HOW DOES PARENTING ROLE IN CARING CHILDREN WITH SEIZURE AND EPILEPSY?

HOW DOES PARENTING ROLE IN CARING CHILDREN WITH SEIZURE AND EPILEPSY?

Seizures are an emergency that is often found in children. Seizure is a condition that is very frightening for people who witnessed at the time of the attack. Scientifically seizures are manifestations of clinical symptoms due to excessive discharge of electricity in the brain that can be in the form of limb movements, sensory disturbances or behaviour changes. Seizures can be manifest as “febrile seizure” or seizure accompanied by fever.  Seizures when accompanied by a fever are usually associated with an infection both in the brain (intracranial infections) and outside the brain (extracranial infection).

FEBRILE SEIZURES

Febrile seizures are common diagnosis in the community. In this condition the child has a seizure after being preceded by a fever a few hours before. Fever occurs due to an infection in the child's body but the infection does not occur primarily in the brain. Infection can be an acute respiratory infection (cough, runny nose, shortness of breath, sore throat, pneumonia), diarrhoea, inflammation of the middle ear, dengue fever or urinary tract infections. As a result of one local infection causes a high fever so that seizures can occur. But not all children who have a fever will experience seizures. Seizures are more common if the child has a low seizure threshold. Some determinant factors associated with recurring seizures are:

1.     The lower temperature when the child was experiencing seizures previously.

2.     The shorter time interval between seizure and onset of the fever

3.     Family history with febrile seizure

4.     Family history with epilepsy

5.     Children with developmental delays or child with neurologic deficits (paresis, paralysis, cerebral palsy)

The etiology of seizures should be known, so it’s necessary consult to the doctor, to determine the cause of seizures. If the child experience fever and seizures in first time, should be aware especially when there is no seizures history in the family.

Seizures accompanied by fever can also be caused by infection/inflammation of the meninges membrane or intracranial infection. Intracranial infection usually characterized by decreased of consciousness, somnolent, irritable, high pit crying, sometimes accompanied by vomiting, headache, blurred vision, chaotic or unoriented speech.

EPILEPSY

There are also seizures without fever or unprovoked, and differentiated into: first unprovoked seizure and epilepsy. First unprovoked seizure can be caused by metabolic abnormalities or disorders, e.g. low blood sugar levels, low blood sodium level, etc. These conditions can occur if the child preceded by less nutritional intake, vomiting, diarrhea, etc. We have to know that a child could have had seizures only once in his life.

Epilepsy is an occurrence of seizure without fever that occurs more than 1 times and the interval between seizure attack more than 24 hours.

WHAT SHOULD PARENTS DO WHEN FINDING CHILDREN EXPERIENCING SEIZURES?

            Parents will feel anxious, worried, unbelieving, and not knowing what should be done to help his child. Some parents may be calm and resigned to the doctor, but some parents deny and try to find out more through browsing about seizures on Google, especially when the doctor states his child has epilepsy. Parents can also consult to other doctors for second or third opinion.

 WILL THE SEIZURE ATTACK REPEAT?

Children with a history of febrile seizures can be seizure experienced again when the child has a fever until the child is 5 years old.

If febrile seizure still occur after a child 6-year-old, is called “febrile seizure plus (FS+)". Usually FS+ occurs in a large family with a history of febrile seizures and/or epilepsy. “Febrile seizure plus” are associated to genetic factors (hereditary).  “Febrile seizure plus should be not recurrent after the child 12 years old.  If it is still occurred after the child is more than 12 years old, the child can be suspected of epilepsy.

When seizures are caused by an infection in the brain, seizures may be not recurrent or recurrent if previously there were insult of infection to the brain parenchymal. The brain damage could lead to epileptic focus or as source of seizures discharges.

WHAT SHOULD YOU DO IF YOUR CHILD HAS EXPERIENCED SEIZURES?

1.     Consult to your pediatrician for well explanation about the seizures. What kind seizure diagnosis of your child (febrile seizure or epilepsy)? Also to find the cause of seizures, to get the problem solving or the appropriate treatment.

2.     Ask the doctor, what you should to do when the child is seizure.

3.     Ask the prescription of a seizure medication (diazepam Intra rectal) to guard in the event of a seizure attack.

4.     Always provide at home: diazepam intra rectal, thermometer and anti-fever drug

5.     Tell to   family members: seizure can be recurrent.

6.     Educate to other people at home (caregivers/family members), how to take when your child experience seizures attack again. Please also indicate how to use a anti-seizure medication and where you place the medication.

7.     Provide your phone number and phone number of nearest hospital/family physician/clinic nearby.

8.     Make sure that was true seizures or not seizure mimicker by consulting a doctor.

9.  When occurred seizures attack, if possible or there are other people in the location, please  make video recorded.  The video will be useful when you consult the doctor for better diagnosis.1.              

