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My Child Has

Autism

What is autism?

Autism is a development disorder. People with autism have trouble communicating and interacting with other people. A child with autism may seem very withdrawn, may not make eye contact with people, may not talk or play the way other children do, or may repeat certain motions and behaviors over and over again.

Signs of autism can vary from person to person. They can also be worse in some people than in others. People can be said to have "low-functioning autism" or "high-functioning autism," depending upon the severity of their symptoms and the results of an IQ (intelligence) test. Some of the more common signs are listed in the box below.

Common Signs of Autism

  • Avoids cuddling or making eye contact
  • Doesn't respond to voices or other sounds
  • Doesn't talk, or doesn't use language properly
  • Rocks back and forth, spins or bangs his or her head
  • Stares at parts of an object, such as the wheels of a toy car
  • Doesn't understand hand gestures or body language
  • Doesn't pretend or play make-believe games
  • Is very concerned with order, routine or ritual
  • Has a flat facial expression or uses a monotone voice
  • Injures himself or herself or is unafraid of danger
What causes autism?

Doctors aren't sure what causes autism. Some studies have shown that the cause is genetic (runs in families). Certain medical problems or something in your child's surroundings may also play a role. In many cases, the cause of a child's autism is never known. Boys are more likely than girls to have autism. As doctors continue to study autism, they may learn more about what causes it.

Can vaccines cause autism?
No. Good research has shown that there is no link between autism and childhood vaccinations ("shots") like the measles, mumps and rubella (MMR) vaccine.

Vaccines are an important part of your child's health. If you have any concerns about the safety of vaccines, talk to your doctor.


How is autism diagnosed?
There is no lab test that can detect autism. Autism is often diagnosed when a baby or toddler doesn't behave as expected for his or her age. If your doctor thinks your child has autism, he or she will probably suggest that your child see a child psychiatrist or other specialist. The specialist will probably test your child to see if he or she shows signs of autism.


If my child has autism, does it mean that he or she is mentally retarded?
Many children with autism are also mentally retarded, but others are not. It can be hard to test autistic children because they do not respond to questions in the same way other children do. An autism expert can give your child special tests that will tell you more about his or her condition.
Some autistic children have special skills, such as the ability to do complex math problems in their heads. However, abilities like these are very rare.


My baby seemed fine. Why does he or she seem to have autism now?
We don't know why this happens, but approximately 20% of children with autism seem to develop normally for the first 1 to 2 years. Then, these babies experience what doctors call a regression. This means that they lose abilities that they had before, such as the ability to talk.


Are there more cases of autism now than there used to be?

More children are being diagnosed with autism. However, we're not sure if this really means that more children have autism. It may mean that parents, teachers and doctors are becoming better at recognizing the signs of autism.

How is autism treated?

Several treatments for autism are available. Research has shown that very intense behavior and language therapy may help some children. There is no medicine that treats autism itself, but medicine may help with some of the symptoms of autism, such as aggressive behavior or sleeplessness. Talk to your doctor about what kind of therapy can help your child.


Children don't "outgrow" autism, and it can't be cured. With therapy, some children may improve as they mature. The individual child's language skills and overall intellectual level may help predict what will happen with the autism.

If I have one child with autism, am I more likely to have another one?

Brothers and sisters of children with autism have about a 5% chance of getting autism themselves. There also seems to be a higher risk (10% to 40%) of another disability, such as a learning disability, in siblings of children with autism.

If you're thinking about having more children, talk with your doctor about whether it would help you to talk with a genetic counselor.

What is Asperger syndrome (AS)?

Asperger syndrome (AS) is very similar to high-functioning autism. Typically, people with AS have a normal IQ and some may exhibit an exceptional skill or interest in a particular area. While verbal language development is considered normal, people with AS can have trouble using this language correctly in social situations. They may also have difficulty communicating in nonverbal ways such as making eye contact, understanding facial expressions and using body gestures. General social skills such as developing relationships and adjusting to new situations can also be affected. Even so, people with AS can often learn how to deal with their difficulties much like someone would learn the multiplication table.

Autism: Resource List
Books for Children
Ages 4 to 8
  • All About My Brother : An Eight-Year-Old Sister's Introduction To Her Brother Who Has Autism; by Sarah Peralta, Edition APC, 2002
  • Andy and His Yellow Frisbee; by Mary Thompson; Woodbine House, 1996
  • Asperger's huh? A Child's Perspective; by Rosina Schnurr; Anisor, 1999
  • Autism; Sudipta Bardhan-Quallen; KidHaven Press, 2005
  • Ian's Walk: A Story About Autism; by Laurie Lears; illustrated by Karen Ritz; Albert Whitman, 1998
  • My Social Stories Book; edited by Carol Gray; Jessica Kingsley Publishers, 2002
  • When My Worries Get Too Big: A Relaxation Book for Children With Autism Spectrum Disorders; by Kari Dunn Baron; Autism Asperger Publ Co, 2006
Teen
  • Asperger Download: A Guide to Help Teenage Males with Asperger Syndrome Trouble-Shoot Life's Challenges; by Joies Santomauro; Autism Asperger Publishing Company, 2007
  • Asperger Syndrome: An Owner's Manual 2: For Older Adolescents and Adults: What You, Your Parents and Friends, and Your Employer, Need to Know; by Ellen Korin; Autism Asperger Publishing Company, 2007
  • Coping With Asperger Syndrome; Maxine Rosaler; The Rosen Pub. Group, 2004
  • Everything You Need to Know When a Brother or Sister Is Autistic; Marsha S. Rosenberg; Rosen Pub. Group, 1999
  • My Strange and Terrible Malady; by Catherine Bristow; Autism Asperger Publishing Company, 2008
  • Your Life is Not a Label: A Guide to Living Fully with Autism and Asperger's Syndrome; by Jerry Newport; Future Horizons, 2001

Books for Adults
Adults
  • Activity Schedules for Children with Autism: Teaching Independent Behavior; by Lynn McClannahan; Woodbine House, 2003
  • Asperger Syndrome and Adolescence: Helping Preteens and Teens Get Ready for the Real World; by Teresa Bolick; Fair Winds Press, 2001
  • Asperger Syndrome and Young Children: Building Skills for the Real World; For People Who Know and Care for 3-to-7-Year-Olds; by Teresa Bolick; Fair Winds Press, 2004
  • Autism Spectrum Disorders: the Complete Guide to Understanding Autism, Asperger's Syndrome, Pervasive Developmental Disorder, and Other ASDs; by Chantal Sicile-Kira and Temple Grandin; Perigee Books, 2004
  • Finding Our Way: Practical Solutions for Creating a Supportive Home and Community for the Asperger Syndrome Family; by Kristi Sakai; Autism Asperger Publishing Company, 2005
  • Girls Under the Umbrella of Autism Spectrum Disorders: Practical Solutions for Addressing Everyday Challenges; by Lori Ernsperger; Autism Asperger Publishing Company, 2007
  • The Autistic Spectrum Parents' Daily Helper: A Workbook for You and Your Child; by Philip Abrams; Ulysses Press, 2004
  • Children With Autism: A Parent's Guide; by Michael D. Powers; Woodbine House, 2000
  • Challenging Behavior and Autism: Making Sense - Making Progress; by Philip Whitaker; Autism Asperger Publishing Company, 2002
  • Could It Be Autism? A Parent's Guide to the First Signs and Next Steps; by Nancy Wiseman; Broadway Books, 2006
  • Demystifying Autistic Spectrum Disorders: A Guide to Diagnosis for Parents and Professionals; by Carolyn Bruey; Woodbine House, 2004
  • Exceptional Parent Magazine, call 1-877-372-7368
  • Helping Children with Autism Learn: A Guide to Treatment Approaches for Parents and Professionals; by Bryna Siegel; Oxford University Press, 2003
  • Parenting Your Asperger Child: Individualized Solutions for Teaching Your Child Practical Skills; by Alan Sohn; Perigee Trade, 2005
  • Reaching Out, Joining In: Teaching Social Skills to Young Children with Autism; by Mary Jane Weiss; Woodbine House, 2001
  • Toilet Training for Individuals With Autism & Other Developmental Issues; by Maria Wheeler; 2nd edition, Future Horizons, 2007

Other Resources
Resources

Autism Society of America
7910 Woodmont Ave. Ste. 650
Bethesda, MD
800-328-8476
http://www.autism-society.org

National Autism Hotline/Autism Services Center
605 Ninth St., Prichland Bldg.
Huntington, WV 25710
304-525-8014

ADHD

What is ADHD?

Attention-deficit hyperactivity disorder (ADHD) is the name of a group of behaviors found in many children and adults. People who have ADHD have trouble paying attention in school, at home or at work. They may be much more active and/or impulsive than what is usual for their age. These behaviors contribute to significant problems in relationships, learning and behavior. For this reason, children who have ADHD are sometimes seen as being "difficult" or as having behavior problems.

ADHD is common, affecting 4% to 12% of school-age children. It's more common in boys than in girls. You may be more familiar with the term attention deficit disorder (ADD). This disorder was renamed in 1994 by the American Psychiatric Association (APA).

What are the symptoms of ADHD?

