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Epilepsy, Puberty and Seizures

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The Autistic Spectrum




Autism, Puberty, and the Possibility of Seizures

by Stephen M. Edelson, Ph.D.
Center for the Study of Autism, Salem, Oregon

About one in four autistic individuals begin to have seizures during puberty. The exact reason for the onset of seizures is not known, but it is likely that the seizure activity may be due to hormonal changes in the body.
Sometimes these seizures are noticeable, (i.e., associated with convulsions); but for many, they are small,subclinical seizures, and are typically not detected by simple observation.

Some possible signs of subclinical seizure activity include:

~ exhibiting behavior problems, such as aggression, self-injury, and severe tantrumming;
~ making little or no academic gains after doing well during childhood and pre-teen years;
~ and/or losing some behavioral and/or cognitive gains.

Personally, I have known a few autistic individuals who were considered high-functioning prior to puberty. During puberty, they experienced seizures which were not treated. By their late teens, they were considered, however,as low functioning. Some parents have an EEG performed to see if their child shows any seizure activity. However, even if the EEG does not detect abnormal activity during the testing period, one cannot conclude that the person does not have seizures. To increase the likelihood of detection, some individuals are assessed with an EEG for 24 to 48 hours.

Interestingly, vitamin B6 with magnesium as well as Dimethylglycine (DMG) are known to reduce or eliminate seizure activity in some individuals, even in cases where seizure drugs are ineffective.

Note that the majority of autistic individuals do not have seizures during puberty. In fact, many parents have told me that their son/daughter actually experienced a dramatic developmental leap forward during this period.

Parents of autistic children should be aware of the possible positive and negative changes that can occur with puberty. Of particular importance is the need for parents to be cognizant of the fact that about 25% of autistic individuals may experience clinical or subclinical seizures which, if left untreated, can lead to deleterious effects.
 
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Meeting the Challenges of Adolescence
A Guide for Parents
By R. Kaan Ozbayrak, MD
 
Adolescence is full of challenges for any child. The change is fast, everywhere, and hard to keep up with: The body changes in response to increasing levels of sex hormones; the thinking process changes as the child is able to think more broadly and in an abstract way; the social life changes as new people and peers come into scope. Yet the child needs to deal with every single one of these changes, all at the same time! With their willingness to help, that’s where the parents come in, who have "been there", with the life experience, maturity and resources. So, how can parents help? Recognizing the complex and sometimes conflicting needs of an adolescent would be a good point to start.
 
Adolescents yearn to develop a unique and independent identity, separate from their parents’. Yes, they love their parents, but they don’t simply want to follow their foot steps. They challenge their parents in any way they can. They disobey their rules; criticize their "old fashioned" values; they discard their suggestions. Experienced parents know that sometimes they have to be very "political" approaching their adolescent children, if they are going to get their point across. On the other hand, adolescents give a lot of credit to their peers. They yearn to belong to a peer group which would define and support their identity. They may attempt to do things very much out of character just to gain the approval and acceptance of their peers. They tend to hide their weaknesses and exaggerate their strengths. Of course, what adolescents consider as "weakness" or "strength" may sometimes shock their parents.
 
Youngsters with autism bring their special flavor to the adolescence, essentially determined by the levels of three ingredients: interest, avoidance and insight.
 
Level of interest: Since all forms of autism has an impact on social development by definition, most adolescents with moderate to severe autism will show little or no interest in others. They may seem to be totally unaware of their peers’ presence or they may appear indifferent when peers try to interact. As autism gets less severe, the level of interest in peers usually increases. For these youngsters, the quality of social interactions mostly depends on the levels of avoidance and insight.
 
Level of avoidance: In the social development of adolescents who show some interest in peer interactions, social anxiety and resultant avoidance play an important role. Some youngsters get very nervous just with the thought of approaching others and may choose to avoid it at all costs. Their avoidance may appear as if they are not interested in others. It is important to differentiate this since anxiety can be treated much more easily than genuine lack of interest.
 
