Care & Maintenance of Cerebral Palsy: Bathing, Toilet Training, Dressing, Feeding &
Nutrition, Play, Fitness, Seizures, Sleep, Suctioning, Hearing, Vision and Teeth
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral PalsySeizures Cerebral Palsy Cerebral Palsy

The first time an infant or child has a seizure can be a truly frightening experience for her parents. About 50 percent of children with cerebral palsy have seizures – episodes in which abnormal nerve activity disturbs the functioning of the brain. Children with quadriplegia or hemiplegia are most likely to have seizures. Seizures can begin even before birth. Seizures are common among children with cerebral palsy because brain injuries provide focus for abnormal nerve impulses to occur. Depending on where the abnormal activity occurs in the brain, seizures may affect children in a variety of ways. A child may have staring episodes; minor involuntary movements such as eye blinking, lip smacking, or arm jerking; or major convulsions with unconsciousness, stiffening of the body, and violent spasmodic jerking of the whole body. When seizures occur repeatedly, they are diagnosed as epilepsy. Different patterns and types of seizures are more prevalent with different forms of Cerebral Palsy. Learning how to manage seizures will make it easier for both the caregivers and the child.

Cerebral Palsy

Cerebral Palsy

Once a seizure has begun, there is nothing you can do to shop it. But if you stay calm, you can make your child more comfortable and keep her from hurting herself During a seizure, the main things to remember are to protect the child from harm and to monitor the seizure. You don't want to attempt to hold the child still or to prevent physical movement; instead, make the environment safe so that she cannot be physically hurt. It is important to remain with the child during the seizure.

If the child is in a sitting position, or standing or walking when you observe the seizure, help him to lie down, so that he will not fall and get hurt. If at all possible, place the child on a blanket or protected surface. Turn your child on her side so the saliva can flow out of her mouth. Do not put anything in the child’s mouth. It used to be the practice to put a tongue depressor into the mouth and hold the tongue down. This is no longer done and can in fact be harmful. The child may clamp down hard with the teeth during the seizure and break either the tongue depressor or a tooth and choke on a piece of it.

Also remember that it is usual for a child’s breathing to become irregular, so don’t be alarmed. .

Move all sharp objects out of the way, as well as any furniture. Pad any sharp objects that cannot be moved, to prevent the child from getting hurt. If the child is wearing restrictive clothing, loosen it, especially in the chest and abdominal area.

Do not interfere with the seizure or try to stop it. Allow the seizure to continue without interruption. Check the child for breathing. If the child has stopped breathing, clear the airway and perform mouth-to-mouth breathing.

Call 911 or call for other emergency medical assistance if the following conditions occur:
1. Color change during seizure
2. Breathing problems during the seizure
3. A prolonged seizure lasting longer than 10 to 15 minutes
4. Repetitive seizures without recovery between seizures

If it is not your child’s first seizure, it is usually not necessary to call a doctor right away. You should, however, seek emergency care immediately if your child’s seizure is very active for more than ten to fifteen minutes.

Being able to describe the seizure for the doctor is very important, because it helps the doctor determine the diagnosis and management of the child’s seizures. If you observe a seizure, take note of the following:

1. Before seizure (If the child can not talk, some of this information will be difficult to ascertain.)
a. Did the child experience an aura? An aura is any strange or unusual feeling, taste, sound (humming, ringing, etc.) or visual changes.
b. Did something trigger the seizure? Some seizure triggers are illness, stress, body changes, (adolescence), hyperventilation, and flashing lights.
2. During the seizure
a. The time of onset of the seizure and long it lasted.
b. The body parts affected by the seizure and what form the movement took (stiffening, jerking, shaking, twitching, etc.)
c. Any eye movements, such as staring, eyelid fluttering, eyes looking in a particular direction, etc.
d. Loss of control of bladder or bowels
e. Loss of consciousness or any type of confusion
f. General appearance
3. After the seizure
a. Confusion or disorientation
b. Fatigue or sleepiness
c. Headache
d. Injury

The most important thing to remember is to remain calm during a seizure. This will allow you to help your child during the seizure or to get medical assistance if necessary.

If it is suspected that your child is having seizures, the doctor with more than likely to recommend that your child get an EEG. If your child’s EEG confirms that she has seizures, the neurologist will discuss possible treatments with you. Usually anticonvulsant medication is recommended, since medication can reduce or eliminate seizures in about 90 percent of children with epilepsy. Medication might not be necessary if your child has febrile seizures or infrequent or minimal seizures such as brief staring spells occurring only every several weeks.