The child with ADHD who is inattentive will have 6 or more of the following symptoms:

  • Has difficulty following instructions
  • Has difficulty keeping attention on work or play activities at school and at home
  • Loses things needed for activities at school and at home
  • Appears not to listen
  • Doesn't pay close attention to details
  • Seems disorganized
  • Has trouble with tasks that require planning ahead
  • Forgets things
  • Is easily distracted

The child with ADHD who is hyperactive/impulsive will have at least 6 of the following symptoms:

  • Fidgety
  • Runs or climbs inappropriately
  • Can't play quietly
  • Blurts out answers
  • Interrupts people
  • Can't stay in seat
  • Talks too much
  • Is always on the go
  • Has trouble waiting his or her turn
What should I do if I think my child has ADHD?

Talk with your child's doctor. A diagnosis of ADHD can be made only by getting information about your child's behavior from several people who know your child. Your doctor will ask you questions and may want to get information from your child's teachers or anyone else who is familiar with your child's behavior. Your doctor may have forms or checklists that you and your child's teacher can fill out. This will help you and your doctor compare your child's behavior with other children's behavior. Your doctor will do vision and hearing tests if these tests haven't been done recently.

Your doctor may recommend trying medicine to see if it helps control your child's hyperactive behavior. A trial of medicine alone cannot be the basis for diagnosing ADHD. However, it can be an important part of evaluating your child if ADHD is suspected.

It might be hard for your doctor to tell if your child has ADHD. Many children who have ADHD aren't hyperactive in the doctor's office. For this reason, your doctor may want your child to see someone who specializes in helping children who have behavior problems, such as a psychologist.


What causes ADHD?

Children who have ADHD do not make enough chemicals in key areas in the brain that are responsible for organizing thought. Without enough of these chemicals, the organizing centers of the brain don't work well. This causes the symptoms in children who have ADHD. Research shows that ADHD is more common in children who have close relatives with the disorder. Recent research also links smoking and other substance abuse during pregnancy to ADHD.

Things that don't cause ADHD:
  • Bad parenting (though a disorganized home life and school environment can make symptoms worse)
  • Too much sugar
  • Too little sugar
  • Aspartame (brand name: NutraSweet)
  • Food additives or colorings
  • Food allergies or other allergies
  • Lack of vitamins
  • Fluorescent lights
  • Too much TV
  • Video games
What can I do to help my child?

A team effort, with parents, teachers and doctors working together, is the best way to help your child. Children who have ADHD tend to need more structure and clearer expectations. Some children benefit from counseling or from structured therapy. Families may benefit from talking with a specialist in managing ADHD-related behavior and learning problems. Medicine also helps many children. Talk with your doctor about what treatments he or she recommends.

What medicines are used to treat ADHD?
Some of the medicines for ADHD are methylphenidate (some brand names: Ritalin, Concerta), dextroamphetamine (brand name: Dexedrine), pemoline (brand name: Cylert), atomoxetine (Strattera), and a combination drug called Adderall. These medicines improve attention and concentration, and decrease impulsive and overactive behaviors. Other medicines can also be used to treat ADHD.


What can I do at home to help my child?

Children who have ADHD may be difficult to parent. They may have trouble understanding directions. Children who are in a constant state of activity can be challenging for adults. You may need to change your home life a bit to help your child. Here are some things you can do to help:
• Make a schedule. Set specific times for waking up, eating, playing, doing homework, doing chores, watching TV or playing video games, and going to bed. Post the schedule where your child will always see it. Explain any changes to the routine in advance.
• Make simple house rules. It's important to explain what will happen when the rules are obeyed and when they are broken. Write down the rules and the results of not following them.
• Make sure your directions are understood. Get your child's attention and look directly into his or her eyes. Then tell your child in a clear, calm voice specifically what you want. Keep directions simple and short. Ask your child to repeat the directions back to you.
• Reward good behavior. Congratulate your child when he or she completes each step of a task.
• Make sure your child is supervised all the time. Because they are impulsive, children who have ADHD may need more adult supervision than other children their age.
• Watch your child around his or her friends. It's sometimes hard for children who have ADHD to learn social skills. Reward good play behaviors.
• Set a homework routine. Pick a regular place for doing homework, away from distractions such as other people, TV and video games. Break homework time into small parts and have breaks.
• Focus on effort, not grades. Reward your child when he or she tries to finish school work, not just for good grades. You can give extra rewards for earning better grades.
• Talk with your child's teachers. Find out how your child is doing at school--in class, at playtime, at lunchtime. Ask for daily or weekly progress notes from the teacher.

Will my child outgrow ADHD?

We used to think children would "grow out" of ADHD. We now know that is not true for most children. Symptoms of ADHD often get better as children grow older and learn to adjust. Hyperactivity usually stops in the late teenage years. But about half of children who have ADHD continue to be easily distracted, have mood swings, hot tempers and are unable to complete tasks. Children who have loving, supportive parents who work together with school staff, mental health workers and their doctor have the best chance of becoming well-adjusted adults.


Attention Deficit Hyperactivity Disorder: Resource List


Books for Children
Ages 4 to 8
  • The ADD Book for Kids; Shelly Rotner; Millbrook Press, 2000
  • ADHD; Woodland Publishing, 1999
  • Otto Learns About His Medicine: a Story About Medication for Children with ADHD; by Sandra Ferrano; Magination Press, 1995
  • Taking A.D.D. To School: A "School" Story About Attention Deficit Disorder and/or Attention Deficit Hyperactivity Disorder; Weiner, Ellen; JayJo Books, 1999
  • Why Can't Jimmy Sit Still?: Helping Children Understand ADHD; by Sandra L. Tunis; illustrations by Maeve Kelly; New Horizon Press, 2004
Ages 8 to 12
  • A Child's Guide to Concentrating: For Kids With ADHD; by Bonita Blazer; Shire Richwood, 1998
  • A.D.D. not B.A.D.; by Audrey Penn; Child & Family Press, 2003
  • ADHD; by Philippa Pigache; Heinemann Library, 2004
  • Attention Deficit Disorder; by Carol Baldwin; Heinemann Library, 2003
  • Cory Stories: A Kid's Book About Living With ADHD; by Jeanne Kraus; illustrated by Whitney Martin; Magination Press, 2005
  • Eagle Eyes: A Child's Guide to Paying Attention; by Jeanne Gehret; Verbal Images Press, 1996
  • Help is on the Way: A Child's Book About ADD; Marc Nemiroff; Magination Press, 1998
  • Jumpin' Johnny Get Back to Work!; by Michael Gordon; GSI, 1991
  • Learning to Slow Down and Pay Attention:A Book for Kids About ADD; by Kathleen G. Nadeau, Ellen B. Dixon; (2nd ed); Magination Press, 1997
  • Sparky's Excellent Misadventures: My A.D.D. Journal; by Phyllis Carpenter; Marti Ford; Magination Press, 1999
  • Stuck on Fast Forward: Youth with Attention-Deficit/Hyperactivity Disorder; by Shirley Brinkerhoff; Mason Crest Publishers, 2004
  • Survival Guide for Kids with ADD or ADHD; by John Taylor; Free Spirit, 2006
  • The A.D.D. Book For Kids; by Shelly Rotner; Millbrook Press, 2000
  • The "Putting On The Brakes" Activity Book For Young People With ADHD; by Patricia O. Quinn, M.D.; Magination Press, 2001.
Young Adult
  • ADD-Friendly Ways to Organize Your Life; by Judith Kolberg, Routlege, 2002
  • Fidget to Focus: Outwit Your Boredom: Sensory Strategies for Living with ADD; by Roland Rotz: iUniverse, 2005
  • Girls' Guide to AD/HD: Don't lose this book!; by Beth Walker, Woodbine House, 2004

Books for Adults
Adults
  • 10 Days to a Less Distracted Child: the Breakthrough Program That Gets Your Kids to Listen, Learn, Focus and Behave; by Jeffery Bernstein, DaCapo Press, 2007
  • A Mind at a Time; by Mel Levine; Simon & Schuster, 2002
  • The AD/HD Parenting Handbook : Practical Advice For Parents From Parents; by Colleen Alexander-Roberts; Taylor Trade Publishing, 2006
  • ADHD: A Complete and Authoritative Guide; by Michael Reiff; American Academy of Pediatrics, 2004
  • ADHD - Living Without Brakes; Martin L. Kutscher; Jessica Kingsley, 2008
  • From Chaos to Calm: Effective Parenting of Challenging Children with ADHD and Other Behavioral Problems; by Janet Heininger; Perigee, 2001
  • Making the System Work for Your Child with ADHD: How to Cut Through Red Tape and Get What You Need from Doctors, Teachers, Schools, and Healthcare Plans; by Peter Jensen; Guilford, 2004
  • Managing Teens With ADD/ADHD: Practical Tools & Strategies For Dealing With Difficult Behaviors; by Grad L. Flick; Center for Applied Research in Education, 2000
  • Practical Ideas That Really Work for Students with ADHD; by Kathleen McConnell; PRO-ED, 2000
  • Teaching Teens with ADD and ADHD: A Quick Reference Guide for Teachers and Parents; by Chris Dendy; Woodbine House, 2000
  • The ADD & ADHD Answer Book; by Susan Ashley; Sourcebooks, 2005
  • Understanding Girls With ADHD; by Kathleen G. Nadeau, Ellen Littman, Patricia O. Quinn; Advantage Books, 1999
  • When Your Child has ADD/ADHD; by Rebecca Rutledge; Adams Media, 2008

Other Resources

Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD)
8181 Professional Place, Suite 201
Landover, MD 20785
(800) 233-4050
www.chadd.org

National ADDA (Attention Deficit Disorder Association)
9930 Johnnycake Ridge Rd., #3E
Mentor, OH 44060
800-487-2282
www.add.org

National Center for Learning Disabilities
381 Park Avenue South, Suite 1401
New York, NY 10016-8806
www.ncld.org

My child has a Learning Disability

What are learning disabilities?

