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In addition to the many types of seizures, there are various patterns of recurrent seizures sufficiently distinctive in their course and outcome and in their response to specific medications to warrant distinct names and separate discussions.

Benign Rolandic Epilepsy is a special form of seizures in children. Often starting after three years of age, it has rather typical clinical manifestations and a typical EEG. It is usually “benign” in that it is outgrown at adolescence whether or not it is treated and in that the children are usually normal before, during, and after this form of epilepsy that is outgrown. In many or most cases, the seizures are infrequent and do not need medication.

Seizures in this form of epilepsy usually start with a sensation at the corner of the mouth, followed by jerking of that corner. The jerking may spread to one side of the face or cause a twisting of that side. The seizure may, on occasion, spread throughout that side of the body or become a generalized tonic-clonic seizure. These seizures occur more commonly at night and during certain stages of sleep. The diagnosis of benign rolandic epilepsy is confirmed by an EEG pattern of repetitive spike activity firing predominantly from the mid-temporal or parietal areas of the brain near the rolandic (motor) strip— hence, the name rolandic epilepsy. Bilateral spike activity on the EEG is not uncommon and inter-ictal activity is more common on the EEG during certain stages of sleep.

The seizures are often so infrequent and benign, occurring only at night, that most children with benign rolandic epilepsy are not treated with medication. If a child’s seizures are more frequent or troublesome, carbamazepine can be very effective and may be tapered and discontinued after puberty. There may be a genetic predisposition to this form of epilepsy.

When epilepsy becomes a handicap

Nearly everyone who has epilepsy lives a normal, ordinary life, with a family and a job. Only a very few are so disabled by their seizures that they can not have an independent existence. And for many of these people the real cause of their disability is usually not the epilepsy itself, but the fact that the brain damage which is responsible for their seizures is severe enough to cause learning disabilities too. However, despite even their double handicap, people with both epilepsy and brain damage can still lead a fulfilled life.

AN ORDINARY LIFE
The move away from institutional care towards community-based care has meant that many people with special needs can now look forward to living an ordinary life within their local community. Small group homes, run by local authorities or housing associations aim to give people with learning disabilities as much support as they need whilst at the same time encouraging their independence and self-development. Staffing levels and levels of support will depend on an individual resident’s needs. This may range from round-the-clock care with night staff, to daily visits from carers. In addition, local Community Learning Disability Teams often work closely with staff and residents from the homes, to help sort out any problems that arise.

One of the difficulties which people with epilepsy have to overcome is other people’s tendency to over-protect them and so make them more dependent. People with learning disabilities need to learn to become as independent as possible, and with help many can take the basic steps towards achieving at least a measure of self-reliance. When someone has severe learning disabilities, they may need to learn how to make simple choices, how to dress or wash themselves, or how to take part in some other aspect of self care. Those with less severe learning disabilities may be able to reach a level of self-reliance that allows them to have an independent life in a home of their own. Everyone, whatever their level of disability, has the potential to achieve greater independence.