Anxiety
A Fifteen year-old adolescent with Asperger’s Disorder was brought by his mother to seek help with his high level of social anxiety. He was refusing to go to school, where he lately had been labeled as "tardy". Their home was in walking distance of school and he would leave home late in the morning to avoid his peers riding or walking to school. He would not go to the school cafeteria to avoid waiting in line. He would avoid classes in which students had to study in groups. Most of his anxiety could be eliminated over a few weeks by the trial of an anti-anxiety medication which he tolerated well and he was able to function better in school.
 
Tip:
Most frequently, interaction with peers will create more anxiety than interaction with younger or older people: Younger children are safer to approach since they would be more likely to accept the dominance of an adolescent with autism and less likely to be critical. Older adolescents and adults are safer because they will be more likely to understand and tolerate. Parents therefore commonly observe that their children with autism prefer to interact with younger children or adults over their peers.
For adolescents with autism who show interest in peers and do not avoid contact, the quality of social interactions will depend on the level of insight.

Level of insight: Yet some adolescents with autism will not avoid interacting with others; younger, older or similar age. Rather, they are eager to communicate, though, often in a clumsy, in-your-face way. The level of their insight into their social disability will then become the determining factor of their social success. If they are unaware of their shortcomings in gauging the social atmosphere and reading social cues, they may inadvertently come across as rude, insulting or boring. They may miss subtle criticism, sarcasm or tease. As they develop better insight, they become more motivated to learn which had not come naturally and intuitively. They also have a better chance to work through a sense of loss, common to all disabilities.
 
Coping with the Loss of Normalcy
Regardless of the individual developmental route, most children with autism start realizing that they are not quite like others at some point during their adolescence. A few factors seem to facilitate the process:
  • A higher level of interest in others
  • A higher level insight into difficulties in social interaction
  • A higher IQ
Once the adolescent realizes that he has significant difficulties in conducting social relationships compared to his peers, he needs deal with this loss, just like dealing with another loss. Understanding the thoughts, feelings and behavior of an adolescent with autism is the necessary first step in helping him out and being there for him. Considering this coping process in a few stages may make the caregivers’ job easier:
 
Anger
Denial
Depression
Acceptance
Adaptation
 
Most commonly, the adolescent will not go through these stages one after another, but rather display a larger or smaller aspect of each at any given time. This is a painful process for not only the adolescent but for others who care for him as well. Parents may find themselves compelled to forget the whole thing and act as if nothing is happening. Well, we are all tempted to avoid pain and denial is an excellent pain killer. The good news is, as much as the denial is contagious, the courage and strength, too, and seeing his parents dealing with the pain calmly and matter-of-factly will encourage the adolescent talk about his anger and frustration. This will in turn help the adolescent get closer to the acceptance and adaptation:
  • You don’t have to bring it up, but when he does, give them a good listening ear and be patient;
  • Don’t try to change the subject, unless your child does so;
  • Don’t try to minimize his difficulties, but also don’t let him exaggerate, providing gentle reality testing;
  • Offer the option of counseling, since sometimes it is easier to talk to a stranger. However, try not to push the idea directly even if you feel that your child clearly needs professional help;
Tip:
Sometimes you have to be very political trying to sell an idea to a teenager. The mere fact that the idea is coming from his parents may make him refuse it. Let the idea come from a family friend, teacher, or a neighbor he trusts. Give him time to think about it. He may come back to the suggestion when he feels he is ready.
 
Consider trying an antidepressant medication if he doesn’t seem to be able to move on. Look for the following common symptoms of clinical depression. If five or more of these are present week after week, put your foot down:
  • Appearing sad for most of the time;
  • Becoming irritable and angry with the drop of a hat so that family members start walking on egg shells;
  • Not being able to fall asleep, waking up in the middle of the night and having difficulty falling back to sleep;
  • Complaining that he is tired all the time and wanting to take naps during the day;
  • Eating less or more than usual;
  • Putting himself down, saying he is stupid;
  • Making remarks like he hates life, he hates you, nobody loves him, or wishing he was dead;
  • Losing interest in activities he usually enjoys;
  • Withdrawing himself from the rest of the family, refusing to participate in group activities;
  • Blaming himself unfairly for anything that goes wrong.
Warning:
Clinical depression is a serious condition which carries a significant risk for self-harming behavior. If you suspect that he may have clinical depression, set up an appointment with a child and adolescent psychiatrist as soon as possible and do not put this as an option. He does not have a veto power on this decision.
 