A learning disability is a disorder that affects the way that the brain receives, processes, stores, and responds to information. There are many kinds of learning disabilities. Your child may have problems with listening, speaking, reading, writing, reasoning, or solving math problems.

What causes an LD?

The causes for most learning disabilities are not known. They tend to run in families. Learning disabilities may be caused by changes in brain chemicals or damage in certain parts of the brain.
Your child is more likely to have a learning disability if you had a problem during pregnancy, such as an infection, or used drugs or alcohol during pregnancy. LDs are also more common in children who:

  • were premature, had low birth weight or had some other trauma during birth
  • had certain conditions after birth (such as metabolic imbalances or infections)
  • have a chronic illnesses, such as asthma or diabetes
  • have a head injury
  • have poor nutrition.

A child who has a learning disability may have other conditions, such as hearing problems or emotional problems. However, LDs are not caused by these conditions. They are also not caused by cultural differences or poor parenting.

What are signs of a learning disability?

There are many types of learning disabilities and they have a wide range of characteristics. If a child has average or above-average intelligence and is doing very poorly in school, he or she may have a learning disability (LD). Your child may have mild or severe problems. Your child may also have more than one LD. All learning-disabled children tend to have problems in school even though they have normal or above-normal intelligence. A child with an LD may have problems in one or many of the following areas:

Attention: Your child may have trouble paying attention, be impulsive, or get tired easily when trying to concentrate.

Language: Your child has trouble following directions and needs to have things repeated. He or she may use the wrong words or mix up words. Telling a story may be hard because the events get mixed up.

Temporal-spatial orientation: Your child has trouble understanding time (such as the difference between tomorrow and next week). He or she may have trouble with directions and often get lost.

Visual processing: Your child may see letters or words backwards (for example, may confuse b's and d's or read "was" as "saw"). Your child may write very slowly or have poor handwriting.

Auditory processing: Your child may have trouble focusing on important sounds instead of background noise. He or she may seem inattentive and have trouble following spoken instructions.

Memory: Your child has trouble remembering basic information like an address and phone number. It may be hard to remember multiplication tables or days of the week. Short-term memory may be a problem. Your child may forget classroom instructions or lose track while telling a story or having a conversation.

Motor control: Your child may have trouble with fine motor control. Your child may have a hard time doing buttons and zippers, or have trouble holding a pencil. If your child seems clumsy or awkward, he or she may have problems with gross motor control.


How do I find out if my child has an LD?

First you need to have your child evaluated. Ask your school to evaluate your child. You can also take your child to a private evaluator, but the school's testing may still be needed for your child to qualify for extra help at school. A team of people will test your child to find out exactly what the problems are and how to help your child. The evaluation includes testing and input from teachers and especially parents.
The team of people that may evaluate your child include a psychologist, a child psychiatrist, special education teacher, speech/language therapist, occupational therapist, physical therapist, social worker, or other healthcare providers.
Sometimes you are given one specific diagnosis. Other times it may be a combination of several learning disabilities. Some of the common disorders are:

  • Reading disorder (dyslexia): Has trouble with reading.
  • Written expression disorder (dysgraphia): Has trouble with handwriting and organizing writing.
  • Mathematics disorder (dyscalculia): Has trouble with numbers and math skills.
  • Nonverbal learning disorder: Has problems with things such as understanding gestures and facial expressions.
  • Sensory integration disorder: Has trouble with fine or large motor skills and may be sensitive to touch, light, sounds, or smells.
  • Auditory processing disorder: Has trouble remembering what was said.
  • Visual perception disorder: Has trouble with copying words and may reverse letters.
  • Language disorder: Has trouble understanding spoken language and may also have trouble with reading or writing.
  • Attention deficit hyperactivity disorder (ADHD): Has trouble staying focused and paying attention. May also be hyperactive.
How does my child get extra help at school?

The results of the testing will determine whether your child can have special education services provided at school. Some services are only given if your child has a certain diagnosis. Ask your school which disorders they provide special services for. Once you understand the problem you can help the school develop an Individualized Educational Plan (IEP). Parents must help write and agree with the IEP. The IEP must outline:

  • your child's current performance
  • specific special education services and who will provide them
  • short-term objectives and yearly goals
  • ways to test and measure your child's progress toward these goals each year.

To get the best help for your child, you must work closely with the other team members. If you hear something surprising about your child or strongly disagree with the conclusions of the test, services, or therapies, voice your concerns at the IEP meeting. Signing the IEP means that you agree to the services, goals, and other matters listed in it.

If the school cannot offer special services, you can look for help from private tutors, learning centers, psychologists, and others to help with your child's specific problem. Even if your child is not on an IEP or in special education classes, your child's teacher can probably still make adjustments to assignments and help your child in the best way possible. Make sure you talk to your child's teacher.


What can I do to help?

Depending on the disability, there are many specific ways to help your child at home. But no matter what disability your child has it is very important to do the following:

  • Build your child's self esteem. Children who are not doing well in school may not feel good about themselves. If they feel they can't cope with the demands of the people around them, they may withdraw from their friends and social activities. It is important for these children to understand that they are smart and that they just have a different way of learning. That is why learning disabilities are also called learning differences. Many smart and creative people have had learning disabilities, such as Walt Disney, Albert Einstein, and Alexander Graham Bell. Your child needs you to accept his condition. Give unconditional love and support. You can build up your child's self-esteem by consistently reminding him of his strengths. Your child may need counseling to help change views and expectations about themselves.
  • Help your child to understand his problem. Talk about the problem. Help your child can focus on coping skills rather than feeling like he or she is the problem. Sometimes talking with other children who also have a LD can help. Children may feel better if they realize they are not alone.
  • Provide an educationally nurturing home environment. Provide an organized place and time for study. Also, a balanced diet, enough rest, play activities, and family outings will strengthen your child's body and mind.
  • Communicate with the school. Stay in close touch with your child's teachers, therapists, and other caregivers. Let your child's teacher know that you want to play an active role in your child's education. Ask how you can reinforce and expand on what is taught in class, both behaviorally and academically.
  • Seek professional counseling for yourself as well as your child. Most parents find advice on handling difficult behavior and feelings very helpful.
  • Join LD associations and support groups. These groups help keep you up to date with the latest information. It will also put you in touch with parents who have children with similar problems.
  • Be cautious of nontraditional treatments. Be sure to check with your healthcare provider before giving supplements, changing to a special diet, or using other kinds of alternative treatments.
  • Give your child medicine, if needed. Medicines are sometimes used, especially if your child has attention problems. Parents and teachers can give feedback to the healthcare provider about how it seems to be working.

My Child has Migraines

Do children get headaches?

Yes. About four out of five children sometimes have a headache. The most common cause is a viral infection such as a cold or the flu. Children and adolescents can also get tension-type headaches and migraine headaches. Brain tumors can cause headaches, but these tumors are very rare. In addition to a headache, brain tumors almost always cause problems with coordination, balance, speech, sight and walking.

What is a migraine headache?

A migraine is usually an intense pounding headache with nausea that occurs from time to time. The pounding or pulsing pain usually begins in the forehead, the side of the head or around the eyes. The headache gradually gets worse. Just about any movement or activity seems to make it hurt more. Nausea and vomiting are common. Bright lights or loud noises make the headache worse. The headache can last for two hours or even up to two or three days.

Some people see a pattern of lines or shadows in front of their eyes as the headache is beginning. This is called a "warning aura." Most people with migraine do not have this.


Do many children get migraine headaches?

As many as 5 percent of children in grade school have migraine headaches. During the high school years, about 20 percent of adolescents get migraine headaches. These headaches are more common in girls than in boys. Boys who get migraines have them more often when they are about 10 to 12 years old. It is not unusual for them to have two to three migraine headaches a week.

How do children describe their migraine headaches?
  • "It feels like my heart is pounding in my head."
  • "All I want to do is throw up."
  • "It is like being inside a big bass drum."
  • "I just want to go into a dark room and lie down."
What causes migraines?

Migraine headaches seem to be caused in part by changes in the level of a body chemical called serotonin. Serotonin plays many roles in the body, and it can have an effect on the blood vessels. When serotonin levels are high, blood vessels constrict (shrink). When serotonin levels fall, the blood vessels dilate (swell). This swelling can cause pain or other problems.
Certain things that can set off migraines include the following:

  • Strong or unusual odors, bright lights or loud noises
  • Changes in weather or altitude
  • Being tired, stressed or depressed
  • Changes in sleeping patterns or sleeping time
  • Certain foods (see the list below), especially those that contain tyramine, sodium nitrate or phenylalanine
  • Missing meals or fasting
  • Menstrual periods or hormones
  • Intense physical activity
Foods that may trigger migraines
  • Aged, canned, cured or processed meat, including bologna, game, ham, herring, hot dogs, pepperoni and sausage
  • Aged cheese
  • Aspartame
  • Avocados
  • Beans, including pole, broad, lima, Italian, navy, pinto and garbanzo
  • Brewer's yeast, including fresh yeast coffee cake, donuts and sourdough bread
  • Caffeine (in excess)
  • Canned soup or bouillon cubes
  • Chocolate, cocoa and carob
  • Cultured dairy products, such as buttermilk and sour cream
  • Figs
  • Lentils
  • Meat tenderizer
  • Monosodium glutamate (MSG)
  • Nuts and peanut butter
  • Onions, except small amounts for flavoring
  • Papaya
  • Passion fruit
  • Pea pods
  • Pickled, preserved or marinated foods, such as olives and pickles, and some snack foods
  • Raisins
  • Red plums
  • Sauerkraut
  • Seasoned salt
  • Snow peas
  • Soy sauce
How is migraine diagnosed?

