Articles on epilepsy


Dr. Apoorva Kumar, Spine Surgeon
Epilepsy: Causes, Symptoms and TreatmentsPeople with epilepsy tend to have recurrent seizures (fits). The seizures occur because of a sudden surge of electrical activity in the brain - there is an overload of electrical activity in the brain. This causes a temporary disturbance in the messaging systems between brain cells. During a seizure the patient's brain becomes "halted" or "mixed up".Every function in our bodies is triggered by messaging systems in our brain. What a patient with epilepsy experiences during a seizure will depend on what part of his/her brain that epileptic activity starts, and how widely and quickly it spreads from that area. Consequently, there are several types of seizures and each patient will have epilepsy in his/her own unique way.Types of seizuresThere are three types of diagnoses a doctor might make when treating a patient with epilepsy:Idiopathic - this means there is no apparent cause.Cryptogenic - this means the doctor thinks there is most probably a cause, but cannot pinpoint it.Symptomatic - this means that the doctor knows what the cause is.There are three descriptions of seizures, depending on what part of the brain the epileptic activity started:Partial seizureA partial seizure means the epileptic activity took place in just part of the patient's brain. There are two types of partial seizure:Simple Partial Seizure - the patient is conscious during the seizure. In most cases the patient is also aware of his/her surroundings, even though the seizure is in progress.Complex Partial Seizure - the patient's consciousness is impaired. The patient will generally not remember the seizure, and if he/she does, the recollection of it will be vague.Generalized SeizureA generalized seizure occurs when both halves of the brain have epileptic activity. The patient's consciousness is lost while the seizure is in progress.Secondary Generalized SeizureA secondary generalized seizure occurs when the epileptic activity starts as a partial seizure, but then spreads to both halves of the brain. As this development happens, the patient loses consciousness.Symptoms of epilepsyThe main symptoms of epilepsy are repeated seizures. There are some symptoms which may indicate a person has epilepsy. If one or more of these symptoms are present a medical exam is advised, especially if they recur:A convulsion with no temperature (no fever).Short spells of blackout, or confused memory.Intermittent fainting spells, during which bowel or bladder control is lost. This is frequently followed by extreme tiredness.For a short period the person is unresponsive to instructions or questions.The person becomes stiff, suddenly, for no obvious reasonThe person suddenly falls for no clear reasonSudden bouts of blinking without apparent stimuliSudden bouts of chewing, without any apparent reasonFor a short time the person seems dazed, and unable to communicateRepetitive movements that seem inappropriateThe person becomes fearful for no apparent reason, he/she may even panic or become angryPeculiar changes in senses, such as smell, touch and soundThe arms, legs, or body jerk, in babies these will appear as cluster of rapid jerking movements.The following conditions need to be eliminated as they may present similar symptoms, and are sometimes misdiagnosed as epilepsy:A high fever with epilepsy-like symptomsFaintingNarcolepsy (recurring episodes of sleep during the day and often disrupted nocturnal sleep)Cataplexy (a transient attack of extreme generalized weakness, often precipitated by an emotional response, such as surprise, fear, or anger; one component of the narcolepsy quadrad)Sleep disordersNightmaresPanic attacksFugue states (a rare psychiatric disorder characterized by reversible amnesia for personal identity)Psychogenic seizures (a clinical episode that looks like an epileptic seizure, but is not due to epilepsy. The EEG is normal during an attack, and the behavior is often related to psychiatric disturbance, such as a conversion disorder)Breath-holding episodes (when a child responds to anger there may be vigorous crying and subsequent apnea and cyanosis - the child then stops breathing and skin color changes with loss of consciousness).

