The best that can happen is that your child will remain seizure free and that there will be an improvement in his learning and behavior. Many adults say, “I’m not so tired any more. I feel so much better. I can think much more clearly.” Many parents say, “Mary is a different child.
Her school work is better. She’s not so irritable and she’s not so tired all the time. I never realized the medicine was affecting her in that way.” Another benefit is that your child would not have to take medication each day, a reminder of his potential problem. He would no longer have “controlled” epilepsy. Now he would be either “recovered” or “cured” and could get on with his life, unimpeded.
For the normal child who has only a 5 to 10 percent chance of having another seizure, we would recommend discontinuing medication. In general, the consequences, should a seizure recur, will be small. For the handicapped child who may have a 50 percent chance of another seizure, we would also recommend trying to discontinue medication. The consequences of another seizure for him are also small, but since he may be less able to compensate for the subtle effects of medication on learning and behavior, the benefits of being free of medication may be even greater. Should a seizure recur, and if it is apparent that the child is functioning better off the original medication, it may be possible to substitute a less toxic anticonvulsant.
On balance, we believe that avoiding the chronic effects of medication and their effects on learning and psychological function outweigh the risks of another seizure in most children who have been seizure-free for two years.
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Apart from listening carefully to the story given by the person and any eyewitness, what else will the doctor do?
She will examine her patient not only to make sure that everything is generally well-for example, that breathing is unobstructed—but she will also ascertain if there are any focal (localized) neurological signs, which may give her a clue to the cause of the seizure. Though she is not likely to find anything abnormal at this stage, there may be some minor signs such as an asymmetry of the reflexes. She will then question the relatives or other witnesses, and satisfy herself that what has just occurred was indeed a seizure, and not some other event of the type discussed later in this chapter. Rarely, the first seizure is an early manifestation of an acute and important illness such as meningitis or encephalitis. If she suspects that this might be the case, she will of course arrange immediate admission to hospital. More often, all that is necessary is for her to give a tablet or injection of diazepam (Valium), which is sufficient to raise the seizure threshold and make a second seizure less likely for some hours. This will give everyone time to collect their thoughts and decide on the long-term policy decisions, including the possible needs for referral to a specialist, for investigation, and for institution of anti-epileptic treatment.
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Tags: Epilepsy
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