loss, coarsening of facial features, gum over growth, skin changes) Pregnancy can increase the risk of having a child with a neural tube defect or other birth defects

Not all paroxysmal events are epilepsy

Not sll paroxysmal events are epilepsy. A generalization is that if a behavior can be triggered interrupted, or modified by extenal stimuli, then it probably IS NOT a seizure. Examples include sleep diorders, movement disorders, behavior disturbances syncope(fainting), migraine, pseudoseizures, and systemic diorders such as gastroesophageal reflux. Exceptions include PARASOMNIAS(eg. night terrors, sleep walking), febrile-induced seizures and abnormal shaking in infancy, hypotonic-hyporesponsive spells agter vaccines and reflex epilepsy in older children (e.g. induced by flickering lights or causing other specific sensory changes).

Lenneox-gastaut syndrome

Often evolves from infantile spasms, is associated with intellectual disability and behavioral disturbances. Unlike other epilepsies, this syndrome is characterized by multiple types of seizures that occur throughout the day. The seizure pattern encompasses tonic seizures during sleep and absence/atypical absence, drop (including myoclonic), tonic-clonic and complex partial seizures during awake hours. The EEG has a characteristic pattern, and there is abundant epileptiform activity during sleep. Treatment of Lennox-Gastaut is difficult, and both seizures and EEG resoution appear to be necessary for improved cognitive and behavioral outcomes.

Jacksonian seizure

On occasion a clonic seizure may spread from one portion of the brain to a contiguous area, producing a spread of the shaking to other body parts called a Jacksonian seizure.

5.) Homonal/metabolic effects

Other side effects are hormonalmetabolic in nature and are more common with long-term therapy. These include abnormal calcium and vitamin D metabolism that may be severe enough to increase the risk of bone fractures or rickets;weight gain or loss, in females, polycystic ovalries, leading to impaired fertility; and decreased thyroid hormone level.

What is a primarily generalized seizure, absent seizure, Partial seizure, myoclonic and atonic seizures, tonic-clonic seizures and status epilepticus?

Primarily generalized seizures account for more that 35% of pediatric epileptic disorders. These seizures do not have a recognizable focus of onset; instead, large areas of each cortex appear to be simultaneously affected. During a generalized seizure the child may have decreased motor activity (eg absence seizures)or vigorous abnormal motor behaviors (eg myoclonic,atonic, and tonic-clonic seizures).

Status Epilepticus

Prolonged seizures(status epilepticus) occur infrequently with any seizure type, theyu deserve special consideration. Such seizures have the potential to be life threatening and to lead to permanent pathological changes within the brain's structural organization. tatus epilepticus is defined as a "single seizure or cluster of seizures that is sufficiently prolonged or repeated at sufficiently brief intervals to produce an unvarying and enduring epileptic condition Most clinicians consider 15-30 mins of continuous seizing or repetitive seizures without a full return of consciousness to represent status epilepticusIt is a medical emergency and requires immediate diagnostic and therapeutic intervention.

What are seizures

Seizures are brief, stereotyped, generally unpredictable neurological events that are commonly followed by a confused stated.

List and discuss the factors that modulate the predispose a child to have seizures.

Several factors modulate the predisposition for seizures and the threshold at which they occur An acute grain insult has the potential to trigger a seizure in anyone, gut not everyone will have a seizure when presented with the same insult. This differing susceptibility reflects genetic and acquired factors that affect structural and chemical chemical brain interactions. Age also influences the threshold.

4) sports 5) family acivities and fatigue 6)family stucture and routines 6) finances

Sports has been controversial. At one time children with epilepsy were pecluded from partivipation in many sports; now it is thought that most sports are permissible once seizures are well controlled. Family vacations and camping trips need not be curtailed int he child with well controlled seizures. Excessive fatigue should be avoided, as it may precipitate a seizure and the family should travel with an adequate supply of the AED and a writen prescription or the doctor's and pharmacist's telephone numbers in case the meds are misplaced or stolen. The family stucture and routine should be kept intact as much as possible, and it is important not to overprotect the child. 6) Financial issues for the family regarding the cost of meds , dr visits, laboratory tests,l hospital izations, and time off work Families may have to make decisions as to where they can live and what jobs they can accept based on their concerns for the care of their children.

