epilepsy

Epilepsy is the name given to the condition of recurrent seizure activity, unrelated to fever or head injury. There are several different types, named according to the type of seizure involved.

Grand mal epilepsy is what most people think of when the term is mentioned. Grand mal seizures are the most dramatic, involving stiffening and jerking of the entire body, breath holding and turning blue (cyanosis), and loss of bowel and bladder control (incontinence).

Petit mal (pronounced as "petty mall") epilepsy or abscence attacks ("ab-sonce") generally afflicts school age children and involves brief periods of "blanking out," staring without seeing - which can be so brief that they are misinterpreted as normal pauses in speech, or attention deficit disorder. Body tone is not lost and the child does not slump over or shake, but the eyelids may flicker. There may be hundred of these little attacks a day, severely disrupting a child's ability to learn and function in school.

There are of course many more types of recurrent seizures, or epilepsy - beyond the scope here. Any child with newly diagnosed or suspected seizures will need a thorough workup to determine the exact nature of the condition, however, usually no specific cause is found for the seizures. See EEG.

The outlook today for most forms of epilepsy is very good with modern drug therapy. Two thirds of children who have an unprovoked seizure will never have another. Of the 1/3 who have a second one, about 1/3 of those children will never have another. Antiepilepsy medications are rarely started for first seizures. These drugs do not totally eliminate seizure recurrence, and do not seem to affect how long the seizures will continue to occur. Side effects of seizure medications are often significant, so they are prescribed when the benefits outweigh the potential side effects.

Most children with epilepsy lead normal lives. Activities are not restricted, with the important exception of tub bathing or swimming alone. They do not need to wear helmets or protective gear. Eventual permission for driving is dictated by individual state laws and seizure control.

Epilepsy can have significant impact on children's self esteem, especially in the teen years. It is important to carefully monitor academic achievement in children on seizure medications, because of possible side effects. Sexually active epileptic teens and young women need intensive counselling about the possibility of medication-related birth defects if they become pregnant. Postpubertal girls taking certain antiepileptic drugs should take 4 mg of folic acid daily, because of the risk of spina bifida in a possible pregnancy.

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