Seizure Disorder
Epilepsy is a common neurologic disorder which can begin at any age. It’s not a single disorder
but rather a wide spectrum of complications. All types of epilepsy share an uncontrolled
electrical discharge from nerve cells in the cerebral cortex. This is the part of the brain that
integrates higher mental functions, general  movement, and the functions of the internal organs
in the abdominal cavity, perception, and behavioral reactions.                

A child's brain contains billions of nerve cells. Normally, the brain continuously generates tiny
electrical impulses in an orderly pattern. These impulses travel along the network of nerve
cells, called neurons, in the brain and throughout the whole body via chemical  messengers
called neurotransmitters. Seizures occur when there's a sudden change in the normal way the
brain cells communicate through electrical signals.

Epilepsy is a condition in which there is a problem with the brain that causes long-term seizures
in the child. In epilepsy  the brain's electrical rhythms have a tendency to become imbalanced,
resulting in recurrent seizures. In patients with seizures, the normal electrical pattern is
disrupted by sudden and synchronized bursts of electrical energy. During a seizure, some brain
cells send abnormal signals, which stop other cells from working properly. Seizures interfere
with the child's normal brain functions. This abnormality may cause temporary changes in
sensation, behavior, movement or consciousness.

Some people use the term "seizure disorder" instead of "epilepsy" to describe this condition.
Both  mean an underlying tendency to experience seizures. Two or more seizures must occur
before a person can receive the diagnosis of epilepsy. Epilepsy can begin at any time of life but
it is most common in children under five years. Although epilepsy varies from person to person,
children with epilepsy generally have seizures that respond well to medication and they enjoy a
normal and active childhood. More that half will outgrow their seizures as they mature, while
others may have seizures that continue into adulthood. For some, it will be a temporary
problem, easily controlled with medication, outgrown after a few years. For others, it may be a
lifelong challenge affecting many areas of life.

Prevalence

About 2.5 million people in the United States have epilepsy, and as many as 9 percent of the
entire population may experience a seizure at some point in their lives. Epilepsy is a variable
disorder affecting individuals in different ways. Some children with epilepsy may, at times,
experience learning or behavior problems. About 326,000 American children under the age of
14 have epilepsy. The incidence of seizures is high before the child's first birthday. It affects
children at different ages, and in different ways. Medical treatment of childhood epilepsy is
getting better, and research toward a cure continues.

Possible Causes

The reasons why epilepsy begins are different for people of different ages. But what is known is
that the cause is undetermined for about half of all individuals with epilepsy.  Many of the  
predisposing factors have been identified, including brain damage resulting from malformations
during brain development, head trauma, other penetrating wounds of the brain, brain tumor,
high fever, bacterial or viral encephalitis, intoxication, and acute or inborn disturbances of the
metabolism. Hereditary or genetic factors also play a role.

Anything that disturbs the normal pattern of neuron activity from illness to brain damage to
abnormal brain development can lead to seizures. Epilepsy may develop because of an
abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters.
In some cases, the brain's attempts to repair itself after a head injury, or other problem  may
inadvertently generate abnormal nerve connections that lead to epilepsy.

Epilepsy Risk Factors

∙        Premature birth or low birth weight
∙        Trauma during birth (such as lack of oxygen)                         
∙        Seizures in the first month of life
∙        Abnormal brain structures at birth
∙        Bleeding into the brain
∙        Abnormal blood vessels in the brain
∙        Serious brain injury or lack of oxygen to the brain
∙        Brain tumors
∙        Infections of the brain such as meningitis or encephalitis
∙        Cerebral palsy
∙        Mental disabilities
∙        Seizures occurring within days after head injury
∙        Family history of epilepsy or fever-related seizures
∙        Lengthy fever-related (febrile) seizures
∙        Alcohol or drug abuse

Types of Seizures

Usually, they classify seizures into two types, primary generalized seizures and partial seizures.

Primary generalized seizures begin with a widespread electrical discharge that involves
both sides of the brain at once. Hereditary factors are important in many of these seizures.
Epilepsy in which the seizures begin from both sides of the brain at the same time is called
primary generalized epilepsy. Primary generalized epilepsy is more likely to involve genetic
factors than partial epilepsy, in which the seizures arise from a limited area of the brain.

∙        Generalized tonic-clonic (grand mal) This type of seizure is characterized by sudden
cries, a fall, rigidity and jerking of the muscles, shallow breathing, and bluish skin. Loss of
bladder control is possible. The seizure usually lasts two to five minutes, and is followed by
confusion, fatigue, and/or memory loss. It can be frightening to witness, especially for the first-
time observer.

Partial seizures begin with an electrical discharge in one limited area of the brain. Some are
related to head injury, brain infection, stroke, or tumor, but in most cases the cause is
unknown. One question that is used to further classify partial seizures is whether
consciousness (the ability to respond and remember) is "impaired" or "preserved." The
difference may seem obvious, but there are actually many degrees of impairment or
preservation of consciousness.