Your doctor can diagnose migraines on the basis of the symptoms your child describes. This is called the medical history. After taking the medical history, your doctor will perform a physical exam. Your doctor may also want to do blood tests or imaging tests, such as an MRI or CAT scan of the brain, to be sure that there are no other causes for the headache. Your child may also be asked to keep a "headache diary" that will help your doctor identify any "triggers" for your child's migraines.

What can help a migraine?

When a migraine headache happens, your child should go to a cool, dark place and lie down with a wet cloth across his or her forehead. If the doctor has given your child a medicine for migraines, your child should take it as soon as he or she knows a headache is starting. Don't wait! If your child feels nausea, the doctor can also prescribe a medicine for that.

How can my child keep from having migraine headaches?

While there are no sure ways to keep from having migraine headaches, here are some things that may help:

  • Eat regularly and do not skip meals.
  • Keep a regular sleep schedule.
  • Exercise regularly.
  • Look for things that might trigger an attack, like certain foods, stress, too much exercise or physical activity, certain activities or stress. Sometimes, life stresses are a trigger. Many psychologists can teach stress management and/or biofeedback to help your child manage stress.
  • Look for foods that might trigger an attack, like cheese, processed meats, chocolate, caffeine, MSG (a preservative in many foods), nuts or pickles. About one third of people with migraine can identify food triggers. Your child only needs to avoid eating these foods if one of them triggers headaches.
If your child has frequent migraine headaches, your doctor may prescribe a daily preventive medicine to try to make the headaches less frequent and less severe.

My Child has Febrile Seizures

What is a febrile seizure?

Most of the time when children have a seizure, or a convulsion, it's caused by a fever. These are called "fever seizures" or "febrile seizures." They are very frightening, but they aren't as dangerous as they may appear.

How serious are febrile seizures?

Generally, febrile seizures aren't harmful to a child. Even though seeing your child have a febrile seizure is frightening, your child will be okay. A febrile seizure doesn't cause brain damage. Also, your child can't swallow his or her tongue during a seizure. Febrile seizures usually last just a few minutes and go away on their own. It's very unusual for a febrile seizure to last more than 10 minutes. Usually, a child who has had a febrile seizure does not need to be hospitalized and may not need x-rays or a brain wave test. Your child may only need to be seen by your family doctor so the cause of the fever can be found.

What should I do if my child has a seizure?
  • Put your child on his or her side so that he or she won't choke on saliva.
  • Don't put anything in his or her mouth.
  • Don't restrain your child's movements during the seizure. The most important (and hardest) thing for you to do is to remain as calm as possible. Most seizures stop on their own within a few minutes, so keep your eyes on a clock or watch.
  • Call 199 if the seizure lasts more than 10 minutes.
What should I do after the seizure has stopped?

Call your doctor. He or she may want to see your child to find a cause for the fever.

Will my child have more seizures?

The chance of your child having another seizure is 25% to 30%. Most children won't have another seizure. The risk of another febrile seizure is slightly higher if your child is younger than 18 months, if there's a family history of febrile seizures, or if the fever wasn't very high when the seizure occurred.

Can these seizures be prevented with medicine?

Maybe, but many doctors and parents believe the side effects from the medicine are worse than the child having another febrile seizure. Even if medicine is used, it may not prevent another seizure.

If my child has a febrile seizure, does this mean that he or she has epilepsy?

No. A single seizure is never epilepsy. Even repeated febrile seizures aren't considered epilepsy, because children outgrow the risk of having a seizure caused by fever. A child with epilepsy has two or more seizures that aren't caused by fever.

Febrile seizures don't cause epilepsy. But the chance of epilepsy developing in a child who has had a febrile seizure is slightly higher than if he or she didn't have a febrile seizure. The chance of epilepsy developing in a child who has had a febrile seizure is about 2% to 4%. There is a better than 95% chance that your child will not have epilepsy, and there is no evidence that treating your child with medicine will prevent epilepsy.

My Child has Breath holding spells

Definition

A breath holding spell is an involuntary pause in breathing, sometimes accompanied by loss of consciousness. It usually occurs in response to an upsetting or surprising situation.

Causes

Breath holding is seen in some normal children from as early as age 2 months, but can start as late as 2 years old. Severe spells can be seen in 4 - 5% of children. Most cases have stopped by the time a child reaches ages 6 - 8.
Breath holding spells appear to be a reflexive response to fear, a confrontational situation, a traumatic event (for example: pain), or to being startled. The sudden reaction can cause the nervous system to slow the heart rate or breathing temporarily, causing breath holding and color changes.

Breath holding spells can run in families, so if a child's parents had similar spells in childhood, the child may be more likely to have spells. They also can occur with genetic conditions, such as Riley-Day syndrome or Rett syndrome. Children with iron deficiency anemia may also have increased episodes of breath holding.



Symptoms
  • Bluish discoloration of the skin caused by lack of oxygen (cyanosis) or loss of skin color (pallor)
  • Crying and then stopping breathing (apnea)
  • Momentary unconsciousness or fainting
  • Short sizure-like movement (one to two jerks)

After being startled or becoming upset, the child may make a short gasp and then exhale and stop breathing. Then the child quickly becomes blue (cyanotic) and may have many jerky movements that look like a small seizure.

The event ends with a brief period of unconsciousness, at which time normal breathing restarts. The child's color improves with the first breath and the event ends. The child may repeat this behavior several times per day, or do it only on rare occasions.

Breath holding can be a frightening experience for parents, who may think it is a seizure or even cardiac arrest. After a doctor has diagnosed the child with breath holding spells, the parent can simply wait for the event's natural end.

Exams and Tests

The doctor will take a history and do a thorough physical exam to rule out a physical cause of the breath holding. Because of a known association with iron deficiency, a blood test may be done.

Sometimes patients will have a cardiac test (such as an EKG) to be sure the heart is not involved in the spells. Sometimes an EEG may be done, especially if it is difficult to tell the seizure-like movements of the breath holding spell from an actual seizure.


Treatment

No treatment is usually necessary. Children who have breath holding spells do not have epilepsy or brain damage.

Avoiding situations that provoke temper tantrums can help reduce the number of spells your child has. Placing a cold cloth on your child's forehead during the spell may shorten the episode.

If your child has an iron deficiency, you should start iron replacement treatment.

When a spell occurs, be sure that your child is in a safe place where he or she won't be hurt during a fall or a brief seizure. After the spell, try to be calm and avoid giving too much attention to the child, because this can reinforce the behaviors that lead to the breath holding spells.

Outlook (Prognosis)

Affected children outgrow breath holding spells by ages 4 - 8.

Possible Complications

The biggest risk is injury, especially head injury, due to a fall during a spell.

When to Contact a Medical Professional

Call your health care provider if your child exhibits breathe holding behaviors, especially if this is a new behavior for the child or if the child does this frequently.

If your child stops breathing or has convulsions for more than a minute, call 199 or your local emergency number for immediate medical help.

Prevention

No specific preventive measures are available. If you know your child is prone to breath holding spells, you might try to distract him or her before the behavior reaches the point that typically provokes a spell.

My Child has Epilepsy

Household Safety

The kitchen and bathroom are two of the most dangerous places in the home for children with epilepsy, according to a 2006 study in the Lancet. Parents should take precautions to prevent burning accidents in the kitchen. Children with epilepsy should never bathe alone. Although all children with epilepsy have an increased risk of accidents, children with severe epilepsy have the highest risk.

Introduction

Epilepsy is characterized by unprovoked, recurring seizures that disrupt the nervous system and can cause mental and physical dysfunction. In the U.S., about 2.5 million people are affected by epilepsy and seizures. About 10% of the population will experience at least one seizure during their lifetime.

Epilepsy affects all age groups. Males have a slightly higher risk than females. The incidence is highest in children with another, but lesser, peak occurring after age 60. According to one estimate, 14% of epilepsy patients are under 15 years old and about 25% are over age 64.

Criteria for Classifying Epilepsies and Seizures

Epilepsy is not a single disorder but rather a wide spectrum of problems. What all types of epilepsy share are recurrent, unprovoked seizures caused by an uncontrolled electrical discharge from nerve cells in the cerebral cortex. This part of the brain controls higher mental functions, general movement, and the functions of the internal organs in the abdominal cavity, perception, and behavioral reactions.
Seizures are a symptom of epilepsy. Epilepsy types are generally put into two categories, which are based on the specific biologic mechanisms involved in the seizure and the anatomical location of the seizure. The two types are:

  • Partial (also called focal or localized) seizures. These seizures are more common than generalized seizures and occur in one or more specific locations in the brain. In some cases, partial seizures can spread to wide regions of the brain. They are likely to develop from specific injuries, but in most cases the exact origins are unknown.
  • Generalized seizures. These seizures typically occur in both sides of the brain. Many forms of these seizures are genetically based. There is usually normal neurologic function.

Experts are finding, however, that these categories do not actually reflect what is now known about the brain's anatomy. For example, the words "partial" and "generalized" suggest that seizures either involve only part of the brain or are widespread. However, a number of events in the brain occur with either type, muddying these distinctions. Researchers are now in the process of making clearer definitions and terms that reflect what actually is happening in the brain.