Anger, Denial and Depression
A young teenager was referred from a clinical study of depression in children and adolescents to maintain his antidepressant medication. My clinical evaluation revealed Asperger’s Disorder in addition to his ongoing depression. The diagnosis of Asperger’s Disorder made very much sense to the parents who had wondered for years what was wrong with their son who, among other things, had difficulty relating to his peers, despite being very bright and able to communicate with adults in a quite sophisticated manner. Since he had responded only partially to the study medication we tried him on another antidepressant. Even though his mother thought that he was happier, more motivated and energetic, he was not able to recognize any improvement. During his most recent follow-up he was very angry with me and announced that he didn’t think that he had Asperger’s, he wanted to stop his medication and wished everybody leaved him alone. My suggestion for counseling was discarded, too. His mother and I firmly insisted that he continues to take his medication. We didn’t push the diagnosis or the counseling idea. I recommended his mother that if he does not feel like coming next time, she comes by herself so that we can strategize how to continue his treatment.
 
Most adolescents with autism excel in one or two subjects. They tend to accumulate a lot of information on the subject and love to talk about it over and over. Unfortunately, after one point family members end up losing interest and start getting bored to death. Rather than avoiding the subject, try finding out new ways to engage the youngster in the subject. Structure the topic in a different way. Find a way to challenge him. Be creative and let sky be the limit! Your interest will make your child feel better about himself, realizing his mastery on the subject will boost his self-esteem.
 
Many adolescents with autism resolve their sense of loss by turning the issue upside down: Rather than clinging to depression and despair, they find their identity in autism. They get in touch with other youth with autism. They take on themselves educating their peers about autism at school. They set up web sites, chat rooms and even write books about it. They gather support for a better understanding and treatment of autism. Encouraging your child, providing him means to this end and removing the obstacles in front of him may turn out to be the best antidepressant treatment ever. All this may seem remote and you may not know where to start. Consider the following tips:
  • Set a good example.
  • Get in touch with the organizations like the Autism Society of America or Asperger Syndrome Coalition of the U.S. and contact their local chapters;
  • Attend support groups for parents and make acquaintances;
  • Leave brochures, leaflets and other information about teen groups around to catch the attention of your teenager;
  • Invite your new acquaintances to your house and encourage them to bring their children;
  • If it doesn’t work right away, don’t get discouraged and keep trying, always letting your child make the first move in showing interest.
Acknowledging Sexuality
 
In contrast with their rather slow social development and maturation, adolescents with autism develop physiologically and sexually at the same pace as their peers. As their sons and daughters with autism grow older and display sexualized behavior, many patents find themselves worrying that
 
  • their child’s behavior will be misunderstood;
  • their child will be taken advantage of;
  • their daughter will get pregnant or their son will impregnate someone else’s daughter;
  • their child will not have the opportunity of enjoying sexual relationships; or
  • their child will contract sexually transmitted diseases.
While some parents get concerned that their children show no interest in sexual matters, others have to deal with behaviors like:
  • touching private parts of own in public;
  • stripping in public;
  • masturbating in public;
  • touching others inappropriately;
  • staring at others inappropriately; and
  • talking about inappropriate subjects.
Talking about sex, especially the sexuality of our children makes us feel uncomfortable. Even though we all wish that our children have safe and fulfilling sexual lives, we hope the issue just gets resolved by itself, or at least somebody else takes the responsibility of resolving it. We may find ourselves lost trying to imagine our children, who have significant problems carrying a simple conversation, building relationships that may lead to healthy sexuality. We may find it comforting to believe that our children don’t have sexual needs and feelings, and avoid bringing up the subject in any shape or form. We may feel uneasy about sex education, believing that ignorance will prevent sexual activity.
 
How can we make sure that our children with autism express sexuality in socially acceptable and legally permissible ways, avoiding harm to themselves and others?
 
