Autism Therapy: epilepsy

definition of epilepsy: Category of various conditions that lead to seizures, which occur several times, and usually without a specific trigger. People can have a seizure and not have epilepsy.

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Journal of Child Neurology, by Kossoff, EH, Zupec-Kania BA, and Rho JM, published in 2009, summarized Jan 1, 2010

A ketogenic diet that cuts down on carbohydrates may be helpful for children with autism and may help reduce seizures.

With a ketogenic diet, most of the daily nutrition comes from eating fat and protein. The Atkins diet is a type of ketogenic diet. Ketogenic diets have been reported to be helpful for children with epilepsy. While on the diet, some children have fewer seizures. Some children with autism also have seizures, so the diet may be helpful for children with autism as well. Neurologists are exploring whether a ketogenic diet may also be helpful for other autism symptoms. However, there were no published studies reported in the article about this diet and autism. There have been side-effects reported, and some can be long-lasting. Side effects include slower growth, digestive system problems, kidney stones, bone fractures, and other problems.


Pediatric Research, by Spence, SJ, and Schneider MT, published in 2009, summarized Aug 27, 2009

Some people with autism may also have epilepsy (seizures), and anti-epilepsy therapy treatments may be helpful.

People with autism may be more likely to have epilepsy than people who do not have autism. Epilepsy may be more common in people with autism who also have low I.Q., fragile X syndrome, or 15q duplication syndrome. The first seizures often occur either between 18-24 months of age, or during adolescence. People with autism may also be more likely to have abnormal EEG patterns called epileptiform EEGs. Brain researchers think that these abnormal patterns are a symptom of brain function problems. But these people do not have seizures or epilepsy. People with epilepsy often use drug therapy to control their seizures. Some children may show improvements in communication or behavior with drug therapy, but treatment usually does not change the autism symptoms very much. Treating people who have epileptiform EEGs is still controversial because there is little evidence that such treatments improve symptoms of autism.


Epilepsy Behavior, by Mantis, JG, Fritz CL, Marsh J., Heinrichs SC, and Seyfried TN, published in 2009, summarized Aug 17, 2009

Reduced calorie diets may improve behaviors in mice with symptoms like Rett syndrome.

These authors did a research study with mice that have a genetic condition that is like Rett syndrome in humans. The authors compared three diets fed to adult mice: 1) a low calorie ketogenic (high fat, low carbohydrate) diet; 2) a low calorie normal diet (normal amounts of fat and carbohydrates); and 3) a normal diet. Mice fed a low calorie diet (either ketogenic or normal) showed better behavior. The mice were more curious, explored more, and had better balance and motor skills. They also showed less anxiety than the normal diet mice. Other studies reported that a low calorie ketogenic diet led to improved behaviors in mice and in some girls with Rett syndrome. Those studies did not test a low calorie normal diet. Therefore, the authors of this article think that low calories may be more important for improved behaviors than the ketogenic diet. The authors said parents should be careful about starting a reduced calorie diet for girls with Rett syndrome. Girls with Rett syndrome tend to be smaller than normal girls and may have special dietary needs. They suggest that parents check with their child's doctor before trying any diet changes.


Sleep Medicine Clinics, by Malow, BA, and McGrew SG, published in 2008, summarized Jul 23, 2009

Melatonin and other therapies may help people with autism who have trouble sleeping.

People with autism may have sleeping problems, such as trouble going to sleep, trouble staying asleep, and night terrors. Sleep problems can occur because of medical problems (like epilepsy), psychiatric conditions (like anxiety), medications, behavioral habits, and sensory issues. Behavioral therapy is usually the first therapy that is tried to improve sleep habits. Parents are often included in a behavioral therapy plan. When behavioral therapy doesn't work, drug therapy may help. Some doctors suggest melatonin, which has few side effects. One large study showed that melatonin helped 85% of children with autism with sleep problems. Other therapy options include anti-epilepsy medications, antidepressants, light therapy, and tonsil removal. Improving sleep can improve the quality of life and the behavior of people with autism.