WHAT SHOULD YOU DO IF YOUR CHILD  IS EXPERIENCING A SEIZURE ATTACK?

1.              Don't panic!!!

2.              Make sure that the airway and breathing are not clogged by objects or food.

3.              Keep child away from dangerous object

4.              Place the child in a flat matrass and tilt it on the 1 side of his body   to prevent choking (aspiration).

5.              Loosen the clothes or something else around the neck.

6.              Do not put anything into the mouth (spoon, fingers, coffee, water)

7.              Children should not be sprayed/flushed by water.

8.              Do not hold/fight the child movement during seizures.

9.              If the seizure persists, insert diazepam intra rectal, maximum 2 times with 5 minutes interval.

10.           Accompany your child until full alert.

11.           If seizures have not stopped immediately, bring the child to the nearest emergency unit.

WHEN DO YOU BRING YOUR CHILD TO THE HOSPITAL?

1.              When the seizure longer than 5 minutes or after inserted intrarectal drug already 2 times but the seizure has not stopped.

2.              Children injured when seizure attack (falling, exposed to sharp object)

3.              Children suspected choking.

4.              There is a change in breath patterns.

5.              Seizure more than 2 times.

6.              Very high fever

7.              The child still unconscious after the seizure stopped.

8.              The first seizure attack.

WHAT IS THE IMPORTANCE NOTICE WHEN SEIZURE ATTACK?

1.     Seizure type such as:

a.     Head position: straight head position, turned to the right side or left side.

b.     Seizure duration, seizure frequency and seizure interval

2.     Observe the child behavior after seizures attack. does the child activity undergo changes after the seizure?

3.     Please Ensure that there is no visual impairment, hearing impairment or weakness/paralysis.  

WHEN YOUR CHILD WAS DIAGNOSED WITH EPILEPSY BY PHYSICIAN, WHAT SHOULD BE CONSIDERED?

1.     Have a complete explanation to the doctor to remove any doubts.

2.     Ask for a description of THE DRUG TYPE/NAME, NUMBER/DOSE OF THE DRUG, DURATION OF MEDICAL ADMINISTRATION, DRUG SIDE        EFFEC, CONSULTATION SCHEDULE etc.

3.     Be aware of the possible causes of epilepsy and ask for advanced supported diagnosis that may be necessary to be done such as the EEG or               imaging.  Some epilepsy may require further examination.

4.     When consulting a doctor, be honest about regularity of taking the drug.

5.     When treating to other doctors/specialists, tell the doctor that your child is under treatment of epilepsy.

6.     Finding the right information from reliable sources: books, seminars, browsing, epilepsy foundation

7.     Do not believe easily to the community myths about seizures/epilepsy, for example: epilepsy will be resolved/healed without medication, epilepsy        God's curse disease, etc.

WHAT ARE THE TIPS IF YOUR CARE THE CHILD WITH EPILEPSY?

1.     Having children with epilepsy is not easy, as well as taking medication for a long period of time is also not an easy thing to obey.

2.     It takes confidence not to break in the administration of epilepsy medication.

3.    Choose the drug according to the ability of purchasing (cheap or expensive drugs). You can use insurance, like BPJS in Indonesia. Not all insurance is willing to bear the cost for epilepsy treatment.

4.     Ask about side effects of the drug, if there is other drug choice, ask the superiority and the inferiority of the drug and adjust to the efficacy/purchasing power.

5.     If possible, provide a box of drugs that have been divided, so that it can be known if forgotten to take medication.

6.     If you forgot to take medication, give it immediately when you remember and do not double the dose of the drug.

7.     Give medication regularly at the same time according to the instruction or recommendation from the doctor.

8.     Immediately back to the doctor before the drug at home is exhausted. Do not run out of drug, that is the possible risk of seizure attack.

9.     Try to involve your child so that responsible for the treatment, if possible

10.  Together with the teachers/guardians at school. Explain your child a problem as necessary, and if the schedule of taking medication at school is inevitable, please inform to the teachers at school to follow up your child taking medication at school.

11.  Explain to other adults at your home, how to give medication.

12.  Don't forget to keep in mind the growth and development of your child.

13.  Provide stimulation according to the wishes or talents of your child.

14.  Do not reduce the dose or stop the drug without instructions from the doctor.

15.  Look for a doctor that you trust and comfortable when discussing.

16. Avoiding the trigger factors such as fatigue, fasting, angry, and excessive activity. 

KEEP PRAYING FOR THE YOUR CHILD HEALING

BE ASSURED THAT YOUR CHILD WILL HEAL WITH YOUR EFFORTS AND PRAYERS

AND MAY GOD BLESS AND SO BE IT