Improved definitions of terms and new diagnostic technologies, including advanced imaging and genetic testing, have spawned new classification systems that better define specific epilepsies. The evolving methods may help researchers more accurately focus on specific epilepsies and allow doctors to make more appropriate therapeutic decisions. For example, some professional groups now suggest that epilepsies be classified in the following five ways:

  • Type of seizure (partial or generalized)
  • Description of the seizure onset and evolution
  • Specific syndromes that are associated with one or more seizure types (however, not all seizures will be part of a syndrome)
  • Specific causes of the seizures, if known
  • Degree of impairment
Partial Seizures (also called Focal Seizures)

Partial, or focal, seizure is the more common type of epilepsy, and is generally defined as a disorder of neurons that starts on one side of the brain. The seizures are currently subcategorized as "simple" or "complex partial."

  • Simple Partial Seizures. A person with a simple partial seizure (sometimes known as Jacksonian epilepsy) does not lose consciousness, but may experience confusion, jerking movements, tingling, or odd mental and emotional events. Such events may include deja vu, mild hallucinations, or extreme responses to smell and taste. After the seizure, the patient usually has temporary weakness in certain muscles.
  • Complex Partial Seizures. Slightly over half of seizures in adults are complex partial type. About 80% of these seizures originate in the temporal lobe, the part of the brain located close to the ear. Disturbances there can result in loss of judgment, involuntary or uncontrolled behavior, or even loss of consciousness. About 20% of these patients have seizures that start in the brain's frontal lobes. Prior to the actual seizure, people sometimes experience a warning sign, known as an aura, which can be a visual or auditory hallucination, an odd odor or a feeling of warmth. They may lose consciousness briefly and appear to others as motionless with a vacant stare. Emotions can be exaggerated; some sufferers even appear to be drunk. After a few seconds, a patient may begin to perform repetitive movements, such as chewing or smacking of lips. Episodes usually last no more than 2 minutes. They may occur infrequently, or as often as every day. A throbbing headache may follow a complex partial seizure.

In some cases, simple or complex partial seizures evolve into what are known as secondarily generalized seizures. The progress may be so rapid that the partial stage is not even noticed.
While the term "partial" implies the seizures affect only small or specific brain locations, in reality, they almost always involve diffuse and even widespread areas. In the future, the term "focal seizures" will most likely replace the term "partial seizures," and its subcategories. Until new classifications are more widely in use, this report will continue to use the term "partial seizures" and its subcategories.

Generalized Seizures

Generalized seizures are caused by nerve cell disturbances that occur in more diffuse areas of the brain than do partial seizures. Therefore, they have a more serious effect on the patient. They are further subcategorized as tonic-clonic (or grand mal) or absence (petit mal) seizures.

  • Tonic-Clonic (Grand Mal) Seizures. The first stage of a grand mal seizure is called the tonic phase, in which the muscles suddenly contract, causing the patient to fall and lie stiffly for about 10 - 30 seconds. Some people experience a premonition or aura before a grand mal seizure. Most, however, lose consciousness without warning. If the throat or larynx is affected, there may be a high-pitched musical sound (stridor) when the patient inhales. Spasms occur for about 30 seconds to 1 minute. Then the seizure enters the second phase, called the clonic phase. The muscles begin to alternate between relaxation and rigidity. After this phase, the patient may lose bowel or urinary control. The seizure usually lasts a total of 2 - 3 minutes, after which the patient remains unconscious for a while and then awakens to confusion and extreme fatigue. A severe throbbing headache similar to migraine may also follow the tonic-clonic phases.
  • Absence (Petit Mal) Seizures. Absence or petit mal seizures are brief losses of consciousness that occur for 3 - 30 seconds. Physical movement and loss of attention may stop for only a moment. Such seizures may pass unnoticed by others. Small children may simply appear to be staring or walking distractedly. Petit mal may be confused with simple or complex partial seizures, or even with attention deficit disorder. In petit mal, however, a person may experience attacks as often as 50 - 100 times a day. About 25% of patients with petit mal develop grand mal seizures. An electroencephalogram (EEG) test that shows a specific brain wave pattern can usually identify these patients.
Other Seizures

Atonic (Akinetic) Seizures. A person who has an atonic (or akinetic) seizure loses muscle tone. Sometimes it may affect only one part of the body so that, for instance, the jaw slackens and the head drops. At other times, the whole body may lose muscle tone, and the person can suddenly fall. A brief atonic episode is known as a drop attack.

Simply Tonic or Clonic Seizures. Seizures can also be simply tonic or clonic. In tonic seizures, the muscles contract and consciousness is altered for about 10 seconds, but the seizures do not progress to the clonic or jerking phase. Clonic seizures, which are very rare, occur primarily in young children, who experience spasms of the muscles but not tonic rigidity.

Myoclonic. Myoclonic seizures are a series of brief jerky contractions of specific muscle groups, such as the face or trunk.


Epilepsy Syndromes

Epilepsy is also grouped according to a set of common characteristics, including:

  • Patient age
  • Type of seizure or seizures
  • Whether a cause is known or not (idiopathic)

A few syndromes and inherited epilepsies are listed as follows. They do not represent all epilepsies.

West Syndrome (Infantile Spasms)
West syndrome, also called infantile spasms, is a disorder that involves spasms and developmental delay in children within the first year, usually in infants ages 4 - 8 months.

Benign Familial Neonatal Convulsions
Benign familial neonatal convulsions (BFNC) are a rare, inherited form of generalized seizures that occur in infancy.

Juvenile Myoclonic Epilepsy (Impulsive Petit Mal)
Juvenile myoclonic epilepsy, also called impulsive petit mal epilepsy, is characterized by generalized seizures, usually tonic-clonic marked by jerky movements (called myoclonic jerks), and sometimes absence seizures. This accounts for 7% of epilepsies, and usually occurs in individuals ages 8 - 20.

Adult Myoclonic Epilepsy

Some research suggests that adult myoclonic epilepsy may be a previously un-described and distinct syndrome. It involves the development of generalized epilepsy of unknown causes in middle-aged adults.

Lennox-Gastaut Syndrome

Lennox-Gastaut syndrome is a severe form of epilepsy in young children that causes multiple seizures and some developmental retardation. It usually involves absence, tonic, and partial seizures.

Myoclonic-Astatic Epilepsy

Myoclonic-astatic epilepsy (MAE) is a combination of myoclonic seizures and astasia (a decrease or loss of muscular coordination), often resulting in the inability to sit or stand without aid.

Progressive Myoclonic Epilepsy

Progressive myoclonic epilepsy is an inherited disorder occurring in children ages 6 - 15. It usually involves tonic-clonic seizures and marked sensitivity to light flashes. Although the disease was previously considered to be progressive throughout life, current therapies have significantly improved its outlook.

Autosomal Dominant Nocturnal Frontal Lobe Epilepsy

Autosomal dominant nocturnal frontal lobe epilepsy is a rare, inherited syndrome that usually occurs during childhood, typically around age 11. However, onset varies widely within families. Seizures can be dystonic (twisting contractions) or tonic (muscle contractions), or involve thrashing. They are brief, frequent, and occur in clusters during the night. The seizures often subside with age.

Landau-Kleffner Syndrome
Landau-Kleffner syndrome is an epileptic condition that results in the inability to communicate either with speech or by writing (aphasia).

Causes

The cause of a seizure is determined in about 28% of partial epilepsy patients. In the rest, however, epilepsy is deemed idiopathic, which means that the cause is unknown. The age of seizure onset can sometimes offer a clue. Idiopathic epilepsy is rare in children and young adults.

General Biologic Mechanisms Involved with Seizures

Epileptic seizures are triggered by abnormalities in the brain that cause a group of nerve cells in the cerebral cortex to become activated simultaneously, emitting sudden and excessive bursts of electrical energy. A seizure's effect depends on the location in the brain where this electrical hyperactivity occurs. Effects range from brief moments of confusion to minor spasms to loss of consciousness.

Ion Channels. Sodium, potassium, and calcium act as ions in the brain. They produce electric charges that must fire regularly in order for a steady current to pass from one nerve cell in the brain to another. If the ion channels that carry them are genetically damaged, a chemical imbalance occurs. This can cause nerve signals to misfire, leading to seizures. Abnormalities in the ion channels are believed to be responsible for absence and many other generalized seizures.
Abnormalities may occur in neurotransmitters, the chemicals that act as messengers between nerve cells. Three neurotransmitters are of particular interest:

  • Gamma aminobutyric acid (GABA), which helps prevent nerve cells from over-firing. GABA deficiencies are of particular interest to researchers in epilepsy. Researchers have recently discovered epilepsy-related genetic factors that regulate the GABA signaling system. The discovery is emphasizing the GABA's importance in the disease process.
  • Serotonin's role in epilepsy is also being studied. Serotonin is a brain chemical that is important for well-being and associated behaviors (eating, relaxation, sleep). Imbalances in serotonin are also associated with depression. A 2005 study indicated that depression may be risk factor for epilepsy and that the two conditions may share common chemical pathways in the brain.
  • Acetylcholine is a neurotransmitter that is important for learning and memory.

Hippocampal Sclerosis. Hardened tissue (sclerosis) in the brain's hippocampus is the most commonly identified abnormality in patients with partial epilepsy. Such abnormal brain tissue leads to structural reorganization, and both the loss and regeneration of nerve cells.