∙        Partial seizures take place when abnormal electrical brain function occurs in one or more
areas of one side of the brain. In about one-third of children with partial seizures, the child may
experience an aura before the seizure occurs. A strange feeling, consisting of either visual
changes, hearing abnormalities, or changes in the sense of smell.

For example, the words "partial" and "generalized" suggest that seizures either involve only part
of the brain or are widespread. Epileptic seizures are triggered by abnormalities in the brain
that cause a group of nerve cells in the cerebral cortex to become activated simultaneously,
emitting sudden and excessive bursts of electrical energy that lead to seizures. Depending on
the location in the brain where this electrical hyperactivity occurs, seizures have a wide range
of effects on the sufferer, from brief moments of confusion to minor spasms to loss of
consciousness.

There are several  more rare seizure types, such as atonic seizures and infantile spasms.
Symptoms can vary from twitching or tightening of one group of muscles (such as jerking of an
arm) in the case of simple partial seizures, to repeated staring spells and confusion (in absence
seizures) to loss of consciousness and jerking of the whole body.

∙        Atonic Seizures a person who has an atonic (or akinetic) seizure loses muscle tone.
Sometimes it may affect only one part of the body so that, for instance, the jaw weakens and
the head drops. At other times, the whole body may lose muscle tone, and the person can
suddenly fall. A brief atonic episode is known as a drop attack.

∙        Infantile spasms (West syndrome) are associated with brain development abnormalities,
tuberous sclerosis, and perinatal insults to the brain. It affects infants between one month and
one year old. It carries a poor prognosis such that only 5-10% of children with infantile spasms
will develop normally to near normal function, while more than two-thirds will have severe
deficits. The typical seizures are characterized by sudden flexor and extensor spasms of head,
trunk, and extremities.
     
∙        Absence (petit mal) is a type of seizure is most common in children. It is characterized by
a blank stare lasting about half a minute; the person appears to be daydreaming. During this
type of seizure, the individual is unaware of his or her surroundings.

During the seizure, the child's lips may become bluish and breathing may not be normal. The
movements are often followed by a period of sleep or disorientation. The symptoms of a seizure
may resemble other problems or medical conditions. Always consult your child's physician for a
diagnosis.

Epilepsy and learning

Children with epilepsy have the same range of intelligence and abilities as other children.
However, some children with epilepsy will develop learning difficulties. This is usually due to a
coexisting condition, such as an underlying brain abnormality, or it might be related to the child’
s frequent seizures. Sometimes the medication is a contributing factor as it may cause
drowsiness or hyperactivity. If the child has the type of seizure characterized by a brief period
of fixed staring, he or she may be missing parts of what the teacher is saying. It is important
that the teacher observe and document these episodes and report them promptly to parents
and to school nurses.

When a learning difficulty is identified in a child, there are strategies available, both medical
and educational, that can be implemented.

Epilepsy and Behavior

Behavioral disturbances can occur in any child, whether or not they have epilepsy, and it can
be difficult for parents to know the cause. The factors that affect learning in a child with
epilepsy may also affect behavior. In addition, low self-esteem can result from overprotection,
lack of discipline or the child feeling different to other children. Parents may find that discussing
the issue with teachers is helpful. Teachers or counselor may provide a gateway to additional
support services.

Children with epilepsy must also deal with the psychological and social aspects of the condition.
These include public misinterpretations and fear of seizures, uncertain occurrence, loss of self
control during the seizure episode, and compliance with medications. To help children feel  
more confident about themselves and accept their epilepsy, the school can assist by providing
epilepsy education programs for staff and students, including information on seizure
recognition and first aid.

Vaccination Concerns

In  young children, high fever from a vaccination can, in rare instances, trigger seizures, which
are almost always temporary and have no serious consequences. Some controversy arose a
few years ago over the possibility that the DTP (diphtheria-tetanus-pertussis) vaccine might
trigger epilepsy or other neurologic disorders. Some experts suggest that children who have
neurologic events following their DTP shot already have a preexisting impairment such as
epilepsy, which is revealed but not caused by the vaccine. Children with existing epilepsy may
be at risk for seizures two or three days after the vaccination. Such a temporary worsening of
their condition does not appear to pose a danger to the child. Infants with suspected neurologic
problems may have their vaccinations delayed until their neurologic situation is clarified, but not
beyond their first birthday.

Diagnosis

Diagnosis is made by a doctor based on symptoms, physical signs, and results of tests such as
an electroencephalogram (EEG), computed tomography (CT or CATS scan), or magnetic
resonance imaging (MRI). It is essential that the type of epilepsy and the type of seizures are
both diagnosed properly. There are several major classifications of seizures, and most are
associated with specific forms of the disorder. During the examination, the physician obtains a
complete medical history of the child and family and asks when the seizures occurred. Seizures
may be due to neurological problems and require further medical to follow up.