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Give me some credit!

Sep 5, 2007 by Anonymous

            Finally, the new school year has begun!  And everyone reading this is going to laugh at me because I actually miss Thomas a tiny bit when he’s at school.  If you read my blogs from May, there was a lot of apprehension and downright horror at the thought of three solid months with no Thomas-breaks.

            The neurologist finally got back to me about the EEG, but not that Friday or Monday right after it.  After I had left repeated messages inquiring about the results – the latter ones conveying a great deal of frustration and desperation – the doctor finally called back and did apologize for the delay.  She mentioned that she really wanted to comb the results and it took longer than usual.  Fine, I understand.  Why couldn’t anybody call me to tell me that?  Who knows?  They know how to bill insurance companies.  They know how to send bills to patients’ homes.  They definitely know how to cash checks with lightning speed and efficiency, but there seems to be a problem with picking up the phone and calling a worried mother.  Hmpf.

            Anyway, the reason it took so long to call back had to do with an abnormal “spike” in the EEG.  So I guess this is good, sort of…Thomas may have a seizure disorder, and we found something on the EEG, so it wasn’t a waste.  I’m kind of worried about what this spike means, though.  It was nothing so obvious that the doctor could diagnose epilepsy, but it was a tiny something.  She also mentioned that she was going to call Thomas’ pediatrician, but after she told me that I wondered why.  What are they discussing?  If she wanted to simply let the pediatrician know about the EEG, then why wouldn’t she just send a letter?  She’s actually going to call?  Herself, in-person?  So that’s been pressing my “worry” button.  She asked about the Clonidine again and when I said that it still helps Thomas fall asleep but doesn’t keep him asleep, her exact words were, “Yeah, see?  I think something else might be going on here.”  But what?

            To find out what, she has ordered a 24-hour in-patient video EEG for Thomas.  She assured me that the EEG people would be calling.  They never did.  I finally called them and was informed that the video EEG machine was broken.  Broken?  Can’t someone fix it?  Do they only have one of these machines?  Then she said that there weren’t any appointments available until the end of September anyway.  This sounds like an angry restaurant manager who doesn’t want your business telling you that they’re out of coffee just so you’ll leave.  I don’t get it.

            So this possible seizure disorder is apparently not life-threatening or very serious because surely the doctor would have known that the EEG machine was not working and would have sent the order to another hospital with working equipment.  I just don’t know what to do now.  How long am I supposed to wait for this stuff?  These people at this particular hospital have never been good about calling me for any reason, so how long should I wait for them to let me know what’s going on?  I’ll keep everyone posted.  Right now, I’m so frustrated that I’m ready to march in there, demand Thomas’ chart and EEG results and go to another doctor.  That may be what I end up doing.

            So Thomas’ teacher called last week to set up the long-awaited and much-anticipated home visit.  She is very nice (and young…it seems like every teacher and doctor I meet lately could be my age or younger) and Thomas seems to like her.  Her aide came over too and colored with the kids while Miss Teacher and I chatted.  Luckily, she didn’t have a long list of required supplies, just a few “must haves” and a list of “optional” things that would help out.  I mentioned to the teacher that I hadn’t yet heard from the transportation center about when the bus would be by to pick up Thomas and she thought that was strange.  She called me on Friday (as I was preparing the family for Labor Day Weekend out-of-town) and said that Thomas’ file was empty.  No bus request form, no emergency card, no permission slips – nothing that I filled out at the end of the last school year!  I had to take the kids and go into school and fill everything out again, but the bad part is that it takes the bus at least one week to begin picking up a new student.  So I’ve been taking Thomas to and from school these last two days and will have to transition him to bus service when SOMEONE calls me SOMETIME to tell me when they’ll begin picking up Thomas.  So if it wasn’t for Thomas’ inquisitive and diligent teacher (who also found that the school had lost the papers for three other students in her class – AND I’ve met several other parents who have the same problem) we would have been waiting for the bus yesterday morning and it would never have come.