The key is making your mind that you will address the issue, rather than avoid it. Set up a time with your child to talk about sexuality, rather than making a few comments about it when the issue is hot, right after an incident, when everybody feels quite emotional about what just has happened. Ask direct questions about what your child knows about sex. Ask about his desires and worries. Tell him what you think should be his first step. After inquiring and talking about the normal behavior, set realistic but firm limits about inappropriate behavior. Seeing your level of comfort around the issue, your child will get the message that it is OK to have sexual feelings and it is OK to talk about them. Getting this message alone will bring the tension around sexuality a few notches down. If this approach fails, please do not be shy about asking for help. Other parents with adolescent children would be a good starting point. Your child’s school may also be able to help. Finally, you may inquire about professional help which should provide:
  • an individualized sexuality assessment and
  • sex education based on individual needs, while
  • utilizing behavioral modification techniques to discourage inappropriate sexual behavior and promote appropriate sexual behavior.

Source:  http://www.aspergers.com/Adolesc.htm

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Links that may be of interest:
 
Autism and Puberty
 

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Electroencephalography (EEG)

 

An EEG, short for electroencephalograph, is a painless test which records the brain's activity by picking up electrical signals or impulses produced by brain cells. These electrical impulses are amplified by the EEG machine and recorded on paper or on a computer.

 

The test gives an indication of how the brain is working. This information may be used together with eyewitness accounts of the persons seizures, in order to help with the diagnosis or to guide decisions about treatment.

 

What happens during the test?

 

At the beginning of the test, the medical technical officer (MTO) attaches a number of electrodes on the surface of the person's head. The electrodes are connected to a recording machine and are held in place with a paste or by a rubber cap. This procedure is painless and takes up to 15 minutes. During this time the patient may ask the medical technical officer any questions they have about the EEG.

 

During the test, which lasts for about 30 minutes, the person sits or lies down. They may be asked to blink repeatedly or breathe deeply, which can help to bring out 'epileptiform' activity: brain patterns associated with epilepsy.

 

A strobe light test may be carried out during the EEG as a small number of people have seizures triggered by flickering lights. The test is stopped before an actual seizure occurs.

 

More information about photosensitive epilepsy.

 

At the end of the test, the electrodes are removed from the hair; any remains of gel can be washed away later with shampoo. Babies and children will not be expected to do all of the above; the test is adapted for them.

 

EEG test results

 

A report on this test is prepared by the medical technical officer. This is passed to the consultant, who will discuss the results with the patient at a later date.

 

Many people, including those who go on to have a diagnosis of epilepsy, have a 'normal' or 'negative' result from a routine EEG carried out between seizures. This is because an EEG can only give information about the electrical activity of the brain during the test itself. Patterns characteristic of epilepsy may only be seen if the person experiences a seizure during that time.

 

However, some people show continuous activity characteristic of epilepsy, even between seizures. A small number of people who do not have epilepsy show some irregular electrical activity in the EEG, so a positive result does not always mean that a person has epilepsy.

 

The results of the EEG may support a diagnosis of epilepsy, but on their own will not give a definite indication one way or another. The EEG results will be considered alongside other information to provide a fuller picture of what is happening in the brain.

 

Different types of EEG test

 

Sometimes more detailed EEG recordings may be taken, with the aim of highlighting any abnormalities not picked up in the routine EEG:

 

Sleep deprived EEG

 

Some people have a sleep-deprived EEG as there may be a greater chance of recording irregular brain activity if the person is sleeping following sleep deprivation. For this procedure the person may be asked to stay awake all or most of the night before. The test is performed in the same way as for a routine EEG but the person is usually asleep during the test. In some cases sleep is induced by a mild sedative, which is given about half an hour before the EEG.

 

Ambulatory EEG

 

An ambulatory EEG allows the activity of the brain to be recorded for several hours, days or weeks. It uses stick-on electrodes, which are hidden under the hair and held in place by glue. The wires are connected to a small recording machine, similar to a personal stereo, which is worn on a belt around the waist. This allows the person to move around and continue with most normal daily activities while recording takes place. The person may be asked to keep a diary with times of meals, exercise, sleep and any seizures. These are then related to the patterns seen on the EEG.