11 Troublesome Myths About Epilepsy!

Dr. Nirmala Lahoti, Neurologist
Despite scientific advances, it is unfortunate that, even today, there are fears, misunderstandings, discrimination and socialstigma surrounding a person with epilepsy.Epilepsy a very rare disorderNo. Epilepsy is not a very rare disorder. It affects 50 million people worldwide. In India, epilepsy has been identified as a public health problem. It is found to be the second leading problem affecting the brain in both the urban and rural populations. It is estimated that in India (with a population of more than 1 billion), there are 6—10 million people with epilepsy.People with epilepsy are mentally illNo. Epilepsy is not the same asmental illness and, in fact, the majority of people with seizures do not develop mental health problems. There may be associated mood problems like anxiety or depression in a patient with epilepsy on account of their disease and associated issues. Equating epilepsy with madness is wrong.People with epilepsy are violent or crazyNo. The belief that people with epilepsy are violent is an unfortunate image that is both wrong and destructive. People with epilepsy have no greater tendency toward severe irritability and aggressive behaviours than other people.Many features of seizures and their immediate after effects can be easily misunderstood as "crazy" or"violent" behaviour. During seizures, some people may not respond to questions, may speak gibberish, undress, repeat a word or phrase, crumple important papers, or may appear frightened and scream. Some are confused immediately after a seizure and if they are restrained or prevented from moving about, they can become agitated and combative. However, once the attack is over, they return to normal and usually display normal behaviour in between attacks.Children with epilepsy are dullExcept for children who are born with obvious mental handicaps, children with epilepsy have normal intelligence and should be encouraged by parents and teachers to attend school and complete their education.Epilepsy is a curse or wrath of GodNo. It is unfortunate that, even today, we have to face such questions. Epilepsy has nothing to do with curses, possession or other supernatural processes, such as punishment for past sins. Like asthma, diabetes and high blood pressure, epilepsy is a medical problem of the brain and can affect anyone irrespective of his/her deeds.Epilepsy spreads through touching or coughingNo, epilepsy does not spread through touching or coughing. People who are having an attack need help and the onlookers should not refrain from helping the person because of such irrational beliefs.Use of an onion, metal, etc., helps in terminating an ongoing epileptic attackNo. Some people think that an epileptic attack can be terminated by making the person smell onions or dirty shoes, or by placing a metal key in the person’s hand. These are irrational beliefs. Relatives, friends and teachers of people with epilepsy should beaware of the measures to be taken during an epileptic attack.Epilepsy medications are ineffectiveNo. Epilepsy medicines of are very essential for the control of epileptic attacks and should not be neglected. The complete treatment should be discussed with your treating doctor and the treatment should be adhered to.Marriage is a cure for epilepsyNo. Marriage is an important aspect of life but not a cure for epilepsy.Life of a person with epilepsy is miserableNo. Life of a person with epilepsy can be very manageable and very similar to life of people without epilepsy provided you have a positive approach towards life. Very important aspect in managing the epilepsy is embracing the treatment as an integral part of your life. Daily intake of medicines can sometimes put you down. However, do not let this affect your life. Taking medicine daily can be equated to taking your food daily. Now “Do you forget to take food or do you feel bad about taking food daily?” Then, why is this attitude towards medicines?Epilepsy is a hindrance in leading a happy and successful lifeNo. People with epilepsy can live a happy and successful life. With the advent of newer medicines, availability of medical care and increased awareness of the condition, it has become possible for a person with epilepsy to lead a good life. There are many famous poets, writers and sportsmen with epilepsy who have excelled in their respective fields. Positive approach towards the problems in life is a key for success and contentment. Our negative outlook towards the disease should be challenged and this will certainly help people lead a normal and happy life.

