My daughter is 7 and has had disruptive sleep patterns her entire life. It started with night terrors (around 1) before she was "old enough" for that disorder and transpired into sleep walking. She has always woken several times in the night. Her doctor finally ordered a sleep study last week. For the first time in years she slept all night, due to pure exhaustion from being so hysterical while hooking her up to everything. We got the results back and they showed she had "significant seizure activity". My question is, do any of your children have seizure disorders and what are the signs? I found info stating that 14% of children with autism have some type of seizure disorder. That sounded high considering it is compounding disorders. I'm wondering if she might be having seizures throughout the day that I have thought were part of her autistic behavior. I haven't had a chance to talk to her doctor directly, since the nurse called me at 4:45 Friday afternoon. Any info would be grately appreciated. Thanks!
AIden also had disrupted sleep and has seizures.
I never really though much about him having seizures durring the day since he has only had a few and they mostly just make him tired and cranky.
I know with my clients it can cause explosive anger, self injurious behavior like head baning, and stims like rocking to increase signifigently. Once the kids have been medicated properly they are better able to attend overall and tend to make much faster progress then perviously.
The signs can be different from person to person. With the behaviorsThere are more than 20 different seizure disorders
Generalized epileptic seizures occur when electrical abnormalities exist throughout the brain. A partial seizure does not involve the entire brain. A partial seizure begins in an area called an epileptic focus, but may spread to other parts of the brain and cause a generalized seizure. Some people who have epilepsy have more than one type of seizure.
Motor attacks cause parts of the body to jerk repeatedly. A motor attack usually lasts less than an hour and may last only a few minutes. Sensory seizures begin with numbness or tingling in one area. The sensation may move along one side of the body or the back before subsiding.
Visual seizures, which affect the area of the brain that controls sight, cause people to see things that are not there. Auditory seizures affect the part of the brain that controls hearing and cause the patient to imagine voices, music, and other sounds. Other types of seizures can cause confusion, upset stomach, or emotional distress.
GENERALIZED SEIZURES
A generalized tonic-clonic (grand-mal) seizure begins with a loud cry before the person having the seizure loses consciousness and falls to the ground. The muscles become rigid for about 30 seconds during the tonic phase of the seizure and alternately contract and relax during the clonic phase, which lasts 30-60 seconds. The skin sometimes acquires a bluish tint and the person may bite his tongue, lose bowel or bladder control, or have trouble breathing.
A grand mal seizure lasts between two and five minutes, and the person may be confused or have trouble talking when he regains consciousness (post-ictal state). He may complain of head or muscle aches, or weakness in his arms or legs before falling into a deep sleep.
PRIMARY GENERALIZED SEIZURES
A primary generalized seizure occurs when electrical discharges begin in both halves (hemispheres) of the brain at the same time. Primary generalized seizures are more likely to be major motor attacks than to be absence seizures.
ABSENCE SEIZURES
Absence (petit mal) seizures generally begin at about the age of four and stop by the time the child becomes an adolescent.
Absence seizures usually begin with a brief loss of consciousness and last between one and 10 seconds. A person having a petit mal seizure becomes very quiet and may blink, stare blankly, roll his eyes, or move his lips. A petit mal seizure lasts 15-20 seconds. When it ends, the person who had the seizure resumes whatever he was doing before the seizure began. He will not remember the seizure and may not realize that anything unusual has happened. Untreated, petit mal seizures can recur as many as 100 times a day and may progress to grand mal seizures.
MYOCLONIC SEIZURES
Myoclonic seizures are characterized by brief, involuntary spasms of the tongue or muscles of the face, arms, or legs. Myoclonic seizures are most apt to occur when waking after a night's sleep.
A jacksonian seizure is a partial seizure characterized by tingling, stiffening, or jerking of an arm or leg. Loss of consciousness is rare. The seizure may progress in characteristic fashion along the limb.
Limp posture and a brief period of unconsciousness are features of akinetic seizures, which occur in young children. Akinetic seizures, which cause the child to fall, also are called drop attacks.