 

Video telemetry

 

This test is carried out in hospital and may last a day or longer. It involves both EEG and video recordings being made at the same time, to try and record what happens during a seizure on video as well as recording the brain activity.The electrodes are attached to the scalp as in the ambulatory EEG, and the person is able to move freely around the room within view of the video camera. This test allows the doctor to compare what the person is doing during a seizure with the electrical activity of the brain. This can be helpful in making an accurate diagnosis and also in deciding what type of seizures the person has.

 

How should I prepare for an EEG?

 

Before the test a person should have eaten breakfast or lunch, less than 2 hours previously. Their hair should be clean and free from hair gel or other substances.

 

Do I need to stop taking my medication for the test?

 

No. If this were necessary, the doctor would request it.

 

Is the test painful?

 

No. The test is harmless and non-invasive, which means that the skin is not broken.

 

Is this shock treatment?

 

No. The EEG is a diagnostic test and does not use electricity; it only records electrical impulses from the brain. 

 

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Syncope
 

Syncope (faint) is a sudden fall of blood pressure resulting in loss of consciousness. About 3% of the population have syncope at some point in life (Savage, 1985).  Syncope also accounts for 3% of all emergency room visits and 6% of all hospital visits. Between 71 and 125 children and adolescents/100,000 population experience syncope each year. The incidence peaks in 15--19 year olds (Driscoll, 1997).

Presyncope consists of unsteadiness, weakness, or cognitive symptoms without loss of consciousness. It is often a symptom of orthostatic hypotension, and may also be a source of drop attacks (Dey et al, 1997).

 

Causes of syncope:


Arrythmia -- abnormal slowing or quickness of the heart

 

. bradycardia (slowness of heart beat)
. sick-sinus (variable)
. supraventricular or ventricular tachycardia (abnormally fast)


Hemodynamic -- obstruction to blood flow

 

. hypertrophic subaortic stenosis  (IHSS)
. aortic stenosis
. pulmonary embolism or hypertension

 

Neurally mediated

 

. vasovagal reaction (usually related to emotional stress)
. carotid sinus hypersensitivity
. postural hypotension (usually related to medication or dehydration)


In the differential diagnosis of syncope one must also consider non-cardiac causes of loss of consciousness:

 

. seizure
. stroke or TIA
. metabolic encephalopathy
. psychiatric conditions


Common drugs that are associated with an excess risk of syncope in the elderly include

 

. fluoxetine (Prozac)
. aceprometazine (Not available in the USA)
. haloperidol (Haldol)
. L-dopa (Sinemet)

 

(Source: Cherin et al, 1997)

 

Evaluation of Syncope:


Physical examination should include at a minimum ~

 

. blood pressure and pulse, standing and supine
. cardiac exam


Carotid sinus testing may also be helpful. Asessment of balance, such as with the tandem Romberg test, may be useful in excluding alternative causes of falls. According to Linzer and associates, a  careful history, physical examination combined with an ECG will yield a diagnosis in 50% of cases.

 

Routine Laboratory Testing:


. ECG
. Exercise stress test
. Holter or ambulatory event monitoring


The diagnostic yield of ambulatory event monitoring is 25-35% (Lanzer). The diagnostic yields of echo, stress testing, holter monitoring and electrophysiological studies alone or in combination varies widely (5-35%). The routine ECG is often helpful in identifying abnormalities of rhythm, conduction or morphology of the heart electrical activity that give a clue as to the underlying etiology of the syncope. Recording the ECG during the spell can be achieved by using 24 hour ambulatory recording (also known as Holter monitoring), an event recorder, or a memory loop recorder. 24 hour monitoring is useful in persons who have frequent spells that can be expected to have an event during the 24 hours that they are monitored. Such individuals need to have a non-life threatening spell to make this modality safe. The event recorder and loop memory recorder are useful in persons whose events occure less frequently than every 24 or 48 hours. These devices require the patient or an accompanying person to activate the monitor at the time of symptoms. (Hammill, 1997). Recently implantable monitors have been made available for persons who need chronic monitoring of heart function (i.e Reveal device, made by Medtronic).