Epilepsy: Types, Symptoms, Diagnosis and Treatment

Dr. Vykunta Raju K. N, Neurologist
What is epilepsy?Epilepsy is a disease of the brain. Brain cells create abnormal electricity that causes seizures. A seizure may cause “jerking” movements. In some cases, seizures cause only a loss of consciousness, a period of confusion, a staring spell or muscle spasms. A single seizure is not considered epilepsy. People with epilepsy have repeated episodes of seizures, at least more than 2 episodes at intervals of more than 24 hours. How common is epilepsy?It is very common with incidence of 10/1000 populations. In India-10 million people are affected.  What causes Epilepsy?There is fine balance in the brain between factors that begin electrical activity and factors that restrict it, and there are also systems that limit the spread of electrical activity. During a seizure, these limits break down, and abnormal electrical discharges can occur and spread to whole groups of neighbouring cells at once. This linkage of electrical discharges creates a “storm” ofelectrical activity in the brain. This is called epileptic seizure.What are the causes forepilepsy? Some important causes in India are 1. Fever-Febrile seizures2. Birth Trauma-lack of oxygen, glucose during the time of delivery.3. Head injury-road traffic accidents, falls.4. Brain Fever-bacteria, virus etc 5. Brain tumors6.Hereditary- if somebody in the family having fits, chances are more, however it will not spread from one person to other person by contact. What are the different types of Epilepsy?There are different types of fits in children. Many times difficult to recognize by parents and even by neurologist. Generalized- involves whole body with loss of consciousness1. Tonic – stiffness of limbs and body 2. Clonic – shaking movements 3. Absence - staring and eye blinking and dreaming like episodes 4. Atonic – sudden falls5. Myoclonic – sudden jerks Partial – involves only one part of the body1. Simple- shaking of one part of the body without loss of consciousness 2. Complex- shaking of one part of the body with loss of consciousnessSpecial types in children Infantile spasms - West syndrome In this type of fits, sudden movement of neck, trunk and limbs in clusters after awakening from sleep. Usually occurs multiple times per day. During these episodes baby can cry or smile without apparent reason. Usual age of onset is around 4-8 months. These are difficult to recognize by parents. Neurologist should be consulted if any doubt. These are very common when child brain has already damaged during the time of birth. These fits are dangerous to brain if not recognised and treated because it causes further damage to brain. Child will forget already leaned activities. What happens during aseizure?Some seizures are hardly noticed perhaps only a feeling of “pins and needles” in one thumb for a few seconds. During other seizures, the person may become unconscious; fall to the floor and jerk violently for several minutes. Between these extremes is an astonishing range of feelings and actions. Many people think that the only real seizures are ones with strong, uncontrolled movements. They think that having a strange feeling in the stomach, blanking out for a few seconds, or jerking one arm a few times is nothing important, at most a minor “spell”. But in fact, any change in feeling or behavior that results from an uncontrolled discharge of electricity in the brain is a seizure. Do seizures cause braindamage?Ina Tonic-Clinic seizure, the person loses consciousness, the body stiffens and then they fall to the ground. This is followed by jerking movements. After a minute or two, the jerking movements usually stops and consciousness slowly returns. Tonic –Clonic seizures lasting less than 5-10 minutes are not known to cause brain damage or injury. However, there is evidence that more frequent and more prolonged tonic-clonic seizures may in some patients injure the brain. Prolonged or repetitive complex partial seizures (a type of seizure that occurs in clusters without an intervening return of consciousness) also can potentially cause long-lasting impairment of brain function.Some children have difficulty with memory and other intellectual functions after seizures. These problems may be caused by the after-effects of the seizure on the brain, by the effects of seizure medicines, or both. Usually, however, these problems do not mean that the brain has damaged by the seizures on brain function, but this effect appears to be rare. What should be donewhen child has a seizure?If someone near you has a seizure, use the following general guidelines:Is epilepsy inherited?Most cases of epilepsy are not inherited, although some types are genetically transmitted (that is, passed on through the family). Most of these types are easily controlled with seizure medicines.What tests should be done?How to Treat?Before starting treatment 1. Need for definite diagnosis whether fits or fits like conditions2. Following first episode of fits treatment usually not indicated unless if associated with some other problems. 3. Treatment usually requires after second episode of fits except in some cases like febrile first. 4. Attempt single drug if requires 5. Start with low dose and increase gradually6. Should be taken regularly DURATIONOF TREATMENTMinimumseizure – 2 year’s free period Longduration     Side-effects—  Sedation —  Hyperactivity —  Calcium/vitamin D/ folic acid deficiency—  Liver problems—  Blood problems —  AllergyNewtreatments—  Ketogenic diet—  Vagal nerve stimulation—  IVIG—  SurgeryHowfrequently one should visit Doctor?As prescribed by doctor. In general, once in 3 months. Doctor will assess for any side effects of medicines. In each visit, all drugs, seizure diary, and reports should bring to the hospital. Is epilepsy a curse?No. Epilepsy has nothing to do with curses, possession, or other supernatural processes, such as punishment for past sins. Epilepsy is not a mental illness, and it is not a sign of low intelligence. It is also not contagious. Between seizures, a child with epilepsy is not different from anyone else. Like asthma, diabetes, and high blood pressure, epilepsy is a medical problem.Should epilepsy be a barrier to success?No. Epilepsy is perfectly compatible with a normal, happy, and full life. The child’s quality of life, however, may be affected by the frequency and severity of the seizures, the effects of medications, and reactions of onlookers to seizures, and other disorders that are often associated with or caused by epilepsy. However with proper treatment and care, the patient’s quality of life can be improved. If I have epilepsy, does my child have to take medicines every day?Yes. Child must take medicine every day, even when child not having seizures or when you think you won’t have a seizure till the time your physician asks to change or stop. To prevent seizures, child has to take the medicine regularly, just asyour doctor tells you. What Should I do if Iforget to take my medicine?Usually you should give medicine as soon as you know you forgot a dose. Should I give extra medicine if I think I’m about to have a seizure?No. The amount of medicine you take is carefully set for child needs. No extra medicine should be taken without your doctor’s approval. Will I have to give the medicine forever?No.It may be possible for some children with epilepsy to stop taking medicine. However, this decision must be made by your doctor. Before you and your doctor can decide to stop the medicine, several questions should be considered. These include how quickly your seizures were controlled, how long child have been free of seizure, and if you have other illnesses that may affect child problem.Can I give other drugswhile taking anti-epilepsy drugs?Yes, only on the basis of the doctor guidance only you can take other drugs. Because many drugs affect the ability of your epilepsy medicine to control child’s seizures, ask your doctor or pharmacist before taking other drugs, even drugs you can buy without prescription. Can be taken with other drugs, however should be informed to treating doctor regarding drugs because they can cause precipitation of seizures.Can I take for a holiday?Travel is much easier if Child's epilepsy is well controlled! Means of transport (plane, train, or car) are not factors that aggravate epilepsy but may cause stress and or lack of sleep that could trigger a seizure. Do’s1. First aid2. Don’t put anything in mouth3. Put in lateral position4. Take child to nearest hospital 5. Take all drugs and reports when you are visiting a doctor Don'ts1. Driving2. Swimming 3. Climbing4. Electricity and machinery works Wrong beliefs—  Fits are Rare—  Fits spreads from one person to other person (Communicable disease)—  Restrain during attack—  It occurs from birth—  Low IQ—  Family isolation LifestyleEducation -They can go to normal school as normal childrenPlaying –They can play as normal children Uncontrolled fits - causes are —  Fits like conditions mistaking for fits—  Type of fits and selection of drug may not work—  Pseudo fits due to stress —  Drug selection: improper selection —  Dose: incorrect dosage—  Compliance: not taking drugs regularly—  Cause: if underlying cause not treatedPrevention: fits can be prevented by preventing —  Birth trauma—  Accidents—  Vaccines are available to prevent occurrence of brainfever—  Good hygiene to decrease worm infestation —  Maintenance of good Environment to prevent fever associated fits and infections

