Neurology: What Shall I Do?

Questions

Epilepsy

Publisher Summary

This chapter discusses the clinical aspects of epilepsy. Children with epilepsy should be encouraged to lead as normal a life as possible within certain safety limits. They can develop their personalities in a satisfactory manner without acquiring too many chips on their shoulders. The type of advice given and the way that certain dangers should be emphasized depends on the personalities of the child and the parents and on the type of epilepsy. A child who is a daredevil with rather careless parents will need checking to avoid physical harm occurring during his episodes whereas an inhibited somewhat introverted child of overcautious parents may disappear into his shell completely if he is warned too strongly and such a family will need encouragement rather than caution. When an epileptic child goes swimming, he must be accompanied by someone specifically looking after him who is capable of rescuing him. He shouldn’t go just as one of a crowd because with the excitement in the pool, it is very easy for someone to be drowning when people think he is just swimming under water.

Question 1 ‘Can I ride my bike, Mum?’

The parents of an 8-year-old boy bring their son to the surgery. He has had three grand mal attacks in the previous 6 months. Idiopathic epilepsy has been diagnosed. He is now on anticonvulsant therapy. He has always been an active child. The parents ask whether he should be allowed to ride his bicycle, ride his pony, do PE at school. What advice would you give?

Children with epilepsy:

• Should not ride a bicycle in traffic.

• Should be able to ride a horse, but not on the road, unless they have poorly controlled major attacks.

• Should not swim without a personal attendant of some kind and should not swim either out of their own depth or their attendant’s depth.

• Should be discouraged from exercises involving heights.

Children with epilepsy should be encouraged to lead as normal a life as possible within certain safety limits. This is so that they can develop their personalities in a satisfactory manner without acquiring too many ‘chips on their shoulders’.

The type of advice given and the way that certain dangers should be emphasized depends on the personalities of the child and the parents as well as on the type of epilepsy. A child who is a dare-devil with rather careless parents will need checking to avoid physical harm occurring during his episodes, whereas an inhibited somewhat introverted child of over-cautious parents may disappear into his shell completely if he is warned too strongly and such a family will need encouragement rather than caution.

The type of epilepsy is very important. Infrequent major attacks may present less of a problem than more frequent minor episodes, although the parents and the child may not think so. It should be explained to them that a child with petit mal may be getting several episodes an hour and therefore statistically the chances of something going wrong due to a momentary lapse of consciousness and concentration are very much greater than in someone who has one major attack every 6–12 months. Some patients report that their attacks only occur when their mind is idling. Unfortunately, this is not totally reassuring because the brain is often idling while cycling and swimming and also occasionally attacks can break through at other times.

Riding a bicycle or a horse are not infrequent causes of injury to children without any lapses of consciousness, though clearly the epileptic child is more at risk from developing injuries to both head and limb when falling. Of the two activities, cycling is the more dangerous, particularly because of the greater chance of problems arising with traffic. One should enquire as to what sort of cycling is envisaged. A child riding a tricycle around the garden is unlikely to suffer serious injury, whereas a teenager riding his cycle 5 miles to school through busy traffic would be at considerable risk, although it is not against the law. It is up to you to explain the problem to the family and for them to make the decision. On balance if a child is well controlled, the risks of just cycling away from traffic are not enormous and parents may decide to allow this. The problems with riding a horse are much less frequent and hazardous. The horse very often does the sensible thing, even when the rider is in a trance on his back. Clearly a serious injury might result from a child having a major tonic–clonic seizure while astride a horse and not being able to protect himself on falling