 

In certain situations consider:

 

. Autonomic testing, including tilt-table testing, for orthostatic hypotension
. Carotid Doppler
. EEG
. Electrophysiological testing (catherization)
. Psychiatric evaluation


The diagnostic yield of EEG, CT scan, and doppler varies from 2-6%. 

 

Prognosis:


30% of people with one syncopal episode have recurrence. In children and adolescents, syncope is a benign event. For patients with cardiac causes, generally an older group, 50% die within 5 years, a third of which due to sudden death. For non-cardiac causes of syncope, excluding children and adolescents, 5-year mortality is 30%.

 

Source:

http://www.tchain.com/otoneurology/disorders/medical/syncope.htm

 

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Epilepsy

Definition
Epilepsy is a brain disorder involving recurrent seizures.

Alternative names
Seizure disorder

Causes, incidence, and risk factors
Epilepsy is a disorder involving repeated seizures of any type. Seizures ("fits") are episodes of disturbed brain function that cause changes in attention and/or behavior. They are caused by abnormal electrical excitation in the brain.

Sometimes, seizures are related to a temporary condition, such as exposure to drugs, withdrawal from certain drugs, or abnormal levels of sodium or glucose in the blood. In such cases, repeated seizures may not recur once the underlying problem is corrected.

In other cases, injury to the brain (e.g., stroke or head injury) causes brain tissue to be abnormally excitable. In some people, an inherited abnormality affects nerve cells in the brain, which leads to seizures. In some cases, no cause at all can be identified.

Some of the more common causes of seizures include:

  • Idiopathic (no identifiable cause)
    • usually begin between ages 5 to 20
    • can occur at any age
    • no other neurologic abnormalities present
    • often a family history of epilepsy or seizures
  • Developmental or genetic conditions present at birth, or injuries near birth -- in this case, the seizures usually begin in infancy or early childhood
  • Metabolic abnormalities
    • may affect people of any age
    • diabetes mellitus complications
    • electrolyte imbalances
    • kidney failure, uremia (toxic accumulation of wastes)
    • nutritional deficiencies
    • phenylketonuria (PKU) -- can rarely cause seizures in infants
    • other metabolic diseases, such as inborn error of metabolism
    • use of cocaine, amphetamines, alcohol or certain other recreational drugs
    • withdrawal from alcohol
    • withdrawal from drugs, particularly barbiturates and benzodiazepines
  • Brain injury
    • may affect any age, highest incidence in young adults
    • most likely to occur if the brain membranes are damaged
    • seizures usually begin within 2 years after the injury
    • early seizures (within 2 weeks of injury) -- do not necessarily indicate that chronic seizures (epilepsy) will develop
  • Tumors and brain lesions that occupy space (such as hematomas)
    • may affect any age, more common after age 30
    • partial (focal) seizures most common initially
    • may progress to generalized tonic-clonic seizures
  • Disorders affecting the blood vessels (such as stroke and TIA)
    • most common cause of seizures after age 60
  • Degenerative disorders (senile dementia Alzheimer type, or similar organic brain syndromes)
    • mostly affect older people
  • Infections
    • may affect people of all ages
    • may be a reversible cause of seizures
    • brain infections like meningitis and encephalitis can produce seizures
    • brain abscess
    • acute severe infections of any part of the body
    • chronic infections (such as neurosyphilis)
    • complications of AIDS or other immune disorders

Seizure disorders affect about 0.5% of the population. Approximately 1.5 to 5.0% of the population may have a seizure in their lifetime. Epilepsy can affect people of any age.

Risk factors include a family history of epilepsy, head injury, or other condition that causes damage to the brain.

The following factors may present a risk for worsening of seizures in a person with a previously well-controlled seizure disorder:

  • Pregnancy
  • Lack of sleep
  • Skipping doses of epilepsy medications
  • Use of alcohol or other recreational drugs
  • Certain prescribed medications
  • Illness

Prevention
Generally, there is no known way to prevent epilepsy. However, adequate diet and sleep, and abstinence from drugs and alcohol, may decrease the likelihood of precipitating a seizure in people with epilepsy.