            Why, why can’t anyone call me?  Doctors and schools have our home phone number, my cell phone number, my husband’s office number, his cell number, my parent’s phone number, their cell numbers, my mother-in-law’s phone numbers and my e-mail address.  So many ways to get in touch with me, but nobody seems to think it’s necessary.  Nobody (except the teacher – thank God for her) even thinks it might be a nice thing to do to keep me informed.  And I hate having to call and harass people, but you know what?  I guess that’s just the way it is.  Information will not be forthcoming, so I have to badger people until I know what I need to know.  I’m so angry about this blatant and frankly rude lack of communication I could just scream.  You pick up the phone, dial eleven numbers and tell someone something.  Is that really so hard?  Is it really so much to ask?  Clearly, it is.

            On a not-frustrated note, Thomas’ first two days of school have been great!  He’s been telling me so much about what he did during the day.  Today on his sheet, the “housekeeping” activity was circled, which blew me away.  Thomas, pottering in the kitchen?  Only if it means sprinkling a bag of flour over his head!  But he was apparently doing some pretend cooking in the little classroom kitchenette!  I asked him what he cooked and he said, “I cooked some little burgers.”  I thought that was so cool!  During his bath tonight, I asked him if he sang any songs and he said that he didn’t, but then he said, “Oh yeah.  ‘Open and shut, open and shut, the doors on the bus go open and shut, all through the town!’”  It’s typical that he should pick that particular verse, since he is so OCD about doors.  Earlier in the day, he had mentioned that a classmate was “driving the bus,” which made no sense, but I put it together with the information garnered from the bathtub conversation and concluded that they must have been play-acting the song.  I was delighted!  I remember a year and a half ago, when he first started preschool.  I would ask him about his day and he was completely silent.  He would look out the window of the car and I would glance back at him in the rearview mirror and see that he was paying no attention to my questions.

            We were at the cottage this weekend.  Thomas, if you can believe it, went swimming in the lake!  We were standing on the pier on Saturday and there were some other kids on the pier next door, getting ready for a boat ride.  Thomas asked, “What are those kids doing?”  I said, “I think they’re going on a boat ride and they’re going swimming.”  Thomas stood there for a second and then said, “Mommy, get in the water with me.”  I said something completely weird like, “What, this water?” indicating the water near the shoreline.  He climbed right into the water and began splashing.  After a minute, it became clear that our swimsuits were needed, so we changed and Hayley wanted to join us, so the kids spend a good two hours splashing in the water!  Thomas kept saying, “See, Mommy?  I’m not afraid anymore!” as he rolled around on his back in the water and thoroughly enjoyed the whole thing.  We were and still are completely shocked by this turn-around, but also overjoyed!  I just couldn’t believe it.  We’re thrilled!

            Everyone in our families has been talking about how great Thomas is doing and we know that he is doing well, but people say things like, “See?  See how he’s playing with those kids?  That’s great!” and “See how much he’s talking?  He’s doing so well!” and “Wow!  He’s in the water!  That’s amazing!”  Jonathan and I take these comments with a bit of an unsavory attitude because we’re the ones who had to teach these things to him.  Nobody gets that.  Everyone thinks that Thomas is doing these things of his own natural instinct.  He’s not; we have urged him repeatedly to talk to other kids, play with other kids, do what the other kids are doing.  It’s only been after repeated discussions about the lake water and watching other kids swimming that Thomas came to the decision that there was nothing to be afraid of.  We’ve had to teach him so many things that come naturally to Hayley and other “typical” kids and nobody seems to understand that.  My mother-in-law was saying to me, “Wow, Jen!  He’s playing with those other kids!”  I said, “Yeah!  Playing with other kids, swimming in the lake – he’s cured!”  We laughed about that, but these things have only come after so much hard work and talking to Thomas until we’re out of breath and showing him and guiding him and teaching him until we’re exhausted.  We just want a little credit for filling in some of the holes that autism has punched in our son’s brain.