Epilepsy in Children

Dr. Rakesh K Jain, Neurologist
A seizure is a disruption of the electrical communication between neurons. There are different types of seizures ranging from subtle absences up to life threatening tonic clonic movement (vigorous shaking) in which sudden stiffening and shaking of body associated with unresponsiveness,loss of consciousness, frothing, tongue bite, clinching of jaws, etc. During seizure, the patient may have any one of these symptoms or all of them could be present together. Seizures are caused by a sudden burst of electric activity in the brain.Someone is said to have epilepsy if they experience two or more unprovoked seizures separated by at least 24 hours. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness. The epilepsies have many possible causes and there are several types of seizures. Anything that disturbs the normal pattern of neuron activity—from illness to brain damage to abnormal brain development—can lead to seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signalling chemicals called neurotransmitters, changes in important features of brain cells called channels, or some combination of these and other factors. Many times, a doctor may not able to pin point the exact cause of epilepsy.How do you Diagnose Epilepsy?A good history of event and proper evaluation by a Child Neurologists paramount in reaching the correct diagnosis. The correct diagnosis is very important not only for the treatment but also to predict the nature of the epilepsy and other comorbid conditions in the future. A doctor might ask for some blood tests along with an EEG (brain wave test) and MRI brain to find out the cause of seizures.Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. For about 70 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines, special diet and surgical techniques depending upon the diagnosis. Some drugs are more effective for specific types of seizures. An individual with seizures, particularly those that are not easily controlled, may want to see a neurologist specifically trained to treat epilepsy. In some children, special diets (Ketogenic diet) may help to control seizures when medications are either not effective or cause serious side effects. While epilepsy cannot be cured, more than 70% of children with the seizures can be controlled with medication, diet, devices, and/or surgery. Most seizures do not cause brain damage, but on-going uncontrolled seizures may cause brain damage. About 30% of children with epilepsy may suffer from other issues like ADHD (Attention Deficit Hyperactive Disorder), Autism, sleeping disorders, behavioral disorders or poor performance in the school. So it is important to monitor the child to identify them and treat these issues at earliest.During the seizure, do not panic; take a note of time if possible.Please do not put anything, water, spoon, finger, food, etc.) into the mouth to prevent the clenching of teeth.Try to keep the child in a safe and flat surface.Do not restrain the childLoosen any tight clothes. Make a video the event if possible.Take help from another person; keep yourself ready to take the child to the hospital if seizure does not stop within five minutes. Your doctor may have given some nasal spray which you can use at this stage in the doses advised and make your way to the hospital, if this is first seizure at home.If the seizure settles, keep the child in left lateral position, recovery position.Inform your local paediatric neurologist for complete assessment and further management.Children need answers. If epilepsy or another health problem affects your child, someone else in the family, or a friend, should give the facts and let your child ask questions. If you keep the lines of communication open, your relationship will be strengthened.Above all, tell the truth. If your children sense that you are lying to them or not telling them everything, they may not believe other things you tell them in the future.Encourage your children to ask questions, and have resources available to help them understand your answers. Children are curious by nature, so they will ask questions, but they will do it in their own time and in their own way. If your child asks something that you cannot answer, say that you will find the information as soon as you can. Then follow through. You may find the answer on this site, or you may need to talk to the doctor or nurse.The most important message for any child is that people with epilepsy are just like everyone else. They deserve respect and understanding, not teasing and cruelty.Emphasize the positive; praise success.Build on things your child likes and can do.Avoid describing your child's seizures or the financial burden of medical care as problems in front of your child.Encourage a special hobby or lessons to acquire a special skill.Discuss seizures and epilepsy openly with your child and answer his or her questions about it.Encourage your child to be active and to have as much social contact with other children as possible.Try not to make your child's seizures a reason not to do things the family would otherwise do, or fail to discipline your child on that account.Take some time for yourself without feeling guilty about it.