PARTIAL SEIZURES
Simple partial seizures do not spread from the focal area where they arise. Symptoms are determined by the part of the brain affected. The patient usually remains conscious during the seizure and can later describe it in detail. In 2003, it was reported that people who experience partial seizures are twice as likely to have sleep disturbances as people their same age and gender.
COMPLEX PARTIAL SEIZURES
A distinctive smell, taste, or other unusual sensation (aura) may signal the start of a complex partial seizure.
Complex partial seizures start as simple partial seizures, but move beyond the focal area and cause loss of consciousness. Complex partial seizures can become major motor seizures. Although a person having a complex partial seizure may not seem to be unconscious, he does not know what is happening and may behave inappropriately. He will not remember the seizure, but may seem confused or intoxicated for a few minutes after it ends.
Causes and symptoms
The origin of 50-70% of all cases of epilepsy is unknown. Epilepsy sometimes is the result of trauma at birth. Such causes include insufficient oxygen to the brain; head injury; heavy bleeding or incompatibility between a woman's blood and the blood of her newborn baby; and infection immediately before, after, or at the time of birth.
Other causes of epilepsy include:
Status epilepticus, a condition in which a person suffers from continuous seizures and may have trouble breathing, can be caused by:
Diagnosis
Personal and family medical history, description of seizure activity, and physical and neurological examinations help primary care physicians, neurologists, and epileptologists diagnose this disorder. Doctors rule out conditions that cause symptoms that resemble epilepsy, including small strokes (transient ischemic attacks, or TIAs), fainting, (syncope), pseudoseizures, and sleep attacks (narcolepsy.)
Neuropsychological testing uncovers learning or memory problems. Neuroimaging provides views of brain areas involved in seizure activity.
The electroencephalogram (EEG) is the main test used to diagnose epilepsy. EEGs use electrodes placed on or within the skull to record the brain's electrical activity and pinpoint the exact location of abnormal discharges.
The patient may be asked to remain motionless during a short-term EEG or to go about his normal activities during extended monitoring. Some patients are deprived of sleep or exposed to seizure triggers, such as rapid, deep breathing (hyperventilation) or flashing lights (photic stimulation). In some cases, people may be hospitalized for EEG monitorings that can last as long as two weeks. Video EEGs also document what the patient was doing when the seizure occurred and how the seizure changed his behavior.
Other techniques used to diagnose epilepsy include:
Treatment
The goal of epilepsy treatment is to eliminate seizures or make the symptoms less frequent and less severe. Long-term anticonvulsant drug therapy is the most common form of epilepsy treatment.
Medication
A combination of drugs may be needed to control some symptoms, but most patients who have epilepsy take one of the following medications:
Dilantin, Tegretol, Barbita, and Mysoline are used to manage or control generalized tonic-clonic and complex partial seizures. Depakene, Klonopin, and Zarontin are prescribed for patients who have absence seizures.
Neurontin (gabapentin), Lamictal (lamotrigine), and topiramate (Topamax) are among the medications more recently approved in the United States to treat adults who have partial seizures or partial and grand mal seizures. Another new medication called Levetiracetam (Keppra) has been approved and shows particularly good results in reducing partial seizures among elderly patients with few side effects. This is important, because elderly patients often have other conditions and must take other medications that might interact with seizure medications. In 2003, Keppra's manufacturer was working on a new antiepilectic drug from the same chemical family as Keppra that should be more potent and effective. Available medications frequently change, and it the physician will determine the best treatment for an individual patient. A 2003 report found that monotherapy, or using just one medication rather than a combination, works better for most patients. The less complicated the treatment, the more likely the patient will comply and better manager the seizure disorder.
Even a patient whose seizures are well controlled should have regular blood tests to measure levels of anti-seizure medication in his system and to check to see if the medication is causing any changes in his blood or liver. A doctor should be notified if any signs of drug toxicity appear, including uncontrolled eye movements; sluggishness, dizziness, or hyperactivity; inability to see clearly or speak distinctly; nausea or vomiting; or sleep problems.