Do what we gotta do

Aug 19, 2007 by Anonymous

            I see that summer is just a slower time of year for family “news,” as I read my last blog which was over a month ago.  Since it’s back-to-school time, I expect to have a lot more to say in the coming weeks and months.

            The only big thing that’s happened with Thomas recently was the EEG last Thursday.  The prep wasn’t nearly as difficult for Thomas as it was for me and Jonathan.  And no, the whole family wasn’t up at 1:30 a.m. – Hayley actually slept through until 6:30 a.m., despite Thomas’ gleeful shrieking over the paper airplane Jonathan made.  We had it all planned out:  I would take the first three-hour shift, and Jonathan would take the next.  I’d be up with Thomas from 1:30 a.m. to 4:30 a.m. and then get to sleep.  I woke at the specified time and Thomas woke up pretty well.  Unfortunately for Mr. Second-Shift, Thomas wanted Daddy to get up with him.  Ha!  I was already awake and pumped for middle-of-the-night play activities, so we both just stuck out the whole night.  Thomas was a little confused, but I had drawn pictures for him on Wednesday depicting the whole gruesome affair.

            Patrice came at 9:00 a.m. to take care of Hayley while we were at the hospital, so we left.  I sat in back with Thomas who was then catching his second wind and did a better job of keeping me awake than I did of keeping him awake.  He was really jacked-up by the time we got into the EEG room, and I thought that there was absolutely no way that we were going to get him to sleep.  The nurse who took us through the procedure was very nice and personable and did a good job of distracting Thomas while she gooped Silly Putty-like stuff on his head and stuck the leads (twenty in all!) to him.  Jonathan was in the bed with Thomas (at Thomas’ request; that day was all about Daddy…he wanted nothing to do with me for a change), and I dozed in a rocking chair.  Really, Jonathan and I would have performed splendidly ourselves had we been the patients.  Thomas seemed like he was close to sleep as the nurse finished the sticky part, but as soon as she dimmed the lights and left, Thomas started whining and poking at the wires which were undoubtedly uncomfortable and it took him about forty-five minutes to actually fall asleep.  Before he did, though, the nurse had him look at the strobe light to see if that triggered anything.

            Once Thomas fell asleep, the EEG only took an additional fifteen minutes.  We woke him up and he cried nonstop after that while the leads came off and the nurse shampooed his hair.  He cried until we got into the elevator at which time he turned off the waterworks and was his normal self again.  He actually stayed awake the whole way home and for the rest of the day, though he had this funny look on his face on the ride home.  His eyes were wide open and his brow was furrowed – he looked like an adult going on very little sleep!  It was kind of funny.  Everyone slept very well that night!

            I’m still waiting to hear from the neurologist who should give us a call tomorrow or Tuesday to discuss the results.  If Thomas does not have epilepsy, then I’m going to have a serious chat with the doctor about what results we could expect from this sleep study she’ll prescribe.  If there is a strong likelihood that we will learn nothing from a sleep study, that we will have no more answers after the test than we did before it, then I’m not so sure I’m going to take Thomas down that path.  I’m certain that this doctor has ideas about what a sleep study could reveal, but I’m going to want her to spell those ideas out very clearly to me before we go ahead.  If she’s being rather vague and unclear about what a sleep study could tell us then I’m going to say, “You’re being rather vague and unclear about what a sleep study could tell us.  Please explain again why this test is worth the preparation, time and money.”  Because she has been so wishy-washy about the whole Namenda/Memantine thing, I’m thinking that she’s one of these doctors who doesn’t really care to go into a whole lot of explanation about her motives.  Unfortunately for her and other medical professionals, I’ve become the sort of person who demands a sensible and coherent explanation.  Either way, I guess we’ll continue to do what we gotta do.  I just hope we don’t gotta do the sleep study.

