Epilepsy Clinic:-
Epilepsy is a chronic
disorder that significantly affects learning and behavior.
Estimated prevalence
of epilepsy in US is < 1 % of general population
with 20-30% in children with mental retardation (MR). In India, evidence suggests rough
prevalence as 0.5% of general population, with 6% in mild MR and 50% in profound MR.
The data clearly suggests that incidence of epilepsy shows an increasing trend with
severity of mental retardation. A high degree of morbidity is seen in epileptic patients
because of frequent accidents and fractures, and side effects of long-term antiepileptic
drugs. Also, these patients have a reduced life span and risk of sudden unexpected deaths.
The disease becomes a social taboo, more so in mentally subnormal patients, restricting
their social engagements and activities.
Most of these
patients can have a good control of their symptoms with single or at the most two drugs,
but few of these tend to develop refractory epilepsy. Refractory epilepsy is
defined as " having at least 1 seizure per month and not responding positively to at
least two antileptic drugs". Causes of refractory epilepsy include mesiotemporal
sclerosis, Struge Weber syndrome, tuberous sclerosis, cerebral tumors, hamartomas, AV
malformations, developmental malformations of brain, sequalae of cerebral infarcts or
trauma and mental retardation. Assessment of medically refractory seizures includes
confirmation of diagnosis of seizure disorder and the type.
A good description of
the type of seizures, post ictal behavior along with video-EEG monitoring may help in
diagnosis. Individuals with refractory seizures require both EEG and MRI evaluation.
Common clinical errors that may contribute to uncontrolled seizures are the errors in
diagnosis, failure to recognize etiology, errors
.
.
in management which
include improper choice of drugs and dosages, poor
compliance on part of
patient or his relatives. Gertain basic elements to be followed for the management of
refractory seizures include classification of the seizure disorder correctly, maximize
monotherapy over polytherapy, balance the maximal
effective dose with
minimal side effects, chose dosing schedule to maximize compliance and treat the patient,
and not serum levels or EEG findings. Goal of the therapy is to achieve complete seizure
control without side effects.
Government Institute
of Mentally Retarded Children- Sec 32 established since 1968, has been providing
educational, prevocational and vocational training to approximately 270 mentally
challenged children. Daily 6-8 new cases are assessed and managed in 'MR clinic' of the
Institute by a team of specialists, which include a pediatrician, psychiatrist, clinical
psychologist, physio-occupational therapist, speech therapist, special educator, nursing
staff and social worker. Service in the form of 'Early Intervention Clinic' is being run
at the institute where children upto six years of age are given special care with the
motive of preventing delay at earliest suspicion and early intervention. Recently, with
the objective of giving special care to patients with epilepsy, a new facility in the form
of "Epilepsy Clinic" has been started at GIMRC every Tuesday from
2.30p.m. to 5.00 p.m. Afternoon timings are chosen to make the clinic convenient for
the parents of school going children on their persistent request, hoping that the facility
will be availed by the maximum. Our aim is to offer our best efforts to control seizures
in epileptic patients and give them an improved quality of life.