Health Issues is a general health based blog concentrating on multiple health topics. » Epilepsy

COPING WITH EPILEPSY: COUNSELING THE YOUNGER CHILD

admin — Fri, 08 Jul 2011 14:17:00 +0000

“Whether counseling a younger child is different from counseling a teenager depends on the age of the child, the child’s level of understanding, and the child’s problems. Let me tell you about Jenny, who was nine years old when I first met her. She was a bright youngster, one of four children. Her mother was a former nurse and had a fair amount of medical knowledge about epilepsy. The father had gone back to law school at night, so the family was under real financial stress. In addition to caring for the family, her mom was working two jobs. Let me tell you, tensions in that family were real high.

“Jenny had several seizures, but that wasn’t the reason she was referred to us. She was initially referred because her doctor thought she might have a degenerative brain disease. Over the previous year, she had deteriorated dramatically, both at school and at home. She was always sick with headaches or stomach aches and was missing a fair amount of school. Visits to the doctor’s office weren’t helping the family financial problems, either. Neither her mother nor her physician could tell what was related to the seizures or to the medication or what was psychological. She had become a very belligerent and disruptive child, causing havoc in the family. Her actual seizures were not that bad, but the family was disintegrating, even though they wanted to stay together.

“Jenny’s behavior was the main issue at our first meeting. She didn’t like taking medicine. She didn’t like being sick and going to the doctors. All kids seek attention, but some do not distinguish between attention for the positive things they do and attention for misbehaving. Jenny was not always aware of what she was doing. Her temper outbursts and not feeling well took up much of the limited time this family had for each other. Her brother and sister resented all the attention and concern Jen was getting, and they let her know it; they also began to manifest the same symptoms in attempts to draw attention to themselves. The family was a mess. This is a good example of how epilepsy becomes a family problem, not just a problem for the affected individual.

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COPING WITH EPILEPSY: COUNSELING THE YOUNGER CHILD – JEB’S CASE HISTORY

admin — Mon, 09 May 2011 09:05:51 +0000

“There’s another child I want to tell you about. Remember Jeb ? He was only six. He had the mildest of seizures, just a few absence seizures, and he was adorable. But what an anxious family. Mom, a former nurse, read everything available and learned of allergic reactions to medication the doctors had never seen before. Jeb was having some stomach problems and had become a monster at home. His mother thought he was not doing well in school. He had taken to fighting at school and misbehaving at home. Jeb was very verbal, bright, and with lots of questions. Both the doctors and I took him aside and explained his epilepsy. We asked him to write down his questions and asked his sister, who was a year younger, to have her mother list hers. We promised to discuss them at the next visit. Jeb knew the family was very upset, but he didn’t know why. He felt different and asked, ‘What’s wrong with me?’ His mom was extremely knowledgeable, but even though she was a former nurse, she was really just a mom. She couldn’t step back, and so she became very nervous. She called me every day for several weeks. That’s another way to do counseling, just to provide reassurance by phone.

“Jeb also was given permission to call me. He didn’t always need to have his mom interpreting things for him. He could tell me, ‘I don’t like this,’ ‘I’m sick of that.’ ‘Do you want to know how I did in school today?’

“What he did was to take ownership of his condition, his medication, and of his young life. That’s pretty remarkable for a six-year-old and also remarkable for a parent to permit it and still provide appropriate supervision.

“His sister, who also played an important role, had her own questions. Her first question was ‘Will I catch this?’ That is a typical question I hear from brothers and sisters. Her second question was, ‘Why did this happen to Jeb ?’ Only after she knew that she was safe could her concern for her brother come out. There were other questions, ‘Do more boys than girls get epilepsy?’ The questions themselves were less important than the fact that both children had the right to ask them. Each child was important, and both were an important part of Jeb’s getting well.

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THE DEFINITION OF EPILEPSY

admin — Tue, 28 Apr 2009 12:26:18 +0000

Although we hope that such gases will never be used, we have deliberately introduced the topic at this point to explain the difference between the diagnosis of ‘an epileptic seizure, and the diagnosis of ‘epilepsy’. It would clearly be ridiculous to label as ‘epileptics’ those soldiers who had convulsed on exposure to the nerve gas. The cause of their seizures is readily apparent, and, not only that, the tendency to convulse is present only in the presence of the nerve gas. Someone is said to suffer from epilepsy if he or she has a continuing tendency to epileptic seizures.

This example polarizes, as it were, the explanation, but there are many grey areas, some of which we explain here. Take for example the case of a young man who has a single seizure at the age of 19, after a rather-too-good office party at Christmas time. It would be justifiable to assume that alcohol played some part in the genesis of the seizure—but there were others who drank just as much who did not have a seizure. So we must presume that the man has a lower convulsive threshold than his colleagues. A single seizure is not considered sufficient to make the diagnosis of epilepsy, as, until time has passed, it will not be known whether or not this seizure will prove to be the first of others.

Doctors will make a diagnosis of epilepsy when they hear of more than one seizure of any type not associated with fever. Convulsions associated with illness. Clearly there is no difficulty in doing this if the time scale is short, but what do we call a man who has one fit at the age of 19 and another at the age of 80? It would seem a bit nonsensical to tell the elderly man that he had been an epileptic all his life, as we would be obliged to do if we followed rigidly the definition of ‘more than one non-febrile seizure’. Another problem—what do we call a woman aged 40, who has had ten seizures between the ages of 15 and 25? We cannot, unfortunately, say that she is a ‘woman cured of epilepsy’, as experience shows she is still slightly at risk from further seizures.

These examples clearly show that the label ‘epilepsy’ has to be applied with common sense. It is not one of those tidy diseases such as myocardial infarction, in which there is little argument about the heart attack or the coronary disease causing it.

These medical uncertainties are reflected in patients’ minds. After all, if a doctor cannot give a crystal-clear definition of a disease, how can the patient be expected to understand it? The uncertainties in peoples’ minds are compounded by a series of half-or un-truths that, perhaps because epilepsy is so common, are held in the collective imagination as folk lore—that epilepsy is inherited; that it begins in childhood; that it is always convulsive in nature; and that it is related in some ways to mental illness. Glimpses of this stereotype of epilepsy are seen in the clinic when a patient, or his relative, says ‘it can’t be epilepsy because . . . .’ We hope that this book will dispel some of these confusions.

Part of the difficulty in understanding about epilepsy is a hangover from the ideas of the great physicians of the nineteenth century. ‘Diseases’ were described—for example, Bright’s disease of the kidneys. Such diseases have proved unexpectedly more and more complex with further research. For example, Bright described the dilute urine containing protein, and changes associated with high blood pressure that are merely symptoms common to a number of processes resulting in chronic kidney failure.

With these comments in mind, an epileptic seizure should be regarded as a symptom—an event that is just one of the few ways that the brain has of reacting to untoward internal processes. The continuation of such reactions constitutes epilepsy. As to the causes of epilepsy, it is the doctor’s task to disentangle, if at all possible, the factors that result in seizures.

We have had some difficulty in deciding what to call the child or person with epilepsy. There are some who instinctively dislike the word—or label—’epileptic’. It is of course an adjective, and one does not talk about those with heart disease or multiple sclerosis as ‘cardiacs’ or ‘multiple sclerotics’. We admit, however, that those with diabetes seem quite happy to be known as ‘diabetics’. We find the word person too impersonal, but to write and read ‘a man, woman, or child with epilepsy’ takes too long, and to write each time ‘those with epilepsy’ seems archaic. We have avoided the use of the word patient, except in a medical context, as people with epilepsy should only become patients for brief moments in their lives. We therefore use whatever phrase seems most appropriate in the context.

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