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PART ONE 1. What is epilepsy? 2. The physical causes and emotional triggers of epilepsy 3. How epilepsy is diagnosed - or should be 4. So, if it isn't epilepsy, what is it? 5. The risks of seizures 6. The management of epilepsy 7. The drugs in use: Pros and cons 8. Other treatments, other problems PART TWO - BEING A WOMAN, HAVING EPILEPSY 9. Being a woman - having epilepsy 10. Epilepsy and sexuality 11. Contraception, epilepsy and epilepsy treatment 12. Epilepsy and fertility 13. Pre-conception counselling 14. Pregnancy 15. Labour, birth and the immediate aftermath 16. Childcare 17. The premenopause, the perimenopause, and the menopause 18. The older woman 19. Being a woman, having epilepsy: Harriet's story Appendix 1 Drugs for epilepsy Appendix 2 Where else to find help and informationCite
he problems of coping with adolescence are greatly increased by an additional chronic disorder.This is particularly so for those with epilepsy, where there is social stigma and the need for potentially sedative and damaging medication.Epilepsy is the most common neurological condition among patients transferred from paediatric to adult care.Many of the problems encountered in the teenager with epilepsy are shared by those with other chronic disabilities. 1 2 This review considers the paediatric environment that the adolescent is leaving, the rationale for a teenage clinic, and the facets of this which make it a desirable facility. c THE TEENAGER WITH EPILEPSYEven when relatively mild, the impact of epilepsy on the teenager and on other members of the family may be profound.Epilepsy has important differences from other chronic disorders, particularly that the disability is intermittent, and so can be hidden.The perceived need to conceal epilepsy, and concern about seizures occurring in public, can induce great anxiety.The consequences of missing epilepsy, or treating it inappropriately, can be disastrous in terms of impaired education, employment, and driving prospects, unnecessary medication, and diminished self esteem.Perhaps these factors are of greater importance for teenagers than for those in other age groups: c Developing independence is impeded, education is at a critical stage, employment and driving prospects are just being realised, and issues of relationships, contraception, pregnancy, and parenthood are becoming increasingly relevant.c Deviations from peer group norms hold great importance for teenagers: epilepsy can be disastrous for self esteem and self identity.c Social handicaps acquired in childhood and adolescence can remain with the individual even after seizures have been adequately controlled.Complete control achieved before adult social and vocational responsibilities can help to avoid these problems.A relatively aggressive approach to treatment, including early consideration of epilepsy surgery, is therefore justified. THE TEENAGER CLINICTaking over a patient's care offers opportunities to reassess the diagnosis by reviewing the history, and to ensure appropriate investigations are to hand.This is best done in the setting of a specialist teenager epilepsy clinic.Developing teenagers often find paediatric clinics embarrassing and inappropriate.A transitional arrangement offers the benefit of consulting both an adult and a paediatric neurologist, supported by an epilepsy specialist nurse. 3The general principles of a teenager epilepsy consultation are listed in box 1.Two main patient groups are referred to this type of clinic: c Patients presenting with blackouts beginning as teenagers (referred from general or hospital practice) where the main initial issue is diagnosis.c Patients with ongoing and often complex epilepsy from childhood (referred from general paediatrics or paediatric neurology) where the main issue is ongoing management of the epilepsy.The following should be addressed at first contact: c Is the diagnosis of epilepsy correct?c If the diagnosis is epilepsy, which type is it?c Is the current epilepsy management appropriate?c Is there appropriate knowledge and understanding of the condition, its prognosis, and its lifestyle implications?In particular, will the seizures interfere with completion of education, training for a career/job, or qualification for a driving licence, and are there special social circumstances that need to be addressed? IS THE DIAGNOSIS OF EPILEPSY CORRECT?A correct diagnosis is essential for the appropriate management of any patient with blackouts.Despite major advances in the technology for investigating blackouts, the most important investigation remains the taking and re-taking of the clinical history.
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A global approach is mandatory for people with epilepsy. Epileptic seizures occur with unpredictable frequency in unexpected place. Patients with epilepsy have fourfold risk of comorbidities (especially cognitive and psychiatric) which reduce quality of life. For improving the lives of persons with epilepsy the stigma and social burden associated withepilepsy must be reduced. Arriving at a more comprehensive and integrative treatment concept is important.Une approche globale des personnes épileptiques est nécessaire. Les crises épileptiques sont imprévisibles et peuvent se produire n’importe où. Les patients épileptiques ont 4 fois plus de maladies comorbides que la population générale, spécialement des troubles cognitifs et psychiatriques. Il faut réduire la stigmatisation et le handicap social associé à l’épilepsie pour améliorer la qualité de vie des patients. Il est important de développer une conception globale de la prise en charge thérapeutique dans l’épilepsie.