Genetic Factors

Dozens of genetic syndromes representing a variety of seizure patterns may account for the different forms epilepsy. The following epilepsy syndromes are known to be caused by single genetic defects:

  • Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). ADNFLE appears to be caused by an alteration in the brain receptor neuronal nicotinic acetylcholine.
  • Benign familial neonatal convulsions (BFNC). BFNC appears to be caused by genetic defects that affect ion channels in nerve cells that carry potassium.
  • Contactin-associated protein-like 2 (CASPR2). CASPR2 is associated with a childhood epilepsy and autism disorder found in closely related relatives in Amish communities.

A genetic cause has been identified for at least some cases of juvenile myoclonic epilepsy, which represents 10% of all epilepsy cases. (Such research and other studies have pointed to the GABA signaling system as an important player in many cases of epilepsy.)

Causes of Childhood Seizures

Febrile Seizures. Febrile seizures are caused by high fever. They usually occur in children ages 3 months - 5 years. Between 10 - 15% of children with epilepsy have a history of febrile seizures before they develop epilepsy. However, febrile seizures are quite common and occur in about 3% of all children under 5 years old. Nearly all are brief and have no long-lasting effect.

Vaccinations. In young children, high fever from a vaccination can, in rare instances, trigger seizures. These seizures are almost always temporary and have no serious consequences. Some controversy arose a few years ago over the possibility that the DTP (diphtheria-tetanus-pertussis) vaccine might trigger epilepsy or other neurologic diseases. Some experts suggest that children who have neurologic events following their DTP shot already have a preexisting impairment such as epilepsy, which is revealed, but not caused by, the vaccine. Children with existing epilepsy may be at risk for seizures 2 or 3 days after the vaccination. Infants with suspected neurologic problems may have their vaccinations delayed until their neurologic situation is clarified, but not beyond their first birthday.

Head Injuries in Infants and Children. Infants are at high risk for head trauma. In fact, one study suggested that any infant who had a scalp fracture with a hematoma may be at risk for brain injury. A hematoma is a swelling caused by a broken blood vessel, which creates a large purplish hue like a bruise. Hematoma is quite common after childbirth, but typically causes no problems.

Childhood Viral Infections. A small 2001 study of children with status epilepticus (sustained periods of convulsions) indicated the presence of several pediatric viruses. Human herpesvirus 6 was particularly associated with severe seizures. Herpesvirus 6 is common in children and causes roseola infantum, an acute, but usually benign, illness that can lead to high fever and skin rash.

Hydrocephalus and Shunts. Hydrocephalus occurs when cerebrospinal fluid (CSF) accumulates in the brain, leading to excessive swelling of the brain ventricles. The resulting pressure can damage the brain's tissue. Hydrocephalus itself is not commonly known to cause seizures, but its treatment, which involves insertion of a shunt, may. The shunt is a device that drains the excess fluid from the brain. A 2001 study noted that up to half of children who receive shunts may experience epileptic seizures, particularly if the shunt is placed before 2 years of age. More research on its relationship to epileptic seizures is needed.

Focal Cortical Dysplasia. This is an abnormality in fetal development in which the normal migration of nerve cells is altered. It can cause very severe epilepsy that is difficult to treat.

Other Causes of Seizures in Children. Seizures in infants and children may be due to birth defects, difficulties during delivery, or poisoning.

Causes of Seizures That Can Occur at Any Age

Infections of the Brain and Central Nervous System (CNS). Acute infections of the brain and the CNS can cause seizures. Some cases are complicated by brain damage that can lead to recurrent seizures afterward. The most common central nervous system infections are encephalitis and meningitis. Researchers have also found an association between epileptic seizures and CNS-occurring herpes simplex virus infections. More research is needed before any causative role can be proved.

The organs of the central nervous system (brain and spinal cord) are covered by three connective tissue layers called the meninges. They consist of the pia mater (closest to the CNS structures), the arachnoid, and the dura mater (farthest from the CNS). The meninges help support blood vessels and contain cerebrospinal fluid. The structures are involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.

Hypoglycemia. Seizures can be caused by low blood sugar (hypoglycemia), a complication of diabetes in both children and adults.
Brain Tumors. Both cancerous and noncancerous brain tumors can cause seizures in all patients.
Cavernous Angiomas. Cavernous angiomas are blood vessels that grow abnormally and, like a tumor, can put pressure on nerve tissue.

Pseudoepilepsy. Between 20 - 45% of cases of untreatable seizures have a psychologic rather than physical origin. In this form of epilepsy, known as pseudoepilepsy or psychogenic epilepsy, the patient has no conscious intent of forcing a seizure and does not show unusual emotional behavior or signs of hysteria. It is very difficult to treat and can be very disabling. Pseudoepilepsy can usually be distinguished from true epilepsy using an electroencephalogram (EEG), which measures brain waves. The cause of pseudoepilepsy is unknown.


Outlook and Effects
General Outlook for Patients with Epilepsy

Most patients can control their seizures with a single drug and stop drug treatment completely after 2 seizureless years. In fact, the sooner patients achieve remission using an anti-epileptic drug (AED), the better their chances for remaining seizure-free in the future. If epilepsy is not effectively treated, and if the patient has continuing seizures, changes in the neurons may eventually cause intractable, or refractive, epilepsy. This type of epilepsy is hard to control. Early treatment is extremely important.

Effects of Epileptic Seizures on the Brain. Some studies have reported changes in brain structures in epileptic patients, but it is unclear if such changes are a cause or result of seizures. A reassuring 2003 study found no indication that seizures cause any progressive abnormalities in the brain. However, a 2005 study suggested that people with a history of epilepsy have a higher risk of later developing schizophrenia or schizophrenia-like psychosis.

Acute Repetitive Seizures. Some patients occasionally experience seizures called acute repetitive, serial, or cluster seizures. These are two or more seizures occurring over minutes to hours separated by periods of consciousness. Left untreated, they can develop into status epilepticus, a very serious condition.

Status Epilepticus. Status epilepticus (SE) is a serious, potentially life-threatening, condition that can lead to chronic epilepsy. It occurs in 100,000 - 150,000 people in the U.S. each year, over half of whom are children. Permanent brain damage or death can result if the seizure is not treated effectively. The longer the seizure lasts, the greater the danger. Mortality rates from this condition are about 10%. (This high mortality rate is most likely due to a high incidence of myoclonic SE in elderly adults after cardiac arrest. One study reported much lower mortality rates from SE when cardiac arrest in elderly epilepsy patients is excluded.).

The condition is defined as recurrent convulsions that last for more than 20 minutes and are interrupted by only brief periods of partial relief. Some experts believe these criteria are too strict, and that the condition should be diagnosed if seizures last at least 5 minutes or more, or when the patient does not fully recover consciousness between two or more seizures. Although any type of seizure can be sustained or recurrent, the most serious form of status epilepticus is the generalized convulsive or tonic-clonic type. In more than a third of cases, status epilepticus occurs with the first seizure. The trigger is often unknown, but can include the following:

  • Failure to take anti-epileptic medications (accounts for about a third of status epilepticus events)
  • Abrupt withdrawal of certain anti-epileptic drugs, particularly barbiturates and benzodiazepines
  • High fever
  • Poisoning
  • Electrolyte imbalances (imbalance in calcium, sodium, and potassium)
  • Cardiac arrest
  • Stroke. In one study, about 9% of stroke patients with seizures had status epilepticus, which resulted in higher disability after the stroke, particularly if these severe seizures occurred within a week of the stroke.
  • Low blood sugar in people with diabetes
Survival Rates

Epileptic patients who are cured have a normal lifespan. Their long-term survival rates are lower than average, however, if medications or surgery fail to stop the seizures. The lower survival rate is partly due to a higher-than-average risk for death due to accidents and suicide. The specific cause of the seizure may also contribute to fatalities.
There is a very low risk for sudden death in patients with epilepsy. Although the causes of such events are not fully known, experts suspect heart arrhythmias in many cases. There is some evidence, in fact, that a malfunction in the autonomic nervous system (which controls heart rate) may be responsible for some of these deaths. Some researchers believe that temporal lobe surgery in appropriate patients may reduce the risk. Drugs that block arrhythmias may also be helpful in reducing this risk.

Effects of Epilepsy in Children

Chance for Recurrence After a First Seizure. According to a 2000 study, about 64% children with one seizure unrelated to fevers have another one, and nearly two-thirds who have a history of more than one seizure are likely to have more seizures. Researchers are trying to find ways of predicting which children have the best chances to become seizure free, and which ones will not. Studies suggest that the frequency of early seizures, not their total number or type, determines whether a child will develop intractable epilepsy.

Long-Term General Effects. In general, the long-term effects of seizures vary widely depending on the seizure's cause. Children with febrile seizures rarely have any long-term effects. In very rare cases, children experience severe fever-related seizures known as complex febrile convulsions. In such cases, there is a risk for brain injury that may lead to temporal lobe epilepsy, but this is very small. Such seizures last over 15 minutes, occur more than once within 24 hours, and may affect only one side of the body.

The long-term outlook for children with idiopathic epilepsy (epilepsy of unknown causes) is very favorable. One study reported that 68 - 92% of these patients were seizure-free after 20 years. Another study reported that they had a survival rate no different from children without these seizures.

Children whose epilepsy is a result of a specific condition (for example, a head injury or neurologic disorder) have higher mortality rates than the normal population, but their lower survival rates are most often due to the underlying condition, not the epilepsy itself.

