Saturday, July 28, 2018

Epilepsy and Autism

Autism and Epilepsy

Summarizing whatsapp discussion on ,epilepsy-precautions,medications and connection with Autism.

Dated 13/6/18 -19/6/18

Epilepsy, a brain disorder characterised by recurrent seizures (hypersynchrony of impulses) can begin at any age.The medical diagnosis is based on ,

Medical and family history
Number of episodes
Results of diagnostic tests such as EEG and MRI.

A seizure can temporarily and adversely affect sensory perception ,posture and locomotion,attention,language functions and consciousness.However a seizure doesnot necessarily indicate an epilepsy.When someone is diagnosed with epilepsy;they have an increased risk of future onset of seizures.

The discussion started of with an analysis from the parents side on the benchmarks for identification of a seizure.They observed drooling/excessive salivation before the onset of a seizure.They also noticed involuntary jerking (lasted from sec to min),heavy muscle spasms,rigidity or flaccidity of the body,eyes rolling up,coughing during sleep followed by nausea and jerks,lack of response,loss of consciousness,unusual stare for a long period and so on

Many parents cautioned on the necessity to be alert on swimming pools and suggested a one on one monitoring since there is  a high chance for seizures in water and the situation is quite risky

Diagnosis is usually done by an 8hr long video EEG. Parents raised the effectiveness of sedatives like pedichloryl or similar as it would affect the reading.Some informed that in U.K melatonin induced sleep is preferred as it doesnot affect EEG readings.They also shared the instructions to be followed before getting ready to take an EEG. Dr Gayathri pointed out the disadvantages of taking short EEG in ruling out conditions where epileptiform discharges themselves cause autistic traits
E.g..Landau Kleffner Syndrome.

https://rarediseases.org/rare-diseases/landau-kleffner-syndrome/

Parents and doctors suggested strong links between autism and seizures. Precautions to be practised during a seizure are:-
1.never restrain the patient
2.make sure the airway is not blocked
3.tilt the child so that he is in a lateral position
4.Be calm and composed
5.Make a video for easy diagnosis of the type of seizure

Discussing further on antiepileptic medications many first line and second line drugs specific for each type of seizure is available.Dose titration and addition of drugs might be required,based on seizure control.They are started only after the onset of 2nd seizure.Most medications have some sort of side effects and some doctors prefer to check blood ammonia when on carbamazepine and valproate . Monitoring the drugs is a key factor since multiple drugs can have synergistic effect but at the same time influence each other's metabolism as well. Generally a 2yr seizure free period and the neurologists discretion is the right path towards tapering off medicines.

Instructions to parents

1.On consultation  with a doctor, the parent should always list out the medicines the child is currently on (e.g... antihistamines,antibiotics etc)
2.The prescribed dose of medicine should be given at the right time (Keep a reminder to help ourselves)
3.Never miss a dose

Homeopathy claimed bright light,imbalance in copper and zinc,high fever,emotional outbursts,head injury and asphyxiation as contributing factors for epilepsy.The significance of Thuja,the pillar of sychotic miasm was provided.

Dr Santhosh George Thomas provided an insight into surgical remedies for intractable epilepsy,when multiple medicines in maximum doses fail to control epilepsy.He informed that after a seizure,the patient would experience intense muscle pain after waking up and feel completely exhausted.He contributed photic stimulation and sleeplessness and hormonal variation as triggering factors for epilepsy.He  adviced to be careful with sensory stimulations provided in A/V rooms. Vagal nerve stimulation and ACTH (works partially) was suggested for intractable epilepsy.Patients with inborn errors in metabolism are also likely to have epilepsy.

Ayurveda foresee epilepsy as the structural and fun tional abnormality of brain.Dr Roshni informed that fluctuations in blood glucose,calcium and magnesium levels can too trigger epilepsy.Tiresome travels ,stress,digestive errors are also factors. She informed that atypical febrile seizure is more common in asd kids.She pointed out that hyperpyrexia (high temperature) induced seizure is not a pathological condition.

Dr Gayathri pointed out the relevance of head to toe examination to look for dysmorphism or neurocutaneous markers.She suggested a genetic evaluation  and MRI as many genetic syndromes share risk of autism and seizures. Studies suggested a peak in seizures due to exitatory-inhibitory neurotransmitter imbalances.

Parents and docs examined the use of Vitamin B6,E,Folate,Mg,DMG and progesterone in controlling seizures. Ketogenic diet to an extend controlled recurrence of seizures.
Parents also suggested to avoid eukalyptus essential oil as suggested by MAPS doctor for kids prone to seizures.

Notes were provided on

Catamenial seizures
Supplements and seizures
Reflex epilepsy
Ayurvedic remedies for epilepsy.

Active participants

Dr Gayathri .S
Dr Santhosh George Thomas
Dr Roshni Anirudhan
Sona Raghavan
Preetha Suresh
Gina
Vinitha Dev
Beena Balakrishnan
Prasanthi Vankamamidi
Priya Koundinya

https://www.ncbi.nlm.nih.gov/pubmed/27513702/


Thank you all

(The discussion is in no way conclusive or decisive.Medicines should be given only on prescription from a licensed medical practitioner)

#ASD parents and Therapists Group,Kerala

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