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Intractable epilepsy
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Etiology
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Epilepsy is defined by the International League Against Epilepsy as a chronic neurological condition characterized by recurrent epileptic seizures. Most physicians who participate in the care of children are aware that epilepsy is one of the most common chronic disorders that affect children. Epilepsy is prevalent in every country, in every race and religion and in every socioeconomic status. There are of course founder effects for particular epilepsies in certain populations, but aside from these considerations the distribution of the epilepsies is remarkably similar across the planet. Epilepsy can begin at any age, although there are two more frequent ages of onset: in early childhood, reflecting hypoxic-ischemic encephalopathy, inborn errors of metabolism, genetic epilepsies and brain malformations, and in adolescence, reflecting for the most part age related genetic epilepsies. When a child with epilepsy presents for the first time to the clinic or to the emergency room, the presenting complaint is not usually of epilepsy but rather of staring spell, inattentiveness or loss of consciousness. It is the pediatric neurologist’s work to determine whether a particular child does in fact have epilepsy, or instead has convulsive syncope, breath-holding spells, myoclonus (either pathologic or of the benign nocturnal variety), chorea, dystonia, micro-sleeps, is inattentive or is enjoying the delights of day-dreaming. As with any disorder, taking a complete history is most important in determining what type of paroxysmal event occurred. Tests including electroencephalography andmagnetic resonance imaging are used to refine and confirm the clinical impression. Children with uncomplicated epilepsy are often returned to the care of their pediatricians, family physicians or pediatric nurse practitioners after diagnosis, although some continue to be cared for by a pediatric neurologist. When epilepsy is refractory, then referral to a pediatric epileptologist in an epilepsy center is warranted. When a child is diagnosed with epilepsy, his or her pediatric neurologist is careful to clearly explain the diagnosis and the principles of seizure management, the choices of anticonvulsant medications to be considered and their risks, benefits and side effects, seizure first aid, seizure precautions, lifestyle modifications and activities to avoid. Introductions to the clinic nurse and social worker are made. The primary health care provider receives an initial communication, and clinic contact information for questions or issues that arise between visits is provided to the family. All of these discussions and activities are extremely important, and yet there remains a large swath of a child’s life that is also affected by the diagnosis of epilepsy, either directly or indirectly. What of the child’s education, the after school activities, the effects on other medical conditions that a child may have, the general medical care of the child and the effects on the family as a whole? These issues are not usually highlighted in the education of a pediatric neurologist, and so this issue devoted to general health concerns for children with epilepsy has been prepared. I hope that you find the thoughtful discussions as interesting and as informative as I have. *Address for correspondence: Carol Macmillan, Department of Pediatrics, University of Chicago, 5841 South Maryland MC 3055, Chicago, IL 60637-1470, USA. Tel.: +1 773 702 6487; Fax: +1 773 702 4786; E-mail: cmacmill@peds.bsd.uchicago.edu. Journal of Pediatric Epilepsy 2 (2013) 145 DOI 10.3233/PEP-13055 IOS Press 145
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Epilepsy is a common neurological disorder, prevalent in about 1% of the population. Almost half of the patients with epilepsy are women. Epilepsy and antiepileptic drugs can affect each aspect of the female human life cycle which includes menstrual cycle, contraception, fertility, conception, pregnancy and menopause. The interplay of the female hormonal state and epilepsy is complex and has to be taken in to consideration when managing their epilepsy. This review focuses on the management of women with epilepsy related to their role in reproduction.
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Epilepsy most commonly starts in the first two decades of life. Adolescence is a time of great change both in the epilepsy itself and in a number of other areas. Growth into adulthood, issues of preparation for university or employment, driving, drinking, preparation for marriage/conception and a general increase of responsibility add to the complexity of this time of life. Epilepsy affects all these areas to a significant degree. The incidence of several epilepsy syndromes peaks in adolescence. These include juvenile myoclonic epilepsy, juvenile absence epilepsy, epilepsy with grand mal on awakening, benign partial seizures of adolescence and reading epilepsy. Photosensitivity also appears to peak around puberty and needs to be managed well to avoid both unreasonable risks and unnecessary restrictions. Early diagnosis and correct management of the epilepsy and the specific epilepsy syndrome are the main factors in minimizing the difficulties. Epilepsy may change in the early adolescent years, with seizures starting and stopping or altering in form, all of which add to the uncertainty. Denial of the epilepsy may lead to risk-taking which may include be provided on the high risk of the unsupervised bath, the effect of irregular sleep, alcohol, driving, sport, employment, genetic implications, advantages/adverse effects of specific antiepileptic drugs and the role of surgery. The doctor should listen, counsel and inform. Adolescents generally do not appreciate being given advice. They should be empowered by the doctor to make informed decisions and encouraged to take control in a situation which they may view as implying devastating loss of control, unless it is managed wisely.
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Abstract Epilepsy is one of the most common neurological disorders with almost one-third of these patients becoming intractable to medical treatments. For some of these patients, epilepsy surgery could be the best option. There are lot of disparities in caring of the epilepsy patients. There are multiple limitations in offering epilepsy surgery for the medically intractable epilepsy patients, resulting in almost 19 years gap from the diagnosis of intractable epilepsy to epilepsy surgery. These limitations range from patient or parental fear to lack of available resources. Sometimes we face an ethical issue being the limitation from doing the right thing for the patient. We want to share our experience with one of our patients with symptomatic medically intractable focal epilepsy from Rasmussen’s encephalitis who could not get the epilepsy surgery treatment because of an ethical issue.
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Epilepsy is the UK's most common serious neurological condition affecting 1 in 131 adults in the UK. Around 75 people are newly diagnosed with the condition every day. Epilepsy can affect anyone, of any age at any time in their life. A diagnosis of epilepsy can have a devastating effect on the individual, his/her lifestyle and his/her family. Antiepileptic drugs (AEDs) are used to stop seizures happening—they do not cure epilepsy.
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