Pediatric Annals

A PEDIATRICIAN'S VIEW

Milton I Levine, MD

Abstract

It has been our effort, since the inception of this magazine, to bring to our readers the latest information on all practical aspects of a specific subject of special interest in each issue.

The material may generally be considered as authoritative since guest editors are selected from physicians recognized as leaders in their particular fields.

As a rule, the subject discussed can be adequately covered in a single issue of the magazine. However, at times two issues are necessary to provide the reader with a comprehensive picture of the subject.

Such was the coverage of the subject of prematurity last fall, and such is the case with the present subjectepilepsy.

In the August issue of Pediatrie Annals, Dr. Samuel Livingston and his contributors devoted themselves to a complete discussion of the etiology, classification, and diagnosis of various types of epileptic seizures.

This issue consists of articles dealing with the treatment of epilepsy, both medical and surgical.

Almost every practicing pediatrician is faced with the care of children suffering from petit mal or grand mal epilepsy. And, as Dr. Livingston pointed out in his article last month, the majority of children suffering from this condition are now being cared for by the pediatrician rather than being referred to a neurologist or a specialized clinic.

However, the successful control of a child with epilepsy depends almost entirely upon the scrupulous care taken by the physician in the diagnosis and treatment. Since epilepsy is a symptom complex rather than a disease, treatment and follow-up of each child must be individualized.

First, the type of epilepsy must be determined and, as far as possible, the etiology. Then, the important questions relating to treatment arise.

What are the most effective drugs and what is the dosage for the particular child? Is a single drug advisable or is a combination of drugs necessary?

For how long should a child be under treatment? How often should a child be examined physically during the course of treatment? Are there methods of determining the optimal time to discontinue treatment? How gradually should drugs be discontinued?

Should blood levels of drugs be performed and, if so, how frequently?

What are the signs of drug toxicity or drug sensitivity in the course of treatment? How often should tests for drug intolerance be made?

These are among the numerous subjects covered in the comprehensive article on treatment by Dr. Livingston and Dr. Lydia Pauli.

The second article, by Dr. Perry Black, concerns the surgical treatment of epilepsy. Although surgery is needed infrequently, it may be important in cases such as those in which the seizures follow accidental head injuries, birth injuries, or intracranial tumors, and for the removal of scar tissue. Dr. Black also considers the question of post-traumatic seizure cases and their safety in entering contact sports.

A special feature by Dr. Herbert L. Livingston and Dr. Samuel Livingston is included in this issue bearing on one of the signs of diphenylhydantoin (Dilantin) sensitivity occurring not infrequently in children receiving the drug as treatment for epilepsy. This is the development of gingival hyperplasia, a condition which becomes a serious cosmetic problem, especially during adolescence. Although this hyperplasia was first described in the mid-forties as a side effect of diphenylhydantoin therapy, this is the first article, to our knowledge, presenting a series of photographs showing the development of this gum enlargement. The beautiful color illustrations cannot but impress all who view them.

Dr. Lee SaIk concludes the issue with a further discussion on the emotional care of the child with epilepsy. Without such care, treatment cannot be considered as truly complete.

We…

It has been our effort, since the inception of this magazine, to bring to our readers the latest information on all practical aspects of a specific subject of special interest in each issue.

The material may generally be considered as authoritative since guest editors are selected from physicians recognized as leaders in their particular fields.

As a rule, the subject discussed can be adequately covered in a single issue of the magazine. However, at times two issues are necessary to provide the reader with a comprehensive picture of the subject.

Such was the coverage of the subject of prematurity last fall, and such is the case with the present subjectepilepsy.

In the August issue of Pediatrie Annals, Dr. Samuel Livingston and his contributors devoted themselves to a complete discussion of the etiology, classification, and diagnosis of various types of epileptic seizures.

This issue consists of articles dealing with the treatment of epilepsy, both medical and surgical.

Almost every practicing pediatrician is faced with the care of children suffering from petit mal or grand mal epilepsy. And, as Dr. Livingston pointed out in his article last month, the majority of children suffering from this condition are now being cared for by the pediatrician rather than being referred to a neurologist or a specialized clinic.

However, the successful control of a child with epilepsy depends almost entirely upon the scrupulous care taken by the physician in the diagnosis and treatment. Since epilepsy is a symptom complex rather than a disease, treatment and follow-up of each child must be individualized.

First, the type of epilepsy must be determined and, as far as possible, the etiology. Then, the important questions relating to treatment arise.

What are the most effective drugs and what is the dosage for the particular child? Is a single drug advisable or is a combination of drugs necessary?

For how long should a child be under treatment? How often should a child be examined physically during the course of treatment? Are there methods of determining the optimal time to discontinue treatment? How gradually should drugs be discontinued?

Should blood levels of drugs be performed and, if so, how frequently?

What are the signs of drug toxicity or drug sensitivity in the course of treatment? How often should tests for drug intolerance be made?

These are among the numerous subjects covered in the comprehensive article on treatment by Dr. Livingston and Dr. Lydia Pauli.

The second article, by Dr. Perry Black, concerns the surgical treatment of epilepsy. Although surgery is needed infrequently, it may be important in cases such as those in which the seizures follow accidental head injuries, birth injuries, or intracranial tumors, and for the removal of scar tissue. Dr. Black also considers the question of post-traumatic seizure cases and their safety in entering contact sports.

A special feature by Dr. Herbert L. Livingston and Dr. Samuel Livingston is included in this issue bearing on one of the signs of diphenylhydantoin (Dilantin) sensitivity occurring not infrequently in children receiving the drug as treatment for epilepsy. This is the development of gingival hyperplasia, a condition which becomes a serious cosmetic problem, especially during adolescence. Although this hyperplasia was first described in the mid-forties as a side effect of diphenylhydantoin therapy, this is the first article, to our knowledge, presenting a series of photographs showing the development of this gum enlargement. The beautiful color illustrations cannot but impress all who view them.

Dr. Lee SaIk concludes the issue with a further discussion on the emotional care of the child with epilepsy. Without such care, treatment cannot be considered as truly complete.

We are sure that practicing pediatricians will find these two issues of Pediatrie Annals of the greatest help in handling the epileptic child.

Successful treatment depends upon scrupulous care

10.3928/0090-4481-19730901-03

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