Status epilepticus requires emergency treatment, usually with Valium (Ativan), Dilantin, or Barbita. An intravenous dextrose (sugar) solution is given to patients whose condition is due to low blood sugar, and a vitamin B1 preparation is administered intravenously when status epilepticus results from chronic alcohol withdrawal. Because dextrose and thiamine are essentially harmless and because delay in treatment can be disastrous, these medications are given routinely, as it is usually difficult to obtain an adequate history from a patient suffering from status epilepticus.
Intractable seizures are seizures that cannot be controlled with medication or without sedation or other unacceptable side effects. Surgery may be used to eliminate or control intractable seizures.
Surgery
Surgery can be used to treat patients whose intractable seizures stem from small focal lesions that can be removed without endangering the patient, changing the patient's personality, dulling the patient's senses, or reducing the patient's ability to function.
Each year, as many as 5,000 new patients may become suitable candidates for surgery, which most often is performed at a comprehensive epilepsy center. Potential surgical candidates include patients with:
A physical examination is conducted to verify that a patient's seizures are caused by epilepsy, and surgery is not used to treat patients with severe psychiatric disturbances or medical problems that raise risk factors to unacceptable levels.
Surgery is never indicated unless:
Every patient considering epilepsy surgery is carefully evaluated by one or more neurologists, neurosurgeons, neuropsychologists, and/or social workers. A psychiatrist, chaplain, or other spiritual advisor may help the patient and his family cope with the stress that occurs during and after the selection process.
TYPES OF SURGERY
Surgical techniques used to treat intractable epilepsy include:
Other forms of treatment
KETOGENIC DIET
A special high-fat, low-protein, low-carbohydrate diet sometimes is used to treat patients whose severe seizures have not responded to other treatment. Calculated according to age, height, and weight, the ketogenic diet induces mild starvation and dehydration. This forces the body to create an excessive supply of ketones, natural chemicals with seizure-suppressing properties.
The goal of this controversial approach is to maintain or improve seizure control while reducing medication. The ketogenic diet works best with children between the ages of one and 10. It is introduced over a period of several days, and most children are hospitalized during the early stages of treatment.
If a child following this diet remains seizure-free for at least six months, increased amounts of carbohydrates and protein gradually are added. If the child shows no improvement after three months, the diet is gradually discontinued. A 2003 study of the diet and its effect on growth noted that If used, clinicians should recommend adequate intake of energy and protein and a higher proportion of unsaturated to saturated dietary fats. The report also recommended use of vitamin and mineral supplements with the diet.
Introduced in the 1920s, the ketogenic diet has had limited, short-term success in controlling seizure activity. Its use exposes patients to such potentially harmful side effects as:
VAGUS NERVE STIMULATION
The United States Food and Drug Administration (FDA) has approved the use of vagus nerve stimulation (VNS) in patients over the age of 16 who have intractable partial seizures. This non-surgical procedure uses a pacemaker-like device implanted under the skin in the upper left chest, to provide intermittent stimulation to the vagus nerve. Stretching from the side of the neck into the brain, the vagus nerve affects swallowing, speech, breathing, and many other functions, and VNS may prevent or shorten some seizures. A 2003 report said that this treatment has reduced partial seizures by 50% or more in about one-third of patient with no adverse effects.
First aid for seizures
A person having a seizure should not be restrained, but sharp or dangerous objects should be moved out of reach. Anyone having a complex partial seizure can be warned away from danger by someone calling his/her name in a clear, calm voice.
A person having a grand mal seizure should be helped to lie down. Tight clothing should be loosened. A soft, flat object like a towel or the palm of a hand should be placed under the person's head. Forcing a hard object into the mouth of someone having a grand mal seizure could cause injuries or breathing problems. If the person's mouth is open, placing a folded cloth or other soft object between his teeth will protect his tongue. Turning his head to the side will help him breathe. After a grand mal seizure has ended, the person who had the seizure should be told what has happened and reminded of where he is.