Noticed Fits / Convulsions / Seizures in Your Child?

Dr. S Velmurugan, Neurologist
These are general terms used when your child has episodes which your doctor considers that it could lead to epilepsy. It is called epilepsy if these episodes are recurrent and associated with abnormal brain electrical discharges. As a parent, you want to know the following:Is it epilepsy?Does she/he need investigations?What treatment is necessary, if any?How will the condition and medication affect my child’s learning and behaviour?Let us visit the questions one by oneIs it epilepsy?This is important to clarify if the episodes are really epileptic seizures. There are many mimics which can masquerade as epileptic seizures. History is the most important component to make a diagnosis of epilepsy.There are 2 types - Generalized and focal. In Generalized epilepsy, discharges start from all over the brain and in focal epilepsy, discharges start from a point in the brain and can spread.There are many types of epilepsy and they vary in severity from a self limiting condition to one which makes the child wheel chair bound.As 30% of uncontrolled epileptic seizures [treated with drugs] do not have epilepsy, making a clear diagnosis at the onset is important.Does he/she need investigations?If epileptic seizures are considered the most likely, than Electroencephalogram [EEG] would be warranted. This records discharges from the brain. This helps to clarify the diagnosis of epilepsy. If can be normal in children with epilepsy and abnormal in children who do not have epilepsy. The other investigation often asked for is MRI scan of brain. This is generally not needed in Generalized epilepsy. ECG is also recommended.What treatment is needed if any?Again, another important question as there are epileptic seizures that often do not need treatment. These decisions are made by a doctor trained in epilepsy after discussion with you. Most drugs do have an effect on the child’s learning. Further some anti epileptic medication can make certain types of seizures worse!!How will the condition and medication affect my child’s learning and behaviour?There are multiple instances when I have withheld medication as the seizures cause less damage than the medication used. Both the condition and medication can affect the learning and behaviour. The extent varies from one condition to another.

