You are FY2 in Paediatrics.
Molly Evra, aged 10, presented to hospital with fits and the diagnosis of Epilepsy has been made. She has been medically managed and is fit for discharge. Neurology consultant has prescribed her some medication. Mother Sarah Evra has some concerns.
Please talk to the mother and address her concerns.
D: We are glad Molly is in good health now and fit to go home. I am here to talk to you regarding some of the important things that need to be done while she is at home, that are important to all the patients of epilepsy.
P: OK doctor.
D: I suppose you understand that she has been diagnosed with epilepsy, would you like me to explain to you what exactly it is, so that we have a better understanding of how to deal with it?
P: Yes, sure
D: It is a condition that is associated with abnormality in electrical activity of the brain. This causes seizures in patients like the one your daughter experienced.
P: OK doctor
D: So now that we know what causes this, there are some medications that need to be given to her on a regular basis to prevent this happening in future. Has anyone talked to you regarding this?
P: No doctor.
D: It is very important to take the medication regularly every day, as prescribed. This medication helps prevent attacks. This medication is given every day to maintain the level of medication in the body.
P: Ok
D: Has she been diagnosed with any medical condition?
P: No doctor
D:Does she take any medication including otc, herbal and supplements?
P:No doctor
D: Does she have any allergy?
P: No doctor
D: There are some triggers that I wish to discuss with you. It is very important to find out if there are any, as this can help prevent any future attacks . We can work together on this, as this is very important. Spending a lot of time in front of TV or Computers and listening to loud music can trigger fits. Does she watch a lot of TV or play with computers?
P: Yes she does
D: I can understand that considering her age, but we can always do that in small sessions instead of being exposed to screens continuously for a longer period of time.
D: Lack of sleep can also trigger her condition. Please make sure that she has enough sleep.
P: Ok doctor
D: There are a few more things like dehydration and skipping meals that can cause a fit. So please make sure that she drinks plenty of water and does not skip meals. Excessive exercise can also be a trigger. However, most sports and leisure activities are possible for people with epilepsy, as long as necessary precautions are taken.
P: She goes for swimming and dance classes, doctor.
D: Sports on or near water, or at heights, may need extra safety measures or supervision.
If you have seizures, it’s a good idea to swim with someone who knows about the condition and type of seizures you have and how to help you if you have a seizure in the water. So, it would be great if you could accompany your child when she goes swimming.
Please make sure that the swimming pool has a lifeguard who is aware of your daughter’s condition. You can also tell the lifeguard how to help your daughter if she has an attack.
Some people swim during quieter swimming sessions, so it is easier for the lifeguard to spot them.
Some swimming pools have got a shallow area, so it is advisable to swim in shallow water.
As long as her dance classes are not so intensive and there is no loud music, you can take her to dance class. It is important to inform her instructor about her condition.
D: Epilepsy medications usually have interaction with some medication. Please don’t give your daughter any medication including OTC. Please always seek advice from her GP.
It is very important for her to be seen by GP regularly. Her GP will review your child’s condition and re-prescribe her medications.
P: Sure Doctor
D: Some health problems such as vomiting and diarrhoea especially after having medication will decrease the efficiency of the medication. So, it is very important to seek medical advice in such a case.
P: Ok doctor thank you for letting me know.
D: Like any other medication, epilepsy medication has some side effects. Some side effects are temporary and subside after some time. If she has any persistent side effect, please seek advice from her GP. It is very important to not stop the medication. We’ll try to tackle the SE, if not possible, we will review the medications.
P: Sure doctor
D: Anything else I can help you with?
P: What should I do if she has another attack?
It is important to put her in a safe position and stay with her while the convulsion is happening. Lay her on her side with her head slightly tilted backwards (recovery position).
This will ensure that she will not swallow any sickness (vomit) and the tongue does not cause any obstruction, which helps to keep her airway clear.
Remove any sharp objects if there are any around. Loosen any tight objects around her neck like a tie if any.
Don’t put anything in her mouth. Your child should be seen by a doctor after having a fit. If your child has a seizure that lasts more than 5 minutes, or doesn’t regain consciousness after a seizure, you need to call an ambulance.
P: Is it bad for the brain? Does it cause damage to the brain?
D: Fortunately, in your child, the duration of seizure was not that long so hopefully it won’t cause any damage to the brain.
P: Will she be able to have a normal life?
D: Like I said it is very important to take the medication regularly and avoid the triggering factors. Most patients can have an almost normal life. Some patients after a while will be symptom free and may not even need any medication.
P: What precautions do I need to take?
D: Since a seizure can happen at any time, it is important that your daughter is not in any situation where she is in imminent danger or harm if she has a fit. For example, a shower is considered to be safer than a bath. Instead of locks on the door you can have “engaged” signs. These are just some examples of how she can be kept safe.