The type of medication prescribed for your child depends on the type of seizures she has. For tonic-clonic seizures, phenobarbital and phenytoin (DilantinTM) are most often used. Carbamazepine (Tegretol TM) is frequently used for psychomotor seizures. Valproic acid (Depakene TM) helps control myoclonic, absence, and tonic-clonic seizures. Other medications that might be used include clonazepam (Klonipin TM), primidone (Mysoline TM), diazepam (Valium TM), and ethosuximide (Zarontin TM). These medications may be used alone or in combination.

Of course, no matter what medicine doctors prescribe, they must carefully calculate the most appropriate dosage for the child's age and weight. Because few clinical trials have tested the use of seizure medicines in children, the doctor must decide on the correct dose based not only on adult doses (which have been tested in clinical trials) but also on experience in using the medicine with other children. Dosages for children are usually expressed as a certain number of milligrams per kilogram per day (mg/kg/day). The "kg" refers to the child's weight in kilograms. One kilogram is about 2.2 pounds, so a 22-pound toddler weighs 10 kilograms and will get 100 mg of medicine each day if the recommended dosage is 10 mg/kg/day.

Parents often worry that their child's medication is too strong or too weak because the number of milligrams in each pill is quite different from the number in another kind of pill. Doctors know that the effective dose of different medicines varies widely. For instance, the usual dose of Trileptal (oxcarbazepine) for a 10-kilogram toddler is 150 mg per day (15 mg/kg/day). But if the doctor prescribed Lamictal (lamotrigine) for the same child, the dose would probably be only 50 mg per day (5 mg/kg/day). This doesn't mean that the Lamictal would be less effective; the two medications are just different. If you are concerned about the dosage of your child's medication, discuss it with the doctor.

Doctors can get information about dosages for children from articles published in medical journals that report on the use of the medicine by children. Not all of the studies reported fit the requirements that would be needed for FDA approval of using that medicine for that particular disorder in children, but they all add some information to the doctor's pool of knowledge. The FDA recently began allowing drug manufacturers to distribute some of these articles to doctors, which should help to increase their knowledge about off-label uses and dosage.

Sometimes doctors want to perform tests to measure the amount of the medication in the child's blood. This is called a "blood level" or "drug level." There is no "right" blood level for all children. Occasionally, knowing the level may help the doctor to tell how the child's body is using the drug and may warn the doctor and parents to be on the lookout for seizures, troublesome side effects, or poor adherence to the schedule of taking the medicine. Most of the time, however, there is no need to measure the blood level. If the child is having frequent seizures and no side effects, the doctor does not need a blood level to know that the dosage should be increased. Similarly, if the child is having trouble with side effects, the dosage should be lowered. Measuring the blood level of medication is very rarely necessary in managing a child's epilepsy.

Although medications are very effective in preventing or reducing seizures when given regularly, they may also produce a variety of side effects. For example, they may cause hyperactivity behavior, irritability, sleep problems, growth of body hair, lethargy, depression, or sedation, and can affect liver function or blood counts. Because of these possible side effects, your pediatrician and neurologist must monitor your child closely when she is on medication. Through periodic blood tests, they will determine your child’s therapeutic level – the amount of drug in the blood which usually controls seizures with a minimum of side effects”

Sometimes medications cannot control a child's seizures. In some cases the parents are concerned about the side effects their child is experiencing from medications. Specifically, your child may be put on the Ketogenic Diet, a very strict diet high in fat and low in protein and carbohydrates. The Ketogenic Diet, which has been around almost as long as Cerebral Palsy has been recognized, is being looked at again as an avenue to try to control seizures and is being very successful in some cases. If this approach is considered for your child, the neurologist will refer her to a nutritionist.It is not the same as other popular low-carbohydrate diets, such as the Atkins diet.

The name ketogenic means that it produces ketones in the body (keto = ketone, genic = producing). Ketones are formed when the body uses fat for its source of energy. Usually the body usually uses carbohydrates (such as sugar, bread, pasta) for its fuel, but because the ketogenic diet is very low in carbohydrates, fats become the primary fuel instead.
Ketones are not dangerous. They can be detected in the urine. This diet alters the body’s metabolism so that the amount of ketone bodies – compounds normally excreted in the body’s fluids – are greatly increased. This metabolic state can help control seizures. The diet works best for children under the age of five whose nutrition can be closely monitored. If this approach is considered for your child, the neurologist will refer her to a nutritionist.

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Care & Maintenance of Cerebral Palsy: Bathing, Toilet Training, Dressing, Feeding &
Nutrition, Play, Fitness, Seizures, Sleep, Suctioning, Hearing, Vision and Teeth