Treatment
                                                     
Most types of epilepsy can be treated and totally or partially controlled through medication, diet
and life style changes as well as surgery. Epilepsy may be treated with drug therapy, surgery,
biofeedback, vagus nerve stimulation (VNS) or a ketogenic diet (low-carbohydrate  diets). The
wide range of antiepileptic drugs (AEDs) remains the foundation of treatment.

AEDs treat the symptoms of epilepsy (the seizures), rather than curing the underlying
condition. The drugs act on the brain to prevent the seizures from starting by reducing the
tendency of the brain cells to send excessive and confused electrical signals. Before any drug
is prescribed, discuss potential benefits, side effects and risks with your doctor.

Surgery for epilepsy and seizures is a very complicated surgery performed by a specialized
surgical team. The operation may remove the part of the brain where the seizures are
occurring, or, sometimes, the surgery helps to stop the spread of the bad electrical currents
through the brain. Surgery is not an option for everyone with seizures. Discuss this with your
child’s physician for more information.        

VNS, approved by the FDA in 1997, is designed to prevent seizures by sending regular, mild
pulses of electrical energy to the brain via the vagus nerve. It requires minor surgery to implant
a stimulator, which is about the size of a silver dollar. The stimulator is placed under the skin in
the upper chest, like a pacemaker. The treatment appears to be effective for seizures that do
not respond well to medications alone. The effectiveness of this treatment is about the same as
drug therapy. VNS decrease seizure numbers by at least half in 40 to 50 percent of patients,
but rarely eliminate all seizures. Almost all patients need to continue taking medications after
the stimulator has been placed, although dosages can usually be decreased.

The ketogenic diet, which is very high in fat (90%), very low in carbohydrates, and low in
protein, has been studied and debated for decades. It has proven to be helpful for many
children with severe epilepsy that does not respond to AEDs. It is not clear why it works.
Studies report significant reductions in seizures in up to 85% of children who are good
candidates for the program. A 2001 study was conducted on children three to six years after
they had initiated the diet. In the study, 27% were with seizure free or had experienced more
than a 90% reduction in seizures. About 40% were either off medication or down to one. Only
10% of the children were still on the diet. Many children also report significant improvements in
attention and social functioning one year after starting the diet.

Suggestions

Children who have epilepsy, you should wear a medical bracelet or necklace that identifies their
disorder and lists any medications they take. Help prevent the seizures by following a healthy
diet, getting adequate sleep, and keeping stress a minimum. Since fevers can trigger seizures,
give them medication that lowers fever at the first sign of illness. If the seizures begin with an
aura (feeling), get the child to safe place where they can lie down until the seizure passes. Also
make sure those close to the child know what to do when having a seizure.

∙        Do not leave the seizure victim alone
∙        Anyone nearby should call 911. Children should be taken to an emergency room if:
∙        Any seizure lasts beyond two or three minutes.
∙        The patient has been injured
∙        The patient is diabetic.
∙        Parents, caregivers, or bystanders are at all uncertain.

Tips for Helping Children

Some of the following tips may help the child with epilepsy:
∙        Children should be treated as normally as possible by parents and siblings.
∙        Children should be assured that they will not die from epilepsy.
∙        Often children can be given the hope that they will outgrow the disorder.
∙        Most children will not have seizures triggered by sports or by any other ordinary activities
that are enjoyable and healthy.
∙        As soon as they are old enough, children should be active participants in maintaining
their drug regimens, which should be presented in as positive a light as possible.

Outcomes

According to one 2000 study, about 64% children with one seizure unrelated to fevers have
another one, and nearly two-thirds who have a history of more than one seizure are likely to
have more seizures. Researchers are trying to find ways of predicting which children have the
best chances to become seizure free, and which ones will not. Studies suggest that the
frequency of early seizures, not their total number or type, determines whether a child will
develop intractable epilepsy.

In general, the long-term effects of seizures vary widely depending on the seizure's cause.
Children with febrile seizures rarely have any long-term effects. In very rare cases, children
experience severe fever related seizures known as complex febrile convulsions. In such cases,
there is a risk for brain injury that may lead to temporal lobe epilepsy, but this is very small.
Such seizures last more than 15 minutes, occur more than once within 24 hours, and may
affect only one side of the body.

The long-term outlook for children with idiopathic epilepsy (epilepsy of unknown causes) is very
favorable. One study reported that individuals were seizure free after 20 years. In addition, a
2000 study reported that they had a survival rate no different from children without these
seizures.

Children whose epilepsy is a result of a specific condition (for example, a head injury or
neurologic disorder) have higher mortality rates than the normal population, but their lower
survival rates are most often due to the underlying condition not the epilepsy itself.
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