Febrile Seizure in Children: Things We Should Know

Dr. Rahul Varma, Pediatrician
What is Febrile Seizure?Febrile means feverish; any seizure or convulsion which is accompanied by fever is known as febrile seizure. The look of child during seizure seems life threatening (Child’s whole body is shivering, shaking, twitching, eyes may roll up, there could be frothing from mouth and child may become unconscious) and it can be very frightening for parents.They are scary to witness but remember that they are fairly common.  But they are usually not serious and have NO long term bad effects on brain.Simple Febrile Seizure typically occurs inAge: 6 months to 5 yearsUsually happens on the first day of febrile illnessLasts for few minutes onlyIt is generalized (i.e. not localized to one body part)Usually occurs once in 24 hoursNo previous neurological illnesses in childSalient Features:Currently there is no evidence that simple febrile seizures cause structural damage to the brainWith the exception of a high rate of recurrence, no long-term adverse effects of simple febrile seizures have been identified.Administering prophylactic acetaminophen/Paracetamol (any other fever drug) during febrile episodes was ineffective in preventing or reducing fever and in preventing febrile-seizure recurrenceLong-term therapy with antiepileptic drugs is not recommendedFebrile seizures are not considered epilepsy, and kids who’ve had a febrile seizure; only have a slightly increased risk for developing epilepsy compared to the general population.Management:Just the site of your baby during seizure can be terrifying and very distressing for parents but Do not Panic (The episode might look life threatening but febrile seizures are very benign and child’s brain development is normal)Follow  these steps:Make sure your child is in a safe place.Put your child sideways by turning the body to one side; to prevent chokingWatch for danger signs like breathing difficulty, child turns blue.Wait for Seizure to get over and then shift the child to nearest hospital/medical care facilities for proper evaluation of your child’s condition and to rule out serious illnesses like Meningitis.Things one should NOT DO:Do not shake the child, or try to hold or restrain your child.Do not put anything in your child’s mouth.Do not try to give any medicine while child is in active seizure not even fever-reducing medicine.Do not try to put your child into cool or lukewarm water to cool off.When the seizure is over, meet your child doctor to look for causes of Fever. The doctor will examine your child and ask you to describe the seizure. In most cases, no additional treatment is necessary. The doctor may recommend the standard treatment for fevers, which is paracetamol or ibuprofen.Conditions which need urgent Hospitalization areIf the child is under 1 year old, looks very ill, or has other symptoms such as diarrhea or vomiting; child will go through few tests to rule out other illnesses like Meningitis and determine the cause of fever.The seizure lasts more than several minutesIf the child is having breathing difficulty or child turns blueIf the child looks ill, lethargic and is not responding normallyPersistent vomiting is thereMedications:Midazolam nasal spray, Tablet Frisium, and various other medications might be prescribed by your child’s doctor as per need of your child and hospital protocol.Investigations:Neuroimaging and EEG need to be done during first episode just to rule out other illnesses with seizure. Investigations to find the cause of fever may also be done which may include few blood test and urine test.Recurrence of Febrile Seizures is high in following cases:Younger children (less than 18 months)Shorter duration of fever before onset of seizure increases the risk of recurrenceFamily history of febrile seizure (in sibling or any other family member)Lower the peak of Fever at onset of seizure ,higher the chances of recurrenceFew children might develop seizure without fever later. These children haveComplex febrile SeizureFamily history of epilepsyNeurological illness or developmental delay (eg. Cerebral palsy, Hydrocephalus etc)Simple Febrile SeizureComplex Febrile SeizureAge: 6months to 5 yearsThey can occur before and after thatLasts only few minuteLast longer even up to 15 minutesGeneralised (Whole body involved)Localised / Focal (May involve only one body part)No previous neurological issuesMay have previous neurological illnesses like Cerebral PalsyOnce in 24 hour periodCan occur more than once in 24 hoursTo SummariseSimple febrile seizure is a benign and common event in children between the ages of 6 and 60 months. Nearly all children have an excellent prognosis. There is evidence that both continuous antiepileptic therapy with phenobarbital, primidone, or valproic acid and intermittent therapy with oral diazepam are effective in reducing the risk of recurrence, the potential toxicities associated with antiepileptic drugs outweigh the relatively minor risks associated with simple febrile seizures. As such, long-term therapy is not recommended. In situations in which parental anxiety associated with febrile seizures is severe, intermittent oral diazepam at the onset of febrile illness may be effective in preventing recurrence. Although antipyretics may improve the comfort of the child, they will not prevent febrile seizures