What is status epilepticus?

Status epilepticus seizures are those that last longer that 15-30 minutes. Because most seizures are brief and self limited they do not require urgent medical attention the exception is status epilepticus.

Myoclonic and Atonic seizures

The briefest types of seizures with motor components are myoclonic and atonic seizures. Myoclonic seizures are lightning motor attacks, with sudden flexion or bending backward of the upper torso and head Some of these seizures are subtle, with just head nodding, whereas others appear to abruptly pull the child over. These seizures which involve loss of muscle tone, and any other type os seizure that leads to an abrupt lossof posture compose a group called DROP SEIZURES. Consciousness is usually impaired during these events and the child makes no attempt to protect himself during the fall. Which risk of the head striking the ground it is recommended that these children should wear a protective helmet throughout the day. Following these brief seizures the child immediately regains consciousness, often crying, seemingly not in pain but upset by the sudden disruption.

What are the two categorized onsets of epilepsy?

The epilepsies are commonly categorized as having either an apparently generalized onset (simultaneously involving widely spread cortical regions over both brain hemispheres) or a partial onset (starting in one limited brain region, with variable degrees of spread).

List and explain the factors that predispose a child to have seizures

The factors that predispose a child to have seizures are poorly understood but include1) injury to brain cells that make them dysfunctional, as occurs in TBI or brain tumors;2) disruption of brain cell circuits, as occurs in tuberous sclerosis and cerebral dysplasia; and 3) alterations in intrinsic brain cell excitability, as occurs in many inherited forms of epilepsy such as severe myo-clonic epilepsy and autosomal dominant nocturnal frontal lobe epilepsy Both the environment and intrinsic qualities of a specific neuron influence its behavior.

What is ictal activity? What does it typically look in terms of a simple partial seizure and complex partial seizure?

The initial ictal activity produces signs and symptoms typical of the function of the brain area from which it arises For example, in a simple partial seizure there may be unusual sensations, called an aura, abnormal motor activity, such as jerking of fingers or hand or abnormal posture. Once the electrical discharge extends beyond the original site to involve brain structures that are necessary to sustain consciousness, the clinical expression change and becomes a complex partial seizure.

Letogenic Diet

The ketogenic diet represents and alternative method to treat epilepsy for some patients. Although controlled studies are lacking, the existing studies indicate that 56% of individuals with epilepsy have a reduction in seizures while on a ketogenic diet, and 16% stop seizing completely. The mechanism of action of the diet is unknown but appears to be associated with utilizing fat rather that carbohydrates for cellular energy. To be effective, the ketogenic diet requires weighing and calculating the amounts of nutrients in all foods the childd eats The sugars/arbohydrates from any medicaitons must be monitored to assure adequate spillage of ketones, a by product of fat metablp;os,/ Tje letpgemoc doet os severely restictive and not very tasty. Side effects include matabolic acidosis, electrolyte disturbances, uric acid kidney stones, diarrhea/vomiting, constipation, and failure to thrive. The diet, similar to AED therapy, can be stopped after the child has a period of being seizure free. It is rarely tolerated for more than a year or two because of the side effects

Surgical interventions

The only "cure" for epilepsy is surgical removeal of the seizure focus This has been most successfully accomplished in complex partial seizueres arising from the mesial temporal lobe. It has also been used in well-defined structural abnormalities such as a tumor, vascular malformation, or focal cortical dysplasia. When there are multiple fuci in one side of the brain, another operation ca be used, hemispherectomy. This procedure involves the removal of mot of one side of the brain. It is used most often in uncontollable seizues resulting from progressive unilateral disorders, such as Rasmussen encephalities, Sturge-Weber syndrome, hemispheric dysplasia, or stroke (porencephaly). Palliative surgical interventions are also available. One example is corpus callosotomy (cutting of the corpus collosum, which connects the two hemispheres) for treating drop seizures. A second is electrical stimulation of the vagus nerve or rarely the thalamus for intractable mixed seizures that have an onset that connot be localized to one area or one hemisphere. Uncommon complications include bleeding, infeciton, and harm to the eloquent (speech), memory or motor cortex. The decision to perform surgery generally follows the failure of the child's seizures to respind to AEDs. Determining how many drugs should be tried without success before considering surgery is difficult After the third or fourth drugh failure the likelihood of completely controlling the seizures with meds is estimated to be only 10% The timing of surger is not only driven by how frequent and how severe the seizues are but also by the seizures' impact on the child's life and family dynamics.

