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MEDICAL TREATMENT OF SEIZURES: HOW ANTICONVULSANT DRUGS WORK IN EPILEPSY

admin — Sat, 14 May 2011 13:10:43 +0000

In an ideal world, we would understand the chemistry and the physiologic mechanisms causing epilepsy—how cells interact, fire, and misfire. Then we would design drugs that interact with the brain and prevent the misfiring, the seizures, without affecting the brain’s normal function. As we have previously indicated, we do not know how or why a seizure occurs. While we have many drugs that are effective in treating and preventing seizures, we do not know how they work.
Because epilepsy is a result of complex interactions in the brain, and since these interactions cannot be accurately simulated in a test tube or by a computer, animal experimentation has been necessary for us to understand epilepsy and learn how to control it. Most anticonvulsants were discovered by experimenting with substances to see if they would work in animals that had seizures caused by certain drugs. Such animal seizures, although not the same as epilepsy, have many similarities. Such research has been highly useful, and it must continue.
Although we do not know how the drugs work, we do know a lot about how they are absorbed and metabolized in the body and about their side effects. This knowledge enables us to use them properly, to calculate a dose, and to predict effects and side effects. This knowledge is called the pharmacology of the drugs; your physician will use this knowledge in treating your child and controlling her seizures.
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SEIZURES AND EPILEPSY IN CHILDHOOD: UNDERSTANDING YOUR CHILD’S TESTS – EEG ABNORMALITIES RELATED TO CERTAIN SEIZURE TYPES

admin — Thu, 06 Jan 2011 15:54:49 +0000

While the EEG does not diagnose seizures, certain abnormalities on the EEG are commonly associated with certain seizure types and can help your physician determine your child’s treatment and the probable outcome. Thus, just as classification of seizures is useful, so classification of the EEG is useful also.
Roger is in the third grade and has been a very good student. But in the second half of the year the teacher sends you a note that Roger is not working up to his ability. He is not paying attention in class; he often daydreams. Sometimes, when he’s asked a question, he claims that he didn’t hear the question or that he has forgotten the answer. What’s happening to Roger? Is he bored and daydreaming? Is he not smart enough to understand the new work and, consequently, confused? Is he upset or depressed by events at home or school? Is he having staring spells (absence seizures)?
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LIVING WITH EPILEPSY: WHAT TO DO DURING A SEIZURE

admin — Tue, 28 Apr 2009 12:38:29 +0000

What should a bystander do during a grand mal attack? The onset is often so sudden that it is difficult to do much at all in the early stage, though it may be possible to break the person’s fall. Parents or other relatives may recognize the warning signs that may occur if the generalized seizure follows a focal discharge, and so may have time to help the person to a chair or to a bed before the grand mal begins.

Don’t try to open the person’s clenched mouth. The tongue, if bitten, is bitten at the onset of the attack, so there is no point in trying to save it. If the bystander uses his own fingers to try to force the mouth open, they may well be bitten in the clonic phase. If he tries to force a spoon or pencil between the teeth, the person’s teeth may be damaged. These manoeuvres are still sometimes attempted by tradition, and sometimes, presumably, because it is assumed that the person’s blue colour and arrest of breathing are due to obstruction to the passage of air into the lungs. Attempts to ‘loosen the collar’ presumably result from the same thoughts. However, all of us have enough gaps between our teeth to allow passage of air around them as readers can readily show for themselves by clenching their teeth, pinching the nose, and breathing in. Obstruction to the airway may occur during a seizure, if the person is lying on his back. The tongue may then fall backwards into the pharynx, and, for this reason, it is worth turning someone suffering a grand mal seizure into a position halfway between lying on his or her side and face, and thumping the back so that the tongue and any dentures fall forwards. This position also has the advantage that if the person vomits, as occasionally happens, the contents of the stomach pass easily out of the mouth, and there is no danger of vomit entering the trachea and lungs.

If a grand mal seizure occurs in a public place, it usually happens that someone calls an ambulance—very often to the annoyance of the person with epilepsy, who is well on the way to recovery by the time the ambulance driver delivers him to the local hospital. There is no need to call an ambulance unless it is clear that repeated seizures are occurring.

There is usually little to be done during a partial seizure, except to stand by in a reassuring manner until seizure activity ceases. Occasionally gentle restraint may be necessary in the case of complex automatic behaviour.

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