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COPING WITH EPILEPSY: WHEN COUNSELING DIDN’T HELP”You’ve only told us about your successes. Tell us about your failures. Everybody with epilepsy doesn’t end up happy, having outgrown epilepsy and off in college, do they?”"No. One of the distressing facts you have to face as a counselor is that you can’t save the world. There are some pathetic people out there. Yes, there are some sad kids, and some miserable parents, as well. There are some who enjoy being unhappy. There are some who derive their pleasures from saying ‘poor me.’ There are those who just don’t have any motivation, and some who don’t have enough motivation to change at the time you see them. You have to try to keep communications open, so if their motivation develops later, they can come back and get help.”The successes I’ve been talking about are primarily among the 80 percent of children whose seizures can be brought under control and who don’t have other handicaps. In this group it is easier to give them hope. You can easily and honestly say to them, ‘Look, most people like you will have their seizures completely controlled. You will probably outgrow your epilepsy’ I can give them some positives to look forward to.*231\208\8*

EPILEPSY AS A PSYCHO-SOCIAL DISEASE: WHERE COUNSELING HELPS”Karen is one of the best examples of the importance of counseling. Karen had her first seizure when she was about ten. It was a tonic-clonic seizure, and then she had a few complex partial seizures later. Medication controlled these for about two years, but when she was about twelve she again began having seizures and first came to Hopkins. The doctor wanted to change Karen’s medicine but was also very concerned about the fact that things were going poorly for her in school and thought the cause might be a problem with the school’s acceptance of her seizures. The doctor asked me to see Karen and find out what was going on.”Karen was a very shy young lady, and during our first visit all she did was cry. I couldn’t get her to talk at all. So I asked her to keep a journal, to go home and write down her thoughts about everything she felt, so that when she came back we could talk about them. What we discovered was that the problems weren’t in school, they were at home. The major problem was a father who blamed Karen for all of the family strife, arguing, and financial problems.Eventually we asked her family to come in to talk. Her father never would participate. He was a very domineering type, her mother a rather meek lady. The counseling, which went on weekly for over a year, helped Karen gain control and do better in school. This may have had less to do with understanding epilepsy than with the fact that the family situation changed. Her mother, who ostensibly came to counseling to understand more about epilepsy, gained insight into her own problems. She ultimately decided to divorce Karen’s father. This led to an additional need for family counseling as they readjusted to a single-parent family.”It took a long time for Karen to realize that the problems were really not due to her but to the dynamics of her family. She finally realized that she was not responsible for having epilepsy. She learned that her medical bills were not the cause of the family’s financial problems. She eventually saw that her father was just using the epilepsy as an excuse and that she was suffering from his blame and her own feelings of guilt.”"So what you’re saying is that the epilepsy wasn’t Karen’s problem, is that right?”"Well, not exactly. Karen’s seizures were not a major problem, but she had no education about epilepsy. She was surrounded by all of these family arguments and strife, and she said to herself, ‘Hey, I’m the only one who is sick. I’m the only one who is different. Therefore, all of this must be my fault.’ This also led to her doing poorly in school, which made her think that she was dumb, which she attributed to her epilepsy. All of these things contributed to a terrible self-image. So we had to work on these issues. We also had to work with her brother and sister, who were jealous that she was getting a disproportionate share of attention. They needed to see that Karen was the victim not the cause of parental discord.*221\208\8*

A convulsion which occurs in association with any illness, usually an infection, which causes a rise in temperature (fever), is known as a febrile convulsion.

Febrile convulsions are not a type of epilepsy. In the past it was thought that febrile convulsions could lead to epilepsy but this is now generally believed only rarely to be the case. There are at least three subgroups of febrile convulsions:

(a) The first and largest subgroup is made up of children who have seizures in response to fever as a result of an individual susceptibility that is usually inherited. These children develop normally and have normal EEGs and normal brain scans. This is the group which constitutes ‘true’ febrile convulsions.

(b) The second subgroup comprises children in whom the fever or high temperature acts as a trigger that unmasks epilepsy. In these children, seizures or fits without a fever soon develop and the children then can be seen to have definite epilepsy. Magnetic resonance imaging in these children usually shows subtle structural abnormalities, often in one temporal lobe. Before their first febrile convulsion, these children may have been developing more slowly than most children.

(c) A very small subgroup comprising children who convulse with fever due to meningitis or encephalitis—meaning respectively an inflammation or infection of the membranes covering the brain, or of the brain substance itself. Obviously it is critically important to recognize this subgroup in order that energetic curative treatment can be started as soon as possible.

‘True’ febrile convulsions, as defined in (a) above are common: 2-4 per cent of children between the ages of 6 months and 5 years will have at least one febrile convulsion. The most common age is between 12 and 20 months. One should be careful about accepting a diagnosis of a ‘true’ febrile convulsion in a child aged less than 6 months or older than 5 years—they are more likely to have epilepsy triggered by fever. Girls are more likely than boys to have a febrile convulsion. Up to a third of children, who have had one, will have a second febrile convulsion before the age of 5 years.

Most of the convulsions are tonic-clonic (grand mal), and last less than 4-5 minutes. This type of febrile convulsion is called ‘simple’. ‘Complex’ or complicated febrile convulsions are ones that involve only one side of the body, last longer than 15 minutes, or are followed by weakness or loss of use of one side of the body. These ‘complex’ febrile convulsions are uncommon and account for no more than 10-20 per cent of all ‘true’ febrile convulsions. Complex febrile convulsions are more commonly seen in children in the other two groups—(b) and (c) described above.

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