Siscuss the issues related to epilepsy and child's education

The student's basic needs are dictated by his or her cognitive and learning abilities. Teachers must be alert for signs of difficulty attributable to seizures or side effects from AEDs. Alternatively, new or worsening school problems may devlop as a resut of side effects from an increased AED dosage or a switch to a new medicaiton Behavioral side effects may include fatigue, inattention, irritability, and aggression. Teachers and fparents must be alert to these signs for they may indicate the need to check drug levels or t change the AED dosage schedule Alternatively these nospecific features may point to intercurrent illness, peer problems, new learning difficulties, or the need to reevaluate the entire educational program.

Tonic-Clonic Seizures

The tonic-clonic seizure is the most frightening seizure to observe; it is what the public generally cas a GRAND MAL SEIZURE. It may arise focally and then secondarily generalize(a partial seizure), or it may arise diffusely from both hemispheres (a primary generalized seizure). Colonic motor activity(repetitive jerking occuring at a regular rate) and tonic motor activity (sustained stiffening) often occur within the same seizure. Tonic seizures may also start in one area of the body(partial seizure) or they may occur bilaterally, involving the trunk and extremities(a generalized seizure). If focal in onset,tonic or clonic seizures can be followed by a perion of weakness on the body side that was firs affected (called Todd's paralyis). This may be misinterpreted as a stroke by parents and health care providers. Tonic clonic seizures account for about 1/4 of seizures in individuals of any age. During the sizure, observers frequently hear raspy breathing or see no breathin effort at all and may mistakenly assume that the tongue has been swallowed. T-C seizures are often associated with an unusual cry, cyanosis, and incontinence. A period of seep is required for recovery, and the individual usually has no memory of the event.

Where does the word epilepsy come from?

The word epilepsy is derived from a Greek word meaning "take hold of" or "seize"

Why is the word seizure not synonymous with epilepsy?

The word seizure is not synonymous with epilepsy, and a single seizure does not qualify and individual for the diagnosis of epilepsy.

Nonspecific Interventions

There are also certain nonspecific interventions taht might be used to decrease seizuere occurrence. These include ensuring that the child obtains regular, reasonable amounts of sleep and avoids sedative meds These strategies heol because many forms of epilepsy are exacerbated by drowsiness. Infecton and /or fever can also trigger seizures, so appropriated hand washing avoidance of contact with people who have viral illnesses, and aggressive fever control should be undertaken. Finall it is important to identify and avoid or alter specific triggers that provoke seizures. The most common of these are the ovulatory cycle in females and flashing lights for the child with photic-induced seizures. In deciding whether a potential trigger is really a precipitant, it ust be remembered how many timesthat event has occurred without precipitation a seizure

What is a generalized tonic-clonic seizure?

There is a progressive alteration of consciousness that is frequently associated with automatisms such as staring, fumbling, or picking at clothing. If the entire brain becomes involved with bilateral motor activity, the result is a generalized tonic- clonic seizure becomes involved, with bilateral motor activity

Seizures occur frequently in whom? Give the percentage.

They occur frequently in childhood, with as many as 1 in 10 children having a least one event.

Complementary and alternative medicine

Various homeopathic and herbal remedies have been touted to treat epilepsy, but none have been shown to be effective in controlled clinical trials. These interventions, althugh often labeled "natural", are not nexessarily harmless. Whe considering the use of complementary and alternative medicine, the remedy should not 1) carry a significant risk of increasing seizured activity 2) compromise any therapy already i p;ace, such as AEDs; 3)be harmful to the child's general health 4) or be costly.