Seizures

Cells within the brain communicate with one another by way of electrical signals. On occasion, a group of cells may send abnormal electrical charges. The firing of these signals is known as a seizure. The type of seizure will depend upon the origin of the abnormal signals. Children with tumors in the cerebral hemisphere may develop seizures.

Following is a list of common seizures encountered in brain tumor patients:

Generalized Seizures

A generalized seizure occurs when there is a loss of consciousness after frequent rhythmic muscular contractions. These may be called grand mal or tonic clonic seizures.

Simple Partial Seizures

Simple partial seizures occur when consciousness is preserved throughout the whole seizure. The symptoms reflect the region of the brain from which the seizure arises:

Motor

Jerking movements in one or several closely related body parts; may "march" from one area to another.
Sensory and psychic
Numbness or tingling in one part or moving from one part to nearby parts of the body.
Visual hallucinations; seeing things that aren't there or real, particularly geometric shapes.
Illusions; distortions of what one is seeing. eg. walls curving.
Hallucination (imagining) of a taste or smell; usually unpleasant.
Auditory; hearing sounds that aren't there.
Mood changes. eg. fear, anger, sadness, joy.
Altered memory. eg. memory playback.

Complex Partial Seizures

Complex partial seizures usually arise from the temporal lobe and consist of loss of conscious awareness without convulsion. The person may have a warning but loses consciousness. During the unconscious period, the person may stare, make simple movements of the mouth (chewing, lip smacking) or swallowing apparatus. More complicated automatisms (e.g. in which the person may pick something up and fumble with it or wander about) may occur.

Partial Seizures with Secondary Generalizations

Generalized tonic-clonic or grand mal seizures may start as a simple or complex partial seizure and may begin so abruptly that there is no warning. If the person is standing, he/she falls stiffly, often with a cry. This stiffness or tonic phase gives way to rhythmic jerking movements on both sides of the body (clonic phase) during which the tongue may be bitten. A person's breathing pattern may change during a seizure. There may be a loss of bowel and bladder control.

Safety

Important safety measures to remember for anyone experiencing a seizure include:

Stay calm and provide for privacy if possible. A seizure cannot be stopped once it has started, other than by careful administration of medication.
Lower the person gently to the floor and loosen any constrictive clothing around the neck to improve respirations.
The patient should not be forcibly restrained during or immediately after the seizure as this may provoke aggressive behavior or the force may injure the patient.
Remove any sharp objects that might injure the person.
Turn the patient on his/her side to allow for saliva to flow from the mouth and guide the patient's movements so he/she will not be injured; do not restrain the patient.
Do not attempt to force anything into the mouth.
Allow the patient to rest after the seizure and reorient him/her after awakening.
Never leave the patient during an attack.
If the patient undergoes a series of convulsions in succession (lasting more than 10 minutes), immediate medical assistance should be sought.
If the patient is having a grand mal seizure, protect him/her from repetitively banging the head by supporting the head in the hand. If there is something loose in the mouth that can be easily removed it is best to remove it.

After a Seizure

Your child may be very drowsy after a seizure. Depending on the area of the brain involved, there may be temporary confusion, speech difficulty or limb weakness. This period may last minutes to hours. You may hear this referred to as the postictal period.

Between Seizures

Some general advice for interictal (between seizure) time:

Children with seizures should not climb.
Swimming is allowed if the "buddy system" is used.
Showering is generally safer than bathing for the older child who bathes alone.
Bike riding is allowed only in quiet subdivisions, not in busy traffic. (Helmets are necessary.)

Seizure Medications

In order for seizure medications (anti-convulsant drugs) to be effective, they must be taken exactly as prescribed. The dose and time of administration is very important. In order for the drug to work for your child, it must reach a certain level in his/her bloodstream. This is known as a "therapeutic level". If there is too little of the drug, the child is at risk of having a seizure, and if there is too much, there could be side effects. Too much of a drug present is referred to as a "toxic level". Your child's "therapeutic level" will be monitored by regular blood tests. Generally this level is simple to attain but some patients are very sensitive to the medication and there may be many adjustments necessary to attain the exact dose required for your child. Common anticonvulsant medications include Dilantin (Phenytoin), Tegretol (Carbamazepine), Depakene (Valproic acid) and Phenobarbital. Some of the more common side effects of these medications are noted in the table below. It is advisable to discuss the anticonvulsant medication both with your physician and pharmacist. Often, side effects are due to a toxic level of the drug in the blood and can be relieved by reducing the dosage.

Anti-convulsant Side Effects

Medication    |  Side effect
______________|_______________________________________________________________
Dilantin®     | · swelling of gums (gingival hyperplasia)
              | · rash (either immediately or after taking medication for a period of time)
              | · mild nausea and constipation initially
              | · drowsiness, incoordination, unsteadiness
              | · poor concentration
              |
Tegretol®     | · drowsiness (initially)
              | · mild nausea (initially)
              | · dry mouth
              | · rash
              |
Phenobarbital®| · drowsiness
              | · hyperactivity
              |
Depakene®     | · nausea
              | · vomiting
              | · hand tremors

NEVER DISCONTINUE ANTICONVULSANT MEDICATIONS WITHOUT CONSULTING A PHYSICIAN.