Side Effects of Medications and Withdrawal from Them. The drugs used for epilepsy can have distressing short- and long-term effects. Eventually, many children with epilepsy can go off medication. Children who tend to relapse after withdrawal from treatment usually have the following conditions or situations:

  • A family history of epilepsy
  • Require multiple medications to control seizures
  • Abnormal EEG readings after treatment has started
  • Partial seizures

Effect on Memory and Learning. The studies on the effects of seizures on memory and learning vary widely and depend on many factors.

  • A 2001 study reported greater mental flexibility and memory capacity in some children with a history of febrile seizures compared to peers who did not have these seizures. Children with a history of febrile seizures before age 1, however, were at higher risk for some learning deficits.
  • A number of studies have demonstrated no diminished intelligence in patients with epilepsy that occurs in the left temporal lobe (the left side of the brain where most complex partial types occur). A 2000 study suggested, however, that it may affect long-term memory. Patients with seizures originating on the left side of the brain may also have less well-developed language skills than those with right-side epilepsy.
  • A 2001 study suggested that children with generalized epilepsy who have petit mal (absence) seizures tend to retain their language skills and verbal memory, but some may have poorer testing scores, problems with nonverbal memory, and a slower recall of events.

In general, the earlier a child has seizures and the more extensive the area of the brain affected, the poorer the outcome. Children with seizures that are not well-controlled are at higher risk for intellectual decline.

Social and Behavioral Consequences. Studies have noted that children with epilepsy perform worse on behavioral tests than do other children. In a 2000 study, girls with severe epilepsy had the highest rate of behavioral problems (and they worsened over time) compared to boys and girls with mild or moderate epilepsy and all children with asthma, another chronic illness. In another study, although there were no differences in intelligence, adults with previous epilepsy (even if they no longer had seizures) were less likely to attain higher-education degrees. They were slightly more likely to be unemployed, unmarried, and childless compared to the general population.

Epilepsy and Pregnancy

Studies have been conflicting on the effects of fertility from epilepsy, but most suggest that fertility rates among women with epilepsy are lower than among women in the general population. A number of factors, including anti-epileptic drugs (AEDs) or social factors, such as marriage at an older age, may contribute to this lower rate. Certain AEDs, particularly valproate, disrupt ovulation and menstruation by increasing male hormone levels and weight and causing polycystic ovaries.

Effects of Epilepsy on the Pregnant Patient and the Fetus
In women who become pregnant, there is a risk for uncontrolled seizures and birth defects from antiseizure medications. In studies of women who were carefully monitored, however, 95% of pregnancies (which is close to normal) had favorable outcomes.

Effects of Seizures. Isolated seizures do not appear to pose any adverse effects to the mother or the unborn child, but repeated seizures and status epilepticus can lead to great dangers. In one study, the effect of epilepsy on complications during pregnancy was the same as in non-epileptic women except for a higher rate of premature deliveries (8.2% in the women with epilepsy).

Effects of Medications on the Fetus. All standard antiseizure drugs pose a significant risk for birth defects, which include malformations of the face and hands or more serious effects on the heart or mental development. The more medications required the higher the risk. (Epilepsy itself, however, does not appear to pose any higher risk for birth defects in the child.) Pregnant women who need to continue medication should be on the lowest possible dose of a single type of drug, if feasible.

Effect of Pregnancy on Seizure Frequency
The frequency and intensity of seizures vary widely in women with epilepsy. About 25% of pregnant women with epilepsy face an increase in events, and the risk is highest in those who have more than one seizure per month prior to becoming pregnant. In most cases, however, there is no change at all. Some pregnant women even have a decrease in seizures. The risk is lower in women who experience less than one seizure in the 9 months prior to becoming pregnant. The following conditions may contribute to an increase in seizures during pregnancy:

  • Nausea and vomiting (vitamin B6 and antihistamines may help with nausea)
  • Fluid retention
  • Higher estrogen levels
  • Psychological and emotional stress
  • Medication noncompliance from fear of side effects
  • Problems with sleeping
  • Changes in absorption of anticonvulsants

Steps for Women Who Want to Become Pregnant

  • A woman who wishes to become pregnant and has been seizure-free for 2 or more years may attempt to discontinue drugs under her doctor’s supervision.
  • If she has not been seizure-free, she should continue medications but try to reduce them to a single drug, if possible. (Again under a doctor’s supervision.)

Steps During Unplanned Pregnancy

  • If a woman taking antiseizure medications has an unplanned pregnancy, there may be no point in switching medications right away, since the effects of the drugs last for 10 weeks. However, she should notify her doctor immediately.
  • She should be carefully monitored for both drug levels and any abnormalities in the fetus. Ideally, drug levels should be measured every one or two months or more often if seizures are not controlled. Dosage levels should be adjusted accordingly.
  • She should also be carefully monitored with ultrasonic evaluation and amniocentesis (visual tests and examination of the fluid in the womb for birth defects and other fetal problems).

Drugs Used During Pregnancy
Some types of anti-epileptic drugs (AEDs) can increase the risks for birth defects, especially when taken during the first trimester of pregnancy. Expert guidelines advise that pregnant women use the most effective medication for their type of epilepsy at the lowest dose possible to control seizures. They should also have their doctors take blood tests during pregnancy to monitor their drug levels.
A 2006 study compared the chances of fetal death or serious birth defects for four commonly prescribed AEDs. The risk was significantly higher for valproate than the other drugs. (Birth defects included skull and limb deformities, and brain, heart, and lung problems.) In this study of 333 mother-child pairs, the following percentages of pregnancies resulted in birth defects depending on drug used:

  • Valproate (20.3%)
  • Phenytoin (10.7%)
  • Carbamazepine (8.2%)
  • Lamotrigine (1.0%)

This study was small, and included only a few types of AEDs. In general, research indicates that 90% of women who take AEDs will give birth to healthy children. Still, doctors recommend that women of child-bearing age use a drug other than valproate if possible.
The risk for malformation is higher when more medications are used. For example, there is a 3% risk of birth defects with women who use one anticonvulsant. The risk increases to 20% when four drugs are used.
Birth Defects Associated with Medication. The most common birth defects related to anti-epileptic drugs are:

  • Cleft lip or palate (risks from lamotrigine, phenobarbital, phenytoin, valproate especially when taken during first trimester)
  • Genital or urinary abnormalities (risk from most standard drugs)
  • Neural tube defects (NTD) in the skull or spinal column (risk of 2% with valproate and 1% with carbamazepine). These complications are most often due to lower folic acid levels caused by both pregnancy itself and antiseizure drugs. Supplements can help prevent this problem. Folic acid is recommended for all pregnant women, in any case, and women with epilepsy should talk with their doctor about taking a supplement of folic acid (5 mg) at least 3 months before conception as well as during the first trimester.
  • Mental impairment (known risk with phenytoin and valproate; inconclusive in carbamazepine and phenobarbital)
  • Heart defects (risk from phenobarbital, phenytoin, valproate)
  • Many antiseizure drugs also cause a deficiency in vitamin K clotting factors that increases the risk for hemorrhage in the newborn. Treatment with vitamin K during the last month of pregnancy and a single dose given to the newborn is recommended.

Labor and Delivery
Seizures occur during labor and after delivery in a small percentage of women with epilepsy. The following labor complications are more common among pregnant women with epilepsy: Vaginal bleeding, anemia, and preeclampsia (extremely high blood pressure in the third trimester). If seizures occur during labor, they are generally treated intravenously with benzodiazepines or phenytoin. If tonic-clonic seizures, absence seizures, or status epilepticus occur, a cesarean section may be appropriate.

Postnatal Care
Monitoring the Infant. The infant should be thoroughly examined for any birth defects. Also, if the mother was given phenobarbital or primidone while pregnant, the infant should be monitored for up to 8 months to see if withdrawal symptoms develop. Drug dosages will also need to be adjusted for the mother after delivery.

Breastfeeding. Women on most AEDs can usually nurse their babies, since usually only a small amount of the drug enters the breast milk. The lowest levels are with phenytoin and valproate. (Ethosuximide and possibly levetiracetam are exceptions and should be avoided when a woman is breastfeeding. Women taking phenobarbital are also usually advised not to nurse.) A mother should watch for signs of lethargy or extreme sleepiness in her infant, which could be caused by her medication.


Injuries and Accidents

Injuries from Falls. Because many people with seizures fall, injuries are common. Although such injuries are usually minor, people with epilepsy have a higher incidence of fractures than those without the disorder. Epilepsy patients who take the drug phenytoin have an even higher risk, since the drug can cause osteoporosis.
Household Accidents. According to a 2006 study, the kitchen and bathroom are two of the most dangerous places for children with epilepsy. Parents should take precautions to prevent burning accidents from stoves and other heat sources. Children with epilepsy should never be left alone when bathing.
Driving and the Risk for Accidents. Being unable to drive is an extremely distressing and severe component of epilepsy. Drivers with well-controlled epilepsy are not at a high or unacceptable risk for automobile accidents. Uncontrolled epilepsy, however, poses a high risk. Needless to say, seizures can be very dangerous if they occur while a person is driving. Studies have reported that more than a fourth of drivers with uncontrolled epilepsy had a seizure-related accident at some time. One study found that over half of these accidents resulted in injuries to the patient or others. In spite of these events, 30% of the patients had driven within the past year, and most drove at least once a week.
Four factors help predict who may safely drive:

  • A long duration between seizures. In one study, being seizure-free for 6 months reduced the risk for accidents by 85%, and being seizure-free for 1 year lowered the risk by 93%. State laws restricting driving in people with seizures vary from requiring seizure-free periods of 3 months (which is too short for protection) to 18 months.
  • Having few seizure-related accidents
  • Having a reliable pre-seizure warning sign, such as an aura
  • Having recently reduced or changed medications

Accidents while Swimming. Swimming poses another danger for people with epilepsy, particularly those with tonic seizures, which can cause the diaphragm to expel air quite suddenly. People with epilepsy who swim should avoid deep and cloudy water (a clear swimming pool is best), and always swim with a knowledgeable, competent, and experienced companion or have a supervisor on site.

