June 2nd, 2011 admin
Your child will go through the same emotional stages you have faced. The manifestations of these stages will vary with the child’s age and maturity and with the kinds of seizures.Fear is real for many of these children. Children may fear dying even though they have no concept of death. This fear of dying should be dealt with forthrightly. All people fear losing control and the fact that one of these seizures could happen at any time. Educating your child about what actually happens during his seizures, what they look like to others, and that he always returns to his previous normal state may help him to adjust to this fear. For the older child, the fear of embarrassment may be even worse than the fear of death. “What will my friends think of me? Suppose I wet myself? Suppose this happens at a dance or in school?” Acceptance by one’s peers is critical in adolescence. The worst thing that can happen is that somebody will notice that he is different.Helping your child to understand epilepsy and accept it to the point where he can explain it to his friends and classmates is the most important element in overcoming these fears.177\208\8*
April 14th, 2011 admin
Butch was sixteen when he came to us. Butch had had three generalized tonic-clonic seizures in the previous several years. He had been taking phenobarbital and had recently had a fourth seizure. Butch had given up football and was barely passing in school. The family told us that they just couldn’t control him. He was staying out late with his friends, drinking beer, and they suspected that he was experimenting with drugs. They asked us if there wasn’t some medication that would control his seizures so they could get their old Butch back.As we talked with his parents, it was apparent that the seizures and medication were only minor issues. His behavior problems were partly related to Butch’s feelings about himself and his seizures. But epilepsy had paralyzed his family. They felt so sorry for Butch because of the seizures that they could not bring themselves to put normal restrictions on him. They were unable to set limits on his behavior. They overcompensated for what they saw as a major disability. Butch was far more handicapped by the lack of discipline, an important element of good parenting, than he was by his seizures.We were able to help Butch’s parents realize how their attitudes, although well intentioned, were handicapping Butch. Butch had taken control of the family and was neither ready for that control nor comfortable with it. He had gone so far that he was also manipulating the medical situation. He refused to let us draw routine blood work that would have been necessary in changing to a more appropriate medication—one that might have had less impact on his behavior. Counselling took weeks, but eventually we were able to develop a contract with Butch. We helped his parents to set limits. We helped him to focus on the possibility of driving, a much desired goal. We enabled him to be a participant in the control of his epilepsy and his life, so that neither he nor epilepsy were the dominant force in his family.It was the overcompensation by his loving family that had led to this intolerable situation and handicapped Butch.*175\208\8*
April 28th, 2009 admin
The Regulations are careful to state ‘attacks whilst asleep’ rather than nocturnal attacks, to take account of those who are on night shift and sleep during the day. The concession to those who have only had attacks whilst asleep is in fact a generous one, insofar as a follow-up study by one neurologist of those who had only had nocturnal seizures showed that about one third had a seizure whilst awake within the next five years. Of course a single seizure of any type whilst awake immediately renders the person who until then has only had seizures whilst asleep ineligible to drive. Likewise a single seizure whilst awake earlier in life prevents the application of this concession even if all subsequent seizures are whilst asleep.
The Regulations state nothing about anti-epileptic medication. The law is, as it were, interested in seizures and not in drugs. This means that there is no need to withdraw medication after a seizure-free interval so that the patient can resume driving. On common-sense grounds it is probably marginally safer to be a passenger with someone who has had seizures in the past, who remains on anti-epileptic medication, rather than travel with someone who had his last seizure three years ago and stopped his drugs yesterday.
The whole area is fraught with difficulties. For example, young adults who have successfully come through a few petit mal and grand mal attacks in childhood may have a few morning myoclonic jerks on rare occasions. Such patients often tell us that there is no detectable disturbances of their consciousness during such jerks. Many patients certainly do not regard such occasional jerks as fits, and yet, as they are the product of a paroxysmal discharge of brain cells, they are, technically, seizures. It is to help in advising on such borderline cases as this that the Department of Transport has available an Honorary Medical Advisory Panel on Epilepsy. It is open to any applicant for a licence who disagrees with the Department’s refusal to grant him a licence, on the grounds that he has epilepsy and does not satisfy the requirements of the Regulations, to appeal to the Advisory Panel. From a compilation of the advice given by members of the Panel, a set of guidelines has been drawn up by the Medical Officers of the Department of Transport. If there is doubt in their minds, the matter is referred to the appropriate specialist, and we know that that happens several times each week.
The relapse rate in the first five years after achieving a remission of five years was 8 per cent. A study organized by the Medical Research Council in the UK has found that about a third of those who stop treatment on medical advice will have a further attack at some time, and of those about a half will have the recurrence within a year. Many will therefore consider it an additional safeguard to continue anti-epileptic medication, if driving, even if they are free from attacks. However, in the same study a number of people had attacks even though they were continuing anti-epileptic drugs so that they could be compared with those who stopped them.
It should also be noted that the 1988 Road Traffic Act prescribes as a relevant disability a liability (sic) to seizures. It follows therefore that on occasion a patient who has never had a fit may be ineligible to hold a licence because he is considered liable to have a seizure. A patient with a frontal tumour, or one who has had an intracranial operation, may fall into this category.
Regulations on those who wish to drive heavy good vehicles are even more strict. The current regulations state all of the following criteria must be met. The person must have been free from epileptic attacks for 10 years, have not taken anti-epileptic medication during this 10-year period, and does not have a continuing liability to an epileptic seizure.
Finally, before leaving this vexed question of driving, we should add two further points. So far we have written exclusively about the practice in the UK. The requirements for eligibility vary from country to country, and, in the USA, from state to state. Enquiry must be made of the licensing authority in each country or state in which patients wish to drive. Secondly, we are fully aware that many patients who are ineligible to drive do in fact do so. In one survey of people with epilepsy in Greater London, 12 out of 62 currently ineligible to drive were in fact doing so. This is not always wilful recklessness. Only 3 of the 12 both were aware of the diagnosis, and admitted that they had been told not to drive. Some of the remainder did not realize, so they said, that they had epilepsy, or they felt that they had received explicit or implicit consent to drive from their doctors.
Those who knowingly drive when ineligible must realize that their insurance policies would almost certainly be void if they had an accident. But the terrible risk of killing or maiming another road user or pedestrian should be sufficient discouragement.
There are no restrictions—other than those of common-sense—on riding a pedal bicycle. Even if a rider has a seizure, they are likely to damage only themselves.