Convulsive disorders for child
Epilepsy”the tendency to have seizures – is one of the oldest and most common medical problems, and can occur as a result of many different causes. The convulsion or seizure is not a disease, but a symptom of what happens when the brain is stimulated by an abnormal discharge of nervous energy. Diagnosis and treatment will depend on the cause of the fit.
When convulsions occur soon after birth they are likely to be caused by an imbalance of chemicals in the blood; kernicterus (severe jaundice within 36
hours of birth); brain damage before or during birth; drug dependency in the mother; diseases such as meningitis and bleeding in the brain, and other reasons. Later on, brain cell damage by infections, dehydration, hydrocephalus, brain tumours, accidents and poisons such as lead, can also cause damage that results in convulsions.
Then there is also the inherited or idiopathic tendency towards seizures with no apparent brain damage although the electrical impulses from the brain may show an abnormal pattern.
Any child who has a convulsion should have a thorough examination by a specialist to establish the cause. Febrile convulsions (224) are common in childhood and do not mean the child has epilepsy.
Modern techniques such as computer-assisted tomography (brain scan) can give a comprehensive picture of the brain and its workings. Unfortunately the equipment for this is only available at a few large teaching hospitals. Other procedures such as lumbar punctures to examine spinal fluid, skull X-rays and electroencephalograms (tracing of the electrical impulses of the brain) can give a picture of the actual working of the brain and of damaged cells or other abnormality.
Epilepsy occurs in various forms, and it is most common after the age of five years. Grand mal or major epilepsy is the most obvious type. More than half those affected by it experience a warning sensation or aura’ before an attack. They may always become aware of a strange smell or a light or stomach pain. This is followed by a tonic’ phase when the body becomes rigid and breathing stops briefly, followed by violent muscular contractions that cause jerking and foaming at the mouth. The attack lasts a few minutes after which consciousness is gradually regained. To the onlooker this form of epilepsy can be frightening and has resulted in many of the myths and misconceptions about the condition. Nevertheless it is nothing more mysterious than a kind of brain short circuit as happens when wires come into accidental contact.
Focal attacks are those which begin in one of the limbs and spread throughout that side of the body. But it is usually the opposite side of the brain which has been damaged.
Psychomotor attacks are epileptic reactions which do not result in a convulsion but in changed behaviour. The child may do the same thing over and over, or her actions may have nothing to do with her situation. Thought processes are confused and she may become impulsive and unreasonable because of the internal seizure she is having.
In petit mal seizures or absences’ the symptoms consist of very brief loss of consciousness sometimes accompanied by slight twitching of a few muscles, usually of the face and head. Petit mal or aphasic attacks are often so mild that they are not noticed by parents and the child may miss out on learning because she has blank spots. In school, too, many children suffering petit mal attacks are thought of as dreamers or as inattentive and they may fail to make progress. When they are diagnosed as suffering from epilepsy and receive medication to eliminate the attacks they often make great strides at school.
Photosensitive epilepsy occurs when the susceptible person watches a flickering image, for instance on a television screen (177) or a line of trees from a speeding car, or a train passing at a station.
In many instances the pattern of epileptic seizures is not confined to one type but is a mixture of several.
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