Book menuEPILEPSY - Full extract 

Kara has always been good at schoolwork and sport, and at the same time very popular with the other kids in her class. So it was most upsetting for her parents when the Grade 3 teacher called them to the school for an interview; Kara was falling behind in class and had become quite disruptive. 

Apparently the problems at school started the previous term. There were times when she seemed to be daydreaming or in a trance for a few minutes. Her parents had noticed the same thing at home. Everyone had been upset for weeks and the call from the school was the last straw. 

On the teacher's advice, Kara's parents brought her to the surgery for a check-up. Her sight and hearing appeared to be normal and she looked healthy in every respect. However, the story of concentration lapses and falling behind at school did raise the question of some sort of epileptic seizure. It is an area outside my expertise so I referred Kara to a paediatric neurologist for assessment. 

After extensive investigation it was established that Kara had been having brief absence seizures due to a condition known as child absence epilepsy. She has been started on a medication called Epilim which she takes twice a day. The seizures no longer occur and Kara is now doing well again at school. The neurologist is confident that Kara will grow out of the condition and may not require permanent medication. 

Epilepsy is a disorder of the brain which is characterized by recurrent seizures. These are caused by sudden bursts of electrical activity and there are several different types, depending on the part of the brain affected.  

With some seizures there is just a momentary lapse of concentration. With others the person may briefly lose control of a limb and localized twitching or involuntary movements can occur. Sometimes there is just an odd sensation affecting a part of the body. With generalized tonic-clonic seizures the person loses consciousness and may fall to the ground with convulsive muscular spasms. Previously known as grand mal convulsions, tonic-clonic seizures represent only a small fraction of seizures that occur. 

There are some conditions that get confused with epilepsy. Febrile convulsions that may occur in young children with a very high fever have no relationship at all to epilepsy; nor do the slight convulsive jerks that can occur after a person has fainted. 

About 350,000 Australians have epilepsy...about two or three percent of the population. It can result from head injuries, birth trauma, strokes, brain tumours and certain types of brain infection. Some forms of epilepsy are also inherited. However, even with modern investigations, in about 50% of cases the precise cause of a person's epilepsy is never established. Sometimes further seizures can be triggered by alcohol, stress and lack of sleep. 

The diagnosis of epilepsy rests mainly on an accurate history of seizure episodes. A clear description from a family member or some other bystander is very important. There are several investigations that allow a more precise diagnosis to be made. The EEG is a tracing of the brain's electrical activity and is still the main diagnostic test. Sometimes the EEG is linked with continuous videotaping of the person in hospital, a technique called videotelimetry. Special imaging tests such as CT brain scans and MRI scans are also used to provide a very detailed picture of the brain's structure. 

The treatment of epilepsy depends on the type and frequency of the seizures and how they affect a person's life. It is not just a matter of preventing seizures with medication. The aim is to help the person with epilepsy achieve a normal lifestyle with a minimum of limitations. Some activities such as driving may have restrictions; usually it is permitted if there have been no seizures in the previous year. Likewise, special care is required with swimming and other water sports, in case a seizure should occur. The treating doctor can advise about these matters. 

There is an excellent range of medications available for epilepsy, and new medications are currently being developed. With more precise diagnosis, more precise medical treatment can be recommended. Usually the decision whether medication is required is made by a consultant neurologist, although it is often supervised by the general practitioner. Blood tests are usually advised to tailor the dosage of medication and to reduce the risks of side-effects. In most cases seizures can be very well controlled with medication. 

In the case of a tonic-clonic seizure there are several things that a bystander can do to help.

  • Try to remove any sharp objects and if possible roll the person onto his or her side. 
  • Do not try to put anything into the person's mouth. 
  • If the fitting lasts longer than a few minutes call for an ambulance. With prolonged fitting, the person may not get enough oxygen from breathing, and complications can occur. Fortunately this is very uncommon. 

For more minor seizures all that needs to be done is to make sure that the person is not at risk of personal injury. It is important to stay with the person until the seizure is over and to explain to the person what happened. 

 

Health Tips:
* Epilepsy is not always obvious and may go undiagnosed for some time. If there is any question of epilepsy ask your family doctor for advice.

* Some people still have misunderstandings about epilepsy. If you, a family member or a friend has epilepsy find out as much as you can about the condition. Contact the Epilepsy Foundation in your state for further information. 

Website:
Epilepsy Foundation of Victoria Inc. www.epinet.org.au/


 Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001