Reduce the risk of head injury by wearing helmets during risky activities; this can help lessen the chance of developing epilepsy.

Symptoms
The severity of symptoms can vary greatly from simple staring spells to loss of consciousness and violent convulsions. For many patients, the event is stereotyped (the same thing over and over) while some patients have many different types of seizures that cause different symptoms each time.

The type of seizure a person experiences depends on a variety of factors, such as the part of the brain affected, the cause, and individual response.

An aura consisting of a strange sensation (such as tingling, smell, or emotional changes) occurs in some people prior to each seizure. Seizures may occur repeatedly without explanation.

SYMPTOMS OF GENERALIZED SEIZURES

Generalized seizures affect all or most of the brain. They include petit mal and grand mal seizures.

Petit mal seizures:

  • Minimal or no movements (usually, except for "eye blinking") -- may appear like a blank stare
  • Brief sudden loss of awareness or conscious activity -- may only last seconds
  • Recurs many times
  • Occurs most often during childhood
  • Decreased learning (child often thought to be day-dreaming)

Tonic-clonic (grand mal) seizures:

  • Whole body, violent muscle contractions
  • Rigid and stiff
  • Affects a major portion of the body
  • Loss of consciousness
  • Breathing stops temporarily, then "sighing"
  • Incontinence of urine
  • Tongue or cheek biting
  • Confusion following the seizure
  • Weakness following the seizure (Todd's paralysis)

SYMPTOMS OF PARTIAL SEIZURES

Partial seizures affect only a portion of the brain.

Simple partial (focal) seizures:

Partial complex seizures:

  • Automatism (automatic performance of complex behaviors without conscious awareness)
  • Abnormal sensations
  • May have nausea, sweating, skin flushing and dilated pupils
  • May have other focal (localized) symptoms
  • Recalled or inappropriate emotions
  • Changes in personality or alertness
  • May or may not lose consciousness
  • Olfactory (smell) or gustatory (taste) hallucinations or impairments -- if the epilepsy is focused in the temporal lobe of the brain.

Signs and tests

The diagnosis of epilepsy and seizure disorders requires a history of recurrent seizures of any type. A physical examination (including a detailed neuromuscular examination) may be normal, or it may show abnormal brain function related to specific areas of the brain.

An electroencephalograph (EEG), a reading of the electrical activity in the brain, may confirm the presence of various types of seizures. It may, in some cases, indicate the location of the lesion causing the seizure. EEGs can often be normal in between seizures, so it may be necessary to do prolonged EEG monitoring.

Tests may include various blood tests to rule out other temporary and reversible causes of seizures, including:

Tests for the cause and location of the problem may include procedures such as:

Disorders that may cause symptoms resembling seizures include transient ischemic attacks, rage or panic attacks, and other disorders that cause loss of consciousness.

 

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What To Do If Witnessing a Seizure

Helping the person

What can you do for the person having a seizure? Here are suggestions from the Epilepsy Foundation of America:

  • Ease the person to the ground or flat surface and put something soft under the head. Clear the area of any hard or sharp objects.
  • Turn the person on one side to prevent choking and keep the airway clear. Loosen anything around the neck that might hinder breathing.
  • Don't try to hold down the person to prevent jerking movements. This could injure the person.
  • Don't force anything into the person's mouth. Contrary to popular myth, seizures do not cause people to swallow their tongues.
  • Keep the person out of harm's way, guiding them away from possible danger such as a busy street or steep stairs.
  • Stay with the person until full awareness returns and offer help in returning home or to some other destination.

Calling for help

You should call for medical assistance if:

  • convulsive shaking and jerking lasts longer than five minutes, or starts again shortly after stopping;
  • breathing is difficult or there is unusual pain in the chest or other body area;
  • the person having the seizure seems ill, injured, or appears to be pregnant.

If you are living with a person who has a seizure disorder, ask the doctor about how you should respond to the particular seizures and when to call for medical help.

