Epilepsy

COPING WITH THE UNCERTAINTIES OF SEIZURES AND EPILEPSY: SPASTIC QUADRIPARESIS AND DIPLEGIA

Spastic Quadriparesis Children with stiffness in all four limbs (spastic quadraparesis) usually have sustained severe damage to the entire brain. They are likely to have severe or even profound retardation. They often have experienced seizures in the newborn period (see neonatal seizures) and may have had infantile spasms during the first year of life. They will have a high incidence of generalized tonic-clonic seizures as well as of atonic attacks and the Lennox-Gastaut syndrome. Seizures in children with spastic quadraparesis may be very difficult to control.DiplegiaDiplegia is the type of cerebral palsy in which both legs are stiff. It is far more common in children who were born prematurely than children carried to full term. These children are usually of normal intelligence and are less likely to develop seizures. Their principal handicap is a difficulty with walking; physical therapy, bracing, and orthopedic surgery can often be of help.*200\208\8*

THE FACTS-THE FIRST SEIZURE AND THE DIAGNOSIS OF EPILEPSY: OTHER CAUSES OF IMPAIRED OXYGEN SUPPLY TO THE BRAIN-DROP ATTACKS AND JUMPING LEGS (MYOCLONIC JERKS; HYPNIC JERKS)

These affect only middle-aged women, and then often only for a year or two. The story is striking. The woman complains that, while walking along, she suddenly finds that her legs have given way. She may land on her knees or pitch forward on her face. In either case she is always adamant that she is fully aware of what is happening, and equally adamant that she does not trip. The condition is variously assumed to be due to some weakness of the thigh muscles, or to a disturbance of blood flow in the brain-stem, interfering with postural reflexes. Whatever the mechanism, neurologists are confident that there is no association with epilepsy.

Jumping legs (myoclonic jerks; hypnic jerks)-About 80 per cent of the adult population, at some time in their lives, are conscious of a sudden jerk of one or other leg, usually in the twilight stage of drifting off to sleep. The jerk is associated with, or may cause, a sudden arousal. Some people have a great number of jerks, so many that their spouse, being bruised by the kicks, will refuse to share a bed with them. These jerks must represent some sort of paroxysmal discharge of nerve cells, not necessarily in the brain. They are therefore in this way close to epilepsy, but are not so regarded because of their near universality in the population, and their lack of association with frank epileptic seizures. Specifically, there is no relationship between these jerks and the morning myoclonic jerks associated with typical absence or tonic-clonic seizures.

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