Diagnosis

An epilepsy diagnosis is often made during an emergency visit for a seizure. If a person seeks medical help for a previous or suspected seizure, the doctor will ask about the patient's medical history, including seizure events.

One interesting study suggested that a doctor might be able to identify the location in the brain where the seizure is originating by watching the patient wipe his or her nose. A runny nose is common after a temporal lobe seizure, but not after seizures in other locations. Furthermore, the hand with which the patient wipes the nose coincides with the side of the brain in which the seizure occurs.


Ruling Out Serious Causes & Similar Conditions

Health- or life-threatening causes of seizures should first be ruled out. (See Causes in this report.)

The doctor will also rule out conditions that cause similar symptoms, including:

  • Syncope. Syncope, a brief lapse of consciousness in which blood flow is reduced to the brain, can mimic epilepsy. It often misdiagnosed as epilepsy. Research continues to suggest that taking the patient's history and giving a physical exam, rather than administering an assortment of cardiac tests, is the most effective way to diagnose syncope.
  • Migraines. Migraine headaches, particularly migraine with auras, may sometimes be confused with epilepsy. With epileptic seizure, the preceding aura is often seen as multiple, brightly colored, circular spots, while migraine sufferers tend to see black, white, or colorless lined or zigzag flickering patterns. Typically the migraine pain expands gradually over minutes toward one side.
  • Panic Attacks. In some patients, partial seizures may resemble a panic disorder. Symptoms of panic disorder include palpitations, sweating, trembling, sensation of breathlessness, chest pain, feeling of choking, nausea, faintness, chills or flushes, fear of losing control, and fear of dying.
  • Narcolepsy. Narcolepsy, a sleep disorder that causes a sudden loss of muscle tone and excessive daytime sleepiness, can be confused with epilepsy.
Diagnostic Tools

Electroencephalogram (EEG). The most important diagnostic tool for epilepsy is an EEG, which measures brain waves. Ideally, it should be performed within 24 hours of a seizure. An EEG recording session may last for less than an hour, but in some cases the doctor will want a day-long recording. Long-term monitoring may be necessary in some cases when patients do not respond to medications. Portable EEG units are available in some places, which can be used to monitor patients throughout normal activities. EEGs are not foolproof; in one study half of people who had experienced an epileptic seizure showed a normal EEG reading. Repeated EEGs are often needed to confirm a diagnosis, particularly for certain partial seizures that often produce an initially normal EEG reading.

Computerized Tomography (CT) Scans. Usually, the first brain imaging test ordered for most adults and children with first-time seizures is a CT scan. This imaging technique is sensitive enough for most purposes. In children, even if the scan is normal, the doctor will follow up to be sure other problems are not present.

A CT or CAT scan (computed tomography) is a much more sensitive imaging technique than x-ray, allowing high definition not only of the bony structures, but of the soft tissues. Clear images of organs such as the brain, muscles, joint structures, veins and arteries, as well as anomalies like tumors and hemorrhages may be obtained with or without the injection of contrasting dye.

Magnetic Resonance Imaging (MRI). Experts strongly recommend MRIs for children with first seizures in certain cases, such as children under 1 year old and those with seizures that are associated with any unexplained significant mental or motor problems. These images may help to determine if the disorder can be treated with surgery, and may be used as a guide for surgeons.

Other Advanced Imaging Techniques. More advanced scanning techniques, particularly magnetic resonance spectroscopy (MRS), magnetoencephalography (MEG), positron emission tomography (PET), and single-photon emission computer tomography (SPECT), are emerging as important tools for epilepsy researchers. They are useful for detecting abnormalities, such as changes in brain activity, damaged or scarred locations in the brain where partial seizures are triggered, or tumors and other abnormalities that may be causing seizures. Some, such as MEG, may help determine which patients with severe epilepsy are good candidates for surgery.

Polysomnography

Some researchers recommend polysomnography for certain patients. This test is used to detect sleep disorders, such as obstructive sleep apnea, that can be associated with epilepsy.

Investigative Diagnostic Procedures

Low brain levels of the neurotransmitter gamma aminobutyric acid (GABA) are associated with an increased risk of seizure recurrence. Some researchers suggest that measuring GABA levels, along with EEG recordings, could help better assess the risk of recurring seizures, and may identify which patients might benefit from GABA-stimulating drugs.

Treatment
Immediate Seizure Treatment

You cannot stop a seizure, but you can help the patient prevent serious injury.
First, it is extremely important to remain calm and not panic. Then take the following actions:

  • Wipe away any excess saliva to prevent obstruction of the airway. Do not put anything in the patient's mouth. It is an old wives' tale that people having seizures will swallow their tongues.
  • Turn the victim gently on the side. Do not try to hold the patient down to prevent shaking.
  • Rest the patient's head on something flat and soft to protect it from banging on the floor and to support the neck.
  • Move sharp objects out of the way to prevent injury.

Do not leave the seizure victim alone. Anyone nearby should call 911. Patients should be taken to an emergency room if:

  • Any seizure lasts beyond 2 - 3 minutes
  • The patient has been injured
  • The patient is pregnant
  • The patient is diabetic
  • Parents, caregivers, or bystanders are at all uncertain

Children with seizures caused by fever rarely require any treatment other than taking precautions to prevent obstruction and reduce the fever. Research on adult patients has found that only 5.7% of adults with epilepsy who refused to go to the hospital following a seizure had a subsequent seizure during the study's 3-day follow-up period. Hospitalization may not be necessary in many patients whose seizure is not severe or repetitive, and who have no risk factors for complications. All patients or caregivers, however, should contact their doctor after a seizure occurs.

Drugs Used for Managing Acute Repetitive Seizures

The initial treatment for acute repetitive seizures (two or more seizures that occur over minutes to hours separated by periods of consciousness) are anti-anxiety drugs known as benzodiazepines. They include diazepam (Valium, Diastat) or lorazepam (Ativan). These drugs are available in the following forms:

  • Tablets taken orally or under the tongue (sublingual). Oral tablets are difficult to give a patient who is convulsing, however.
  • Rectal solutions, gels, or suppositories. Rectal administration is preferred. Solutions and gels work faster than suppositories. Diastat is rectal gel form of diazepam and, although more expensive than rectal solutions, it can be administered at home by a trained caregiver. The gel is safe and effective in reducing seizure frequency in both children and adults, and it may help prevent status epilepticus. Studies suggest that it significantly reduces the rate of hospitalization, and may even prove to be an alternative to drug therapy among children with prolonged or repetitive seizures.
Treatment of Status Epilepticus

The treatment goals of status epilepticus are:

  • Stop the seizures
  • Prevent recurrence
  • Determine and prevent any factors that might have triggered it
  • Manage any complications

Initial Management. The earlier a patient is treated, the better the results. In one study, seizures stopped in 80% of patients who were treated within 30 minutes. Only 40% of patients responded when they were treated after 2 hours. Initial management of status epilepticus consists of:

  • Administer any seizure medications
  • Support systems to maintain or attain normal breathing, blood pressure, electrolyte balances, body temperature, and heart functions
  • Oxygen for patients who may need it
  • Attention by medical personnel trained to determine any treatable cause of status epilepticus, such as drug withdrawal, low blood sugar, infection, substance abuse (particularly cocaine), or eclampsia (elevated blood pressure induced by pregnancy)

Medications for Status Epilepticus. One or more of the following medications may be used initially:

  • Benzodiazepine. An intravenously (IV) administered or injected benzodiazepine such as lorazepam (Ativan), diazepam (Valium), clonazepam, or midazolam (Versed) is usually used. Lorazepam or clonazepam is now preferred since they have a longer duration of action. Midazolam is the only benzodiazepine available as a muscular injection. Intravenous diazepam is currently the first choice for children with status epilepticus. Rectal administration of benzodiazepines, either diazepam or lorazepam, may also be beneficial. Some evidence suggests that rectal administration of lorazepam is safer and more effective than diazepam in children, but more research is needed.
  • Phenytoin or Fosphenytoin. Many doctors use phenytoin or fosphenytoin if seizures are not controlled by a benzodiazepine. These drugs must be prescribed with caution for patients who have liver and blood abnormalities or certain heart arrhythmias. Fosphenytoin works faster, and is safer than phenytoin.
  • Phenobarbital. Although effective, barbiturates, such as phenobarbital (Barbita, Luminal), can reduce consciousness, blood pressure, and respiratory rate. They are generally used only when other drugs have failed.

Other medications or higher doses of the above-mentioned drugs may be used for status epilepticus patients who fail to respond to initial treatments. They include:

  • Higher-dose barbiturates.
  • Higher-dose intravenous benzodiazepines. In one study midazolam, the injected benzodiazepine was as effective and possibly safer than propofol, an intravenous sedative also used for uncontrolled status epilepticus.
  • Propofol (Diprivan), an intravenously administered sedative. A 2003 an
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