What A Doctor Can Do

Doctors use several approaches to determine if a person has a seizure disorder, the type, and its extent.

Gathering Information

An important tool for the doctor is gathering as much information as possible about what the seizures looked like and what happened just before they started. Sometimes other people -- family, friends, or coworkers -- can better describe what happened after the seizure started, since the person who had the episode often cannot.

Testing

EEG

A doctor also diagnoses epilepsy using an electroencephalogram (EEG), a painless test that measures electrical activity in the brain. Electrical signals from brain cells are picked up by small wires placed on the head and recorded as wavy lines by a special machine. The brain waves may show patterns that are typical of certain seizure types. 

CT/MRI

Once epilepsy is suspected, computed tomograph (CT) or magnetic resonance imaging (MRI) scans of the brain may help pinpoint a cause. These record pictures of the brain to see if there are any growths, scars, damage from injury or stroke, or other physical conditions that might be producing seizure activity.

Other tests

The doctor may order blood tests, liver and kidney function studies, an electrocardiogram (ECG) measuring heart function, and other tests to find other possibly treatable causes of seizures.

Treating Epilepsy

Epilepsy is typically treated with medicines, a special diet, lifestyle changes, or in some severe cases, surgery. If you experience seizures, your doctor can help determine which treatment is right for you.

Drug Therapy

Treatment with medicines is most common and is usually tried first. There are different drugs that can be used, depending on the type of seizures, and doctors often attempt to use one drug at a time if possible. No single drug can control all types of seizures. Some people have their seizures controlled with a single drug others must take several.

Medications that are prescribed for seizures should be taken regularly as prescribed.

Diet

A special diet very high in fats -- called a ketogenic diet -- sometimes helps prevent seizures, especially in children. It must be prescribed and monitored by a doctor, and is usually tried only if medications and other treatments do not work effectively.

Surgery

If medication fails to control the seizures, or if epilepsy is caused by a brain tumor, surgery might be recommended. It is usually tried only if seizures begin in a small area of the brain. Treating that small portion may stop the seizures or greatly reduce them, without damaging the patient's ability to function in other ways. Surgeons will operate only when the possible benefits outweigh the risks.

Living with Epilepsy

If you have epilepsy, here are some suggestions from the Epilepsy Foundation for living with this disorder:

  • Educate yourself and others about epilepsy to dispel any misunderstandings about this medical condition.
  • Take all medications as directed by your doctor. Never miss a dose or take more or less than prescribed.
  • Tell your doctor if you are having any side effects from medications or if there is a change in your seizures.
  • Learn what may trigger your seizures and do what you can to avoid those things.
  • Limit or avoid alcohol, since it can interact with medicines you are taking and/or trigger seizures.
  • Lead an active life, however, precautions are needed for activities that might be hazardous if you were to suddenly lose consciousness or be unable to control your movements. Discuss your activities with your doctor.
  • Most states allow people with epilepsy to drive if they have not had seizures for a certain length of time. Your doctor can advise you on qualifications.
  • Fight off feelings of sadness, or depression. They may be related to your seizures or medication, so talk to your doctor rather than remaining silent.
  • Overall, try to live as independently and actively as you can. Try not to let concerns about having a seizure keep you at home. Wear a medical identification bracelet and carry a first aid card, so if you have a seizure, people will know what to do.

Epilepsy is a medical condition. There is no such person as an "epileptic."

Epilepsy may be a part of your life, but it is not your entire life. This disorder doesn't have to make your life different in any major way.

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American Medical Alarms, Inc.

Consumer Reports MedicalGuide.org - Independent, trustworthy information on best treatments and prescription drugs.

E Fact A Day

Epilepsy Action (UK)

Epilepsy Canada

Epilepsy.Com

Epilepsy Foundation.

Epilepsy Ontario

International League Against Epilepsy

Medical Bracelets

Medic Alert Products and Services

Merck Source

National Institute of Neurological Disorders and Stroke

National Society for Epilepsy.

The EpiCentre

Washington University and Barnes-Jewish Hospital Epilepsy Center