Child Health and Febrile Seizures: Symptoms, Causes and Treatment

Dr. Vykunta Raju K. N, Neurologist
Febrile seizures are fits that is associated with a significant rise in body temperature in children ages of six months to five years. Febrile seizures are also known as fever fits or febrile convulsion.SymptomsDuring simple febrile seizures, the body will become stiff and the arms and legs will begin twitching. Also, the eyes roll back. The patient loses consciousness, although their eyes remain open. Breathing can be irregular. They may become incontinent (wet or soil themselves); they may also vomit or have increased secretions (foam at the mouth). The skin may appear to be darker than normal during an episode. The seizure normally lasts for less than one minute, but uncommonly can last up to fifteen minutes.CausesThe direct cause of a febrile seizure is not known; however, it is normally precipitated by a recent upper respiratory infections or gastroenteritis. A febrile seizure is the effect of a sudden rise in temperature (>39°C/102°F) rather than a fever that has been present for a prolonged length of time. Febrile seizures represent the meeting point between a low seizure threshold (genetically and age-determined; some children have a greater tendency to have seizures under certain circumstances) and a trigger, which is fever. Fever most of the time accompanies respiratory illnesses such as influenza, pneumonia, ear infections, sore throats, and colds. It can occur also with various viral illnesses. The genetic causes of febrile seizures are still being researched. Some mutations that cause a neuronal hyper excitability (and could be responsible for febrile seizures) have already been discovered. Several genetic associations have been identified.DiagnosisThe diagnosis is one that must be arrived at by eliminating more serious causes of fits and fever: in particular,meningitis and encephalitis must be considered. If a child has recovered and is acting normally, bacterial meningitis is very unlikely. The diagnosis of a febrile seizure should not prevent evaluation of the child for source of fever, although this is usually limited to evaluation of the urine in the younger age groups.TypesThere are two types of febrile seizures.• A simple febrile seizure is one in which the seizure lasts less than 15 minutes (usually much less than this), does not recur in 24 hours, and involves the entire body (classically a generalized tonic clonic seizures).• A complex febrile seizure is characterized by longer duration, recurrence, or focus on only part of the body.Simple febrile seizures are more likely to be harmless that they do not cause brain damage nervous system problems, mental retardation, paralysis, or death, but should be reported immediately to the child specialist or child neurologist. They do not tend to recur frequently (children tend to outgrow them); and do not make the development of adult epilepsy. Children who are younger than one year old that have a simple febrile seizure have a 50 percent chance of having another seizure. Children older than one year old have a 30 percent chance of a second seizure. Children with complex febrile convulsions are more likely to suffer from a febrile epileptic attacks in the future if they have a complex febrile seizure, a family history of a febrile convulsions in first-degree relatives (a parent or sibling), or abnormal neurological signs or developmental delay. InvestigationsInvestigations are required in few children’s after clinical assessment like, lumbar puncture for cerebrospinal fluid examination, CT/MRI of brain, EEG.TreatmentThe vast majority of patients do not require treatment for either their acute presentation with a seizure or for recurrences. Children have a rectal temperature of 100.4 degrees Fahrenheit or higher have a fever. The best way to manage is to control the temperature with acetaminophen. Acetaminophen should be based on a child’s weight not his age. Ask your doctor for the appropriate dosage. It is not recommended to use aspirin to treat a simple fever. Another way to manage is to combine medication with sponging or just use sponging alone.Place your child sitting down in a regular bathtub with slightly warm water. Cold water can cause shivering, which raise the child’s temperature. Then sponge water all over the body until the temperature reached a good level.In the home, diazepam rectal suppository medication can be used to control fits immediately. Drugs like diazepam and clobazam can be used during episodes of fever till 5 years of age. Daily medications may be needed in few children after detailed assessment of fits, development, examination, and investigations.

Delayed Speech: Can It Be Autism?

