The Health Blog » Epilepsy

MEDICAL TREATMENT OF SEIZURES: COMMON QUESTIONS ABOUT BLOOD LEVELS – “MY CHILD’S BLOOD LEVEL OF HIS MEDICATION IS LOW. WHY?”

admin — Mon, 16 May 2011 13:10:53 +0000

There are several possible reasons, perhaps the most common that the child is not on a high enough dose, a second that she is not receiving enough medication or is not taking the medicine. Non-compliance is a common reason for a low blood level, particularly among adolescents. Occasionally also an individual absorbs medicine poorly and must take more to achieve the same blood level. Rarely, an individual metabolizes the drug more rapidly than average and, therefore, has a low level. Whatever the reason, increasing the dose should help to determine the answer. If the person is taking the drug erratically or not at all, then prescribing more will usually have little or no effect. If the dose prescribed is too low, a higher dose should correct the problem, as it will do if the patient absorbs poorly or metabolizes rapidly.
Your child does not necessarily need a blood level test every time he visits the doctor!
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DRUGS FOR PARTIAL SEIZURES AND TONIC-CLONIC SEIZURES: REACTIONS TO PHENYTOIN – OTHER SIDE EFFECTS

admin — Sat, 12 Mar 2011 09:14:07 +0000

Phenytoin also affects behavior and learning. The child’s mood may change, and she may seem to have less energy. The child’s motor abilities and her alacrity in performing tasks may also be affected. Hyperactivity is less common than with phenobarbital, however, and the effects on learning may be less severe than with phenobarbital.

Some of the dose-related side effects of phenytoin are cosmetic, that is, they affect the appearance of the child. Gum hyperplasia (overgrowth of the gums) occurs in almost one-half of the children who have therapeutic blood levels. The overgrowth is made much worse by poor dental hygiene; thus, when children are wearing braces gum overgrowth becomes an even more severe problem. Children taking phenytoin should be taught good tooth-brushing techniques, and young children should have their teeth brushed by their parents. Good hygiene will diminish the gum swelling but not necessarily prevent it entirely. Overgrown gums can be cut back by the dentist. Overgrowth of the gums may make secondary teeth come in with wide spaces and may later require extensive orthodontic care.

Children who have been on high doses of phenytoin for long periods of time often develop coarse facial features and more extensive body hair. The hair does not disappear when the drug is discontinued, although it may decrease. Such a side effect may become a cosmetic problem, especially for young women. Although phenytoin is an excellent anticonvulsant, we prefer not to use it as our initial drug in young children because of its cosmetic side effects. The cosmetic effects seem to be a lesser problem with adolescents and adults.

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DRUGS FOR PARTIAL SEIZURES AND TONIC-CLONIC SEIZURES: REACTIONS TO PHENYTOIN – OTHER SIDE EFFECTSPhenytoin also affects behavior and learning. The child’s mood may change, and she may seem to have less energy. The child’s motor abilities and her alacrity in performing tasks may also be affected. Hyperactivity is less common than with phenobarbital, however, and the effects on learning may be less severe than with phenobarbital.Some of the dose-related side effects of phenytoin are cosmetic, that is, they affect the appearance of the child. Gum hyperplasia (overgrowth of the gums) occurs in almost one-half of the children who have therapeutic blood levels. The overgrowth is made much worse by poor dental hygiene; thus, when children are wearing braces gum overgrowth becomes an even more severe problem. Children taking phenytoin should be taught good tooth-brushing techniques, and young children should have their teeth brushed by their parents. Good hygiene will diminish the gum swelling but not necessarily prevent it entirely. Overgrown gums can be cut back by the dentist. Overgrowth of the gums may make secondary teeth come in with wide spaces and may later require extensive orthodontic care.Children who have been on high doses of phenytoin for long periods of time often develop coarse facial features and more extensive body hair. The hair does not disappear when the drug is discontinued, although it may decrease. Such a side effect may become a cosmetic problem, especially for young women. Although phenytoin is an excellent anticonvulsant, we prefer not to use it as our initial drug in young children because of its cosmetic side effects. The cosmetic effects seem to be a lesser problem with adolescents and adults.*121\208\8*

PREJUDICE, AND TELLING OTHERS ABOUT EPILEPSY

admin — Tue, 28 Apr 2009 12:39:07 +0000

It is unfortunately true that those with epilepsy do encounter a fair amount of prejudice against them, especially in the field of employment. This prejudice is perhaps based on dimly held knowledge of those in special care, or institutions, with the very worst epilepsy, often in association with mental retardation due to major neurological disease.

Prejudice against those with other illnesses is rare. No one minds if you have only one kidney or varicose veins. Most people go out of their way to help a blind person, or someone in a wheelchair. However, a blind or physically disabled person is immediately perceived as ‘different’. Bystanders can make judgements about his abilities. They may relate to him in a special way—a manner which is instantly perceived and resented by an occupant of the wheelchair! Such a visible handicap is perceived and managed as such by society. Someone with epilepsy, however, is perfectly normal for 99.9 per cent of the time. His ‘handicap’ is invisible. He then discredits himself, as it were, by having a seizure. His acquaintances feel deceived. The man they thought was a bank manager turns out to be ‘really an epileptic’, passing himself off as normal. Such an attitude is ridiculous, yet there is persistent evidence for it. Such prejudice will, we hope, gradually fade, as misconceptions about epilepsy are dispelled. However, it would be foolish to deny its existence at the present time.

A major problem that someone with epilepsy has to decide, therefore, is how much to tell, and to whom. For example, no mother wants to tell everyone that her son has epilepsy, but if the boy is staying the night at the house of a friend, it is only sensible to let his friend’s parents know that he might have a seizure, and to tell them how to cope. Most parents would agree with this policy if the boy was having seizures every fortnight or so—but what if they occurred only every six months? Parents might feel that they were spoiling the boy’s chances of friendship and social development if they sent him off with the label of epilepsy around his neck.

Young people with epilepsy forming friendships with the opposite sex also suffer agonies about these decisions. If the epilepsy is not talked about early in the relationship the subject becomes more and more difficult to bring up. The problem may then be revealed by the occurrence of a seizure without prior explanation. Both parties feel devastated—the one guilty and ashamed at not having had the courage to explain the problem, the other surprised and ashamed of their surprise and inability to cope both with the seizure and their own feelings about it.

On balance, we are sure that it is best for a person with epilepsy to tell those he meets frequently something of the facts, so that they can cope if a seizure occurs. Friends will appreciate the confidence shown in them by the fact of this disclosure.

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