Diagnosis

One of the most important clues in diagnosing epilepsy is usually found in the child's medical history, which includes as much information as possible about the actual seizures. Family members often will be asked to record details about the seizures to help the doctor determine the type of epilepsy.

A doctor can diagnose epilepsy from a number of different tests. Which tests are ordered may vary, depending on how much each test reveals, but they may include:

• a thorough physical examination, especially of the nervous system

• blood work (blood sugar, complete blood count, electrolytes, and liver and kidney function tests)

• electroencephalogram (EEG)

• brain scans (magnetic resonance imaging [MRI], computed tomography [CT] scans, or PET scans [positron emission tomography])

Treatment

Epilepsy is a lifelong condition that is usually controllable with some combination of medication, diet restriction, surgery, or a new type of therapy called vagus nerve stimulation. Unfortunately, about 20 percent of children with epilepsy are unable to gain complete control over their seizures.

Of all available treatments, medications known as antiepileptic drugs are the most often prescribed therapy for seizures. More than 20 medications are available to treat epilepsy. If medicines are not able to prevent seizures, other methods such as surgery or a special diet may be tried. The goal of all epilepsy treatment is to prevent further seizures, avoid side effects, and make it possible for the patient to lead a normal, active life.

Most epilepsy medicines are taken by mouth in the form of tablets, capsules, sprinkles, or syrup. They may include:

• carbamazepine (Tegretol, TegretolXR, Carbatrol)

• clonazepam (Klonopin)

• ethosuximide (Zarontin)

• phenobarbital

• phenytoin (Dilantin)

• primidone (Mysoline)

• valproic acid (Depakene)

• divalproex sodium (Depakote)

Newer drugs which are also prescribed for epilepsy include felbamate (Felbatol); gabapentin

(Neurontin); lamotrigine (Lamictal); levetirac-etam (Keppra); oxcarbazepine (Trileptal); tiaga-bine (Gabitril); topiramate (Topamax); and zonisamide (Zonagran). Other new drugs are in development.

A rectal gel form of diazepam (Diastat) may be prescribed to stop cluster seizures or prolonged seizures. Some doctors may prescribe pills of diazepam (Valium), lorazepam (Ativan), or clon-azepam (Klonopin) for the same purpose.

A steroid drug (ACTH) may be injected to treat children with a type of epilepsy called infantile spasms, or for severe seizures that cannot be controlled with other drugs.

The particular drug that is prescribed depends on what kind of seizure a child is having, since different drugs control different types of seizures. People also react to these medicines in different ways. Some experience side effects, others may not. Some people's bodies break down medicines at a faster or slower rate than the average person. Once a medication is found to be successful, it can be closely monitored by blood tests to ensure that the correct amount of medication remains in the blood at all times.

Diet A special diet called a ketogenic diet may help treat seizures by changing the way the body derives energy. When the diet is first introduced, a child may need to be hospitalized so the physician can closely supervise the process. Although this diet was first introduced 80 years ago before the advent of most antiepileptic drugs, it has recently become more popular, especially with children whose seizures do not respond to medication. About 30 percent of children may control their epilepsy by the ketogenic diet alone.

Surgery Up to 30 percent of children who have epilepsy are candidates for surgery because they either do not respond to antiepileptic drugs or experience unpleasant side effects and may not succeed on the ketogenic diet. At least one-half of these children may be successfully treated through epilepsy surgery, if the seizures are confined to a small segment of the brain.

Surgery for epilepsy is a delicate, complicated operation that must be performed by an experienced surgical team. In addition to operations that remove a small part of the brain where seizures begin, other procedures may be done to interrupt the spread of electrical energy in the brain.

Vagus nerve stimulation This newer type of treatment may help children whose seizures are hard to control. With this treatment, a surgeon implants a small pacemaker under the skin below the collarbone that is attached to wires programmed to deliver a small burst of electrical energy to a nerve in the neck.

Epilepsy Foundation A national, charitable organization founded in 1968 and dedicated to the welfare of people with epilepsy. The foundation's mission is to work for children and adults affected by seizures through research, education, advocacy, and service. More than 60 affiliated Epilepsy Foundations serve people with seizures, and their families, in hundreds of communities nationwide.

The foundation is composed of volunteers committed to the prevention and cure of epilepsy and to a positive quality of life for everyone who lives with seizure disorders. Goals include broadening and strengthening research, providing easy access to reliable information, and assuring access to appropriate medical care for those affected by seizures.

On the local level, affiliate groups offer a variety of services including school Alert, camping, information and referral, education, and support groups. Respite care, assisted living, employment services, advocacy, and case management may also be offered. Nationally, the foundation offers research and research training grants and fellowships to scientists working to find the answers to epilepsy. The foundation supports national public education, legal and government advocacy, a national library, toll-free information services, media campaigns, and a broad array of educational materials. (For contact information, see Appendix I.)

Epstein-Barr virus (EBV) One of the most common human viruses that occurs around the world. A member of the herpes family, EBV infects almost everyone at some point. In children, the virus causes no symptoms or only mild signs. In the United States and other developed countries, many children are not infected by the virus; if they become infected during adolescence, the virus causes infectious mononucleosis.

Epstein-Barr virus (EBV) does not leave the body but establishes a lifelong dormant infection in some of the body's immune system cells. A very few carriers will go on to develop Burkitt's lymphoma and cancer of the nose and throat, two rare cancers that are not normally found in the United States. EBV appears to play a major role in the development of these cancers, but it is not considered to be the only cause.

Transmission of the EBV requires contact with saliva of an infected person, since the virus is not normally transmitted through air or blood.

erysipelas Contagious infection of the facial skin and subcutaneous tissue caused by Streptococcus pyogenes and marked by rapid-spreading redness and swelling, which is believed to enter the skin through a small lesion. While this disease is contagious, it does not produce huge epidemics like those of SCARLET FEVER.

Before the advent of antibiotics, this disease could be fatal, especially for infants and the elderly. Today it is quickly controlled with prompt treatment.

Symptoms

After a five- to seven-day incubation period, the patient experiences a sudden high fever with headache, malaise, and vomiting. The skin feels tight, uncomfortable, itchy and red, with patches appearing most often on the face, spreading across the cheeks and bridge of the nose. it also occurs on the scalp, genitals, hands, and legs. Within the inflammation, pimples appear, blister, burst, and crust over.

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