            Jonathan and I were discussing how much Thomas has improved over the summer.  He’s doing a lot better with transitions, and even his temper tantrums have gotten less horrible.  The bad ones are still really bad, but they’re fewer and farther between than before.  I’ve been taking the kids to the zoo by myself lately, and there’s a merry-go-round there.  It has all different animals on it (even cicadas!), but no horses.  Anyway, the first time I took them (by myself) Thomas wanted to ride the carousel.  I bought tickets and we got in line; we rode and then it was time to get off.  Only Thomas didn’t want to.  I ended up dragging him away, but instead of hitting me and screaming, he just sat on a bench and cried.  It was the best!  We just sat there and waited for him to feel better, and when he did we continued with our day.  It was great!  Plenty of kids get over-stimulated and end up crying at the zoo!  Nobody was staring at me because my son was abusing me and I was just taking it!  Nobody was looking on while Thomas slapped my face and hit his head and spat at me!  Just crying…in the words of Homer Simpson, “Woo-hoo!”

            We’ve been mentioning school more and more lately, and while Thomas would get upset as recently as a couple weeks ago at the mere mention of teachers and busses, he now is pleased to say that yes, he would like to ride the bus again and yes, he would like to go to school again.  Huzzah!  Everything is falling into place.  I am eagerly awaiting a call from Thomas’ teacher to schedule a home visit.  I just wish that this could happen sooner in the summer than late August.  When the teacher comes to call, she has a list of supplies she’d like parents to purchase for the school year, but by the time I get this list, the stores have been cleaned out of markers, glue sticks, folders, tape and most other items on the list.  I ended up going to a scrapbook store last year for the glue sticks and I think they weren’t the right ones anyway.  And there’s no pre-prepared list sent by the school; every teacher has different requirements.  At least the Superman backpack from last year is in good enough condition for use this year.

            We have something exciting to look forward to in my family over the coming months:  My youngest sister has recently become engaged to her boyfriend of seven years, and we are all just thrilled!  I’m really excited because this is the promise, albeit far-away, of a get-dressed-up (even if it is in a bridesmaid’s dress) and-ditch-the-kids-for-the-weekend kind of affair.  Luckily, my sister has decided that there will be no ring-bearer or flower girl, so Thomas and Hayley will be spending the day doing something else.  We’ll show them plenty of pictures after.  I wonder who the lucky party will be that gets to watch Thomas and Hayley?  We have plenty of time to riddle that one out!


Keep those diagnoses comin'!

Jul 26, 2007 by Anonymous

            Lots has happened since my last blog.  My grandmother’s birthday party was a complete surprise to her, even though I had my doubts.  How do you keep fifty family members from accidentally spilling the beans?  Somehow, though, it came off without a hitch.  The only problem we had was that Thomas and Jonathan missed the surprise because Thomas was concerned with the fact that we had left our car on the next block.  He kept wandering over there and Jonathan had to follow.  Once the surprise was over, I moved the car to our usual Uncle Tom’s House parking spot and Thomas settled down.  Again, the kids swam until it was dark.  We had a really good time and Grandma was very surprised.

            We visited the neurologist again last week and we chatted for a while about Thomas’ nighttime antics.  The Clonidine is still not keeping him asleep like the doctor thought it would, so we talked about exactly what he does when he gets up in the night.  After thinking for a moment, the neurologist asked that we bring Thomas for an EEG (electroencephalogram), when they put stickers and wires on his head while he’s sleeping and wait for something (a seizure) to happen.  The doctor was concerned, after I told her about how Thomas wet his bed several times in one night and seems to have a “lights are on but no one’s home” look about him when he wakes, that he is having seizures.  I’ve been asked many times before if Thomas has seizures, but I wrongly assumed that seizure behavior is passing out and writhing on the floor for a few seconds.  After educating myself with the pamphlet entitled “Understanding Epilepsy” that the doctor provided, I’ve learned that seizures can be a blank stare, slight twitching, a single severe muscle spasm and other things I had never thought of as “seizure behavior”.  Once she gave me that particular piece of literature, a red flag was raised:  So Thomas could have epilepsy ON TOP OF autism?  Swell!  Let’s keep those diagnoses comin’!  By the way, I gave the neurologist the studies on Namenda/Memantine, and she remains unconvinced that there is enough information available on the drug for use in children with ASD.  I’m not sure what to do next…how much money would I need to bribe her, I wonder?  Maybe I should turn these requests into a singing telegram.  I can bring balloons and my tap shoes next time and wear an ape suit.

