Does mother often do this?’ Sue Usiskin’s young son was asked by an indignant customer, as Sue lay on the floor after a seizure in a butcher’s shop.Children are going to be exposed to other people’s ignorance or intolerance early on and so it is doubly important that the message you give them about epilepsy is a positive one.Having a parent with epilepsy can have a huge emotional and social impact on a child. How they respond and how well they cope with it will depend more than anything else on how they see their parents behave. Children are great imitators. If their parents’ response to a seizure is calm and matter-of-fact, and their attitude is that it is no big deal, then this is the attitude the child is most likely to adopt too.Parents who have epilepsy need to talk to their children about it, to give them some kind of explanation about what is happening when they have a seizure and to reassure them that it is not dangerous. But many parents do not do this. One survey showed that less than a quarter of parents with epilepsy told their children about it. Sometimes the first a child knows about a parent’s epilepsy is when they see that parent having a seizure, a situation which can be very frightening.Sometimes the problem is that the parents themselves have only a vague understanding of what epilepsy is, and so obviously they find it hard to explain what is wrong to their child. Or they may simply be too embarrassed to talk about it, feeling that their condition is something to be ashamed of and hidden from their children – an attitude which the children themselves will inevitably pick up and reflect.In some families parents even try to avoid the word epilepsy. They may describe the seizure as a blackout, or a funny turn. Yet these euphemisms may confuse the child even more. Worse still is if the parents decide to tell the child nothing.The more reluctant parents are to answer questions or give reassurance, the more the child is likely to assume that something is very badly wrong. Inevitably the child will try to piece together an answer for him or herself, and inevitably they will come up with one that is largely based on their own fears. What they imagine to be the truth is almost always infinitely worse than the reality.Your child’s worst fear may be that their parent will die. At the very least, seeing their mother or father taking pills every day, the child is quite likely to assume that they are ill. They may need reassurance that you take medicine not because you are ill, but so that you can stay well. And if your child has seen you having a generalized tonic clonic seizure it is a good thing to tell them quite clearly, even if they do not ask, that seizures are not painful.If a parent is taken into hospital a young child may worry that they have been abandoned, and that the parent will never return. Children who are told what is happening, and allowed if possible to see or at least speak to the parent while they have to be in hospital, are much less likely to be clingy and insecure when the parent does finally come home.Older children are often afraid that they too will develop seizures. They need to know that while they may have a higher than average risk, having a parent with seizures does not necessarily mean that they will develop seizures themselves.HELPING CHILDREN COPEWhen a parent has epilepsy there may be times when the natural order of things is reversed, and the parent becomes helpless and dependent while the child finds him or herself temporarily in the role of responsible carer in a situation over which he or she has no control. How can you best prepare your child to meet this situation?One way is to make sure that your child knows what they can do to help if you have a seizure when they are there. Sue Usiskin, who has epilepsy and is an epilepsy counsellor, recommends giving children a simple, practical task to carry out. When her own children were small and she had a seizure, her son would run to get a cloth to place under her face to protect it, while her daughter would sit stroking her face, comforting her. Even very young children can be given some small part to play, and this will make them feel less helpless and less afraid.Occasionally, in families where the parent finds it difficult to cope with their own seizures, or has severe, disabling epilepsy, the parent may not be able to give the children the emotional support they need. Sometimes this situation leads to a child trying to take on too much responsibility for the parent, so that there is a swopping of roles which may not be healthy for either of them. Children are still children and they need their childhood; they should not have to take on responsibility for a parent. They need to feel protected and to be looked after themselves. If the parent can not provide this support, it is important that another adult should do so.*61\193\2*
Disturbance of consciousness in syncope is due to failure of blood supply to the brain, due in part to a fall in cardiac output. Cardiac output may also be less than normal if the rhythm of the heart is abnormal. Both very slow and very fast heart rates diminish cardiac output.
The distinction of a disturbance of consciousness due to an abnormality of cardiac rhythm from a seizure is not easy. Occasionally, though, a bystander will note that someone is pulseless or has a very irregular pulse during the attack, and sometimes the sufferer himself notices palpitations before disturbance of consciousness. Cardiac rhythm is easily monitored by electrocardiography. The changes in voltage associated with contraction of the different chambers of the heart are of sufficient amplitude that they can easily be recorded on a cassette recorder for periods of 24 hours, and their occurrence in relation to symptoms analysed. A cardiac cause for disturbance of consciousness has been found in up to one quarter of cases first presenting to neurological clinics with blackouts.
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