People with epilepsy : report of a joint sub-committee of the Standing Medical Advisory Committee and the Advisory Committee on the Health and Welfare of Handicapped Persons.

  • Great Britain. Standing Medical Advisory Committee.
Date:
1969
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Licence: Public Domain Mark

Credit: People with epilepsy : report of a joint sub-committee of the Standing Medical Advisory Committee and the Advisory Committee on the Health and Welfare of Handicapped Persons. Source: Wellcome Collection.

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    CHAPTER II A BASIC FRAMEWORK FOR CARE 31. In considering the medical and social needs of people with epilepsy, attention must constantly be paid to the possibilities of prevention. In the light of current knowledge there is scope for the primary prevention of the condition in a small minority of cases, although it is to be expected that this will increase as more is discovered about its causation. Attention must therefore, at present, be concen- trated on secondary and tertiary prevention, in other words on the prompt diagnosis of epilepsy and on the provision of a full range of services, both medical and social, for the assessment, treatment and care of those who develop it. Parallel with the provision of these it will be necessary to take active steps towards modifying public attitudes towards epilepsy. PRIMARY PREVENTION 32. In broad terms it may be said that an epileptic attack results from a sudden excessive, uncontrolled discharge of the nerve cells of the brain. In many cases known factors have given rise to damage of brain tissue or to disturbance of its function which result in epileptic discharges reaching the clinical level of recognizable attacks. With increasing medical knowledge and improvement in diagnostic aids, more and more cases are being discovered to have a specific physical cause. In prevention, efforts must be directed not only at eliminating such underlying causes but also towards mitigating the harmful effects of the attacks, and both family doctors and specialists have important rdles to play. 33. One approach to prevention lies in expert genetic counselling, which is available at the advisory centres listed in the Standing Medical Advisory Committee’s booklet ““Human Genetics”, which was issued in 1967(/2). Blanket figures quoted in textbooks, such as “‘epileptics have a 1-in-40 chance of having epileptic children”, are inaccurate, as it is now known that the risks of epilepsy appearing in the children vary according to the cause of the epilepsy in the prospective parent. Some epilepsies, for example those caused by infection or trauma, are not genetically based. Recent work has shown that there is a genetic tendency to febrile convulsions below the age of 4 years. Consequently, there is a substantially enhanced risk, of the order of 30 per cent, to brothers and sisters of a child in whom temporal lobe epilepsy began with severe febrile convulsions, though most of these 30 per cent will not develop prolonged or serious epilepsy, but will simply have one or two harmless, brief convulsions in early life. The risk to brothers and sisters of a child with epilepsy complicating one of the rare dominant genetic disorders, such as tuberose sclerosis, rises to 50 per cent, but epilepsy acquired, say, during the course of meningitis, would not bring any enhanced risk to any first degree relatives of seizure disorders of any kind. 34. Other factors leading to epilepsy operate from the beginning of foetal development. As yet no specific disturbances of development in utero due, for example, to placental insufficiency, are known to produce epilepsy, but physical