            Thomas may not have epilepsy, in fact; the doctor wants the EEG just to make sure that epileptic seizures are not to blame for the sleeping problems.  So if Thomas has the EEG and it’s abnormal, then we come back for a consultation with the neuro.  If the EEG is normal, then she wants him to do a sleep study.  I’m so excited for these tests that I can’t even express it in words!

            Not.

            The preparation for an EEG is horrific.  I mean, if I was the one who had to have the test, it would be no big deal.  The fact that I have to prepare a four-and-a-half year-old autistic child for it absolutely curls my hair.  The whole idea of this test is to get a look at the brain waves while Thomas is sleeping, so sleep deprivation is key to the success of the EEG.  The person on the phone instructed me to put Thomas down for bed at the normal time and then wake him at 1:30 a.m. (in the morning, in case you missed the “a.m.”) and keep him awake until the test which is scheduled for 10:45 a.m.  Trying to get him to stay awake in the car on the way there is going to be a scream!  Jonathan is taking that day off work so that one of us can drive the car while the other entertains Thomas.  If we can just get him to stay up all that time, the test should go fairly smoothly.  Of course, I’m going to need someone to keep me awake all those hours.  Everyone’s sleep schedule is going to be completely screwed up.  I already know exactly what’s going to happen.  Our whole family is going to be up at 1:30 a.m. like a bunch of vampires.

            The main thing is that I really don’t know what to hope for in all of this.  Like, what are the best-case and worst-case scenarios?  How can the best-case be that Thomas has epilepsy?  That’s just silly.  Then again, if he doesn’t have epilepsy, we have to dig even further and do a sleep study (again, my hair is curling just thinking about that) and continue to grab at straws.  Then, they may want to do an all-day EEG where I have to get Thomas to walk around like Frankenstein for twenty-four hours with a mobile EEG pack around his waist and wires sticking out of his head.  What should I hope for?  This may sound horrible, but I would be fine with it if Thomas has epilepsy.  My best friend has epilepsy and she’s completely normal with her daily medication.  If epilepsy would help us pinpoint Thomas’ sleeping problems, fine.  So we’re beginning another journey to possible diagnosis, and possible nothing.  This whole thing may lead us to no answers at all.  “Yeah, your son has sleep problems.  We can’t figure out why.  That’ll be nine zillion dollars.  Have a nice day!”

            Yeah, yeah, I’ll try to stay optimistic.  The EEG is scheduled for August 16th.

            Otherwise Thomas has been pretty good.  We’ve gotten Hayley almost completely potty-trained, so we’re done with diapers!  She sometimes doesn’t make it through the night without wetting the bed, so we’re putting her in a diaper at bedtime (okay, so not “done-done” with diapers, but pretty close).  In the morning, bless her little heart, she gets up and goes to the bathroom all by herself without waking me up!  She’s doing a great job (even with #2!) and we’re so proud of her.  Thomas is obsessed with our cars (again or still?) and demands that I pull our truck in the garage in the morning so he can look at it and get in and out of it.  He enjoys it and it’s not hurting anyone, so I let him do it.  He has been talking about how he wants to be a racecar driver, which is cute.  Today he wanted us to go to the “car store” and buy a Toyota Highlander like the one my dad drives.  I told him that I don’t have enough money to buy one and that they cost around forty thousand dollars.  Thomas remained firm in his desire despite my silly lack-of-funds problem.  He’ll just have to wait for Grandpa to work on our boring old Suburban again so we can borrow his car.


Epilepsy

Feb 23, 2007 by Anonymous

Epilepsy has been described as "an excessive and disorderly discharge of cerebral nervous tissue on muscles." Between 30 and 40% of individuals with autism have epilepsy. It can be very stressful for the individual as well as the family. Treatments include: antiepileptic drugs, surgery, vagal nerve stimulation, and a ketogenic diet.



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