Dr. Rakesh K Jain, Neurologist
Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive,and stereotyped patterns of behaviour. Males are four times more likely to have an ASD than females. A recent study in US found 1 in 68 children suffering from autism.The main feature of ASD is impaired social interaction.  As early as infancy,a baby with ASD may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time.  A child with ASD may appear to develop normally and then withdraw and become indifferent to social engagement.Children with an ASD may fail to respond to their names and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can’t understand social cues, such as tone of voice or facial expressions, and don’t watch other people’s faces for clues about appropriate behaviour. They lack empathy.Many children with anASD engage in repetitive movements such as rocking, or self-abusive behaviour such as biting or head-banging.  They also tend to start speaking later than other children. Children with an ASD don’t know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favourite topics, with little regard for the interests of the person to whom they are speaking.Children with characteristics of an ASD may have co-occurring conditions, including Fragile X syndrome (which causes mental retardation), tuberous sclerosis, epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder. About 20to 30 percent of children with an ASD develop epilepsy by the time they reach adulthood. Very early indicators that require evaluation by an expert include:If you find any of these features in your child, please consult the local pediatrician or child neurologist if available who can assess your child in detail. There is no single blood test to diagnose autism. However, the doctor needs to look into certain disorders in which children have similar features or having features of autism in addition to other signs of that disorder. E.g. Tuber sclerosis, Landau-kleffner syndrome (a form of Epilpesy), other childhood epilepsies, some metabolic and genetic disease. So your doctor may do some blood test, hearing assessment, EEG, etc. depending upon the presenting features and assessment.Twin and family studies strongly suggest that some people have a genetic predisposition to autism. Identical twin studies show that if one twin is affected, there is up to a 90 percent chance the other twin will be affected. In families with one child with ASD, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population.   For many children, symptoms improve with treatment and with age. Children whose language skills regress early in life (before the age of 3) appear to have a higher than normal risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with an ASD may become depressed or experience behavioural problems, and their treatment may need some modification as they transition to adulthood. People with an ASD usually continue to need services and supports as they get older, but many are able to work successfully and live independently or within a supportive environment.There is no cure for ASDs. However, it is important to diagnose it early and look for associated conditions like ADHD (Attention deficit hyperactive disorder), Epilepsy, sleep disorders, etc. Earlier is intervention, better is the outcome. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of individual children.  Educational/behavioural interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as AppliedBehavioural Analysis. Family counselling for the parents and siblings of children with an ASD often helps families cope with the particular challenges of living with a child with an ASD.Medications:  Doctors may prescribe medications for treatment of specific autism-related symptoms, such as anxiety, depression, or obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioural problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity.Other therapies:  There are a number of controversial therapies or interventions available, but few, if any, are supported by scientific studies. Parents should use caution before adopting any unproven treatments. Although dietary interventions have been helpful in some children, parents should be careful that their child’s nutritional status is carefully followed.Conclusion: Autism is seen commonly now a day. The main features are delayed speech, poor eye contact and social interaction and restricted interest with repetitive behaviour. Parents and physician should aware of its early symptoms so that early intervention can be started.

Keto Diet and Its Health Benifits

Dr. Yogesh Kumar, Ayurveda
What is a Ketogenic Diet?The ketogenic diet (often termed keto) is a very low-carb, high-fat diet and is similar to other  low-carb diets.It involves drastically reducing carbohydrate intake, and replacing it with fat. The reduction in carbs puts your body into a metabolic state called ketosis. When this happens, your body becomes incredibly efficient at burning fat for energy. It also turns fat into ketones in the liver, which can supply energy for the brain .Ketogenic diets can cause massive reductions in blood sugar and insulin levels.What is Ketosis?The “keto” in a ketogenic diet comes from the fact that it makes the body produce small fuel molecules called “ketones” . This is an alternative fuel for the body, used when blood sugar (glucose) is in short supply.Ketones are produced if you eat very few carbs (that are broken down into blood sugar) and only moderate amounts of protein (excess protein can be converted to blood sugar).Ketones are produced in the liver, from fat. They are then consumed as fuel in the body, including by the brain. This is important as the brain is a hungry organ that consumes lots of energy every day, and it can’t run on fat directly. It can only run on glucose (blood sugar)… or ketones.On a ketogenic diet your entire body switches its fuel supply to run almost entirely on fat. Insulin levels become very low and fat burning increases dramatically. It becomes easy to access your fat stores to burn them off. This is obviously great if you’re trying to lose weight, but there are also other less obvious benefits.The ketogenic diet actually originated as a tool for treating neurological diseases, such as epilepsy.Health Benefits Of Keto Diet:Epilepsy: Research has shown that the ketogenic diet can cause massive reductions in seizures in epileptic children .Polycystic ovary syndrome: The ketogenic diet can help reduce insulin levels, which may play a key role in polycystic ovary syndrome .Heart disease: The ketogenic diet can improve risk factors like body fat, HDL levels, blood pressure and blood sugar.Cancer: The diet is currently being used to treat several types of cancer and slow tumor growth .Alzheimer’s disease: The diet may reduce symptoms of Alzheimer’s and slow down the disease’s progression .Parkinson’s disease: One study found that the diet helped improve symptoms of Parkinson’s disease.Acne: Lower insulin levels and eating less sugar or processed foods may help improve acne.Who should NOT do a ketogenic diet?Most people can safely do a ketogenic diet.Consult your Doctor if you have situations like:People who are  on the medication for Diabetes, e.g. insulin. People on medication for high blood pressure. Women who Breastfeed.