Epilepsy is a form of chronic disorder and it is characterized by recurrent seizures. The episodes of epileptic seizures may differ from person to person. These seizures could be a result of a genetic disorder or a result of trauma or stroke. During a seizure, a patient may also experience symptoms of neurological disorders and sometimes lose consciousness.

Medical help for epilepsy
Epilepsy itself cannot be cured using medication, but proper medicines help in eliminating recurrent seizures. These medicines stabilize the electrical activity within the brain preventing seizures.

How effective is the medication for epilepsy?
The success of controlling seizures using medicines depends on the type and severity of epilepsy. Medicines for epilepsy are usually very effective and may fully keep seizures under control. However, controlling seizures caused due to brain problems may be more difficult. Usually, epilepsy medicines can control seizures for a long period of time when they are taken regularly.

When is medical help needed?
The decision about when to start medicines for epilepsy is a tricky one. This is because a first seizure cannot confirm whether a person has an on-going epilepsy problem. A second seizure may occur after many years or may not happen at all. Prediction of seizures is also quite difficult.

The severity of seizures also indicates when to start medicines for treatment. In case a first seizure is quite severe, medication should be started at once. Some people have very mild seizures even though they may be recurring in nature, and medication can be avoided in this situation.

The decision of starting medication will vary from case to case and in most cases, medications may be prudent after the first seizure itself. You should always consult a doctor to know when you need to start taking medicines to treat the condition.

For making the most out of the medicines to control seizures, you should follow certain steps:

You must take medications exactly as your doctor has prescribed.
Before switching to generic versions of your medicines or before taking other prescribed medicines, you must consult your doctor.
You should never stop taking the medicines.
In case you experience enhanced depression, mood swings and suicidal thoughts, you should talk to your doctor immediately.
In case you have the migraine, you should let your doctor know so that he can prescribe you anti-epileptic medicines, which also prevent migraines.
Medicines cannot treat the underlying cause of epilepsy, but these help in controlling seizures and this is the most common symptom of epilepsy. Medication should be started at a proper time and must be continued without stopping.

Epilepsy - When To Seek Medical Help?

Valvar aortic stenosis, commonly called aortic stenosis, is a disorder which occurs when the aortic valve of the heart becomes narrow. The narrowing of the valve prevents its full opening, and hence, blood flow from the heart to the aorta is restricted. When the aortic valve gets obstructed, the heart has to exert much more effort to pump the blood. The heart muscles get weakened as a result. This condition is more common in children.

Diagnosis of valvar aortic stenosis-
Before diagnosis, we should know about the symptoms of valvar aortic stenosis in children. They include:

 Feeling breathless
 Angina or chest pain with a feeling of pressure or tightness
 Syncope of fainting
 Palpitations and enhanced heartbeats
 A steady decline in regular activities and energy levels
 Fatigue due to little exertion
 Not gaining weight
 Poor eating patterns
 Problems in breathing

The wall of the left ventricle also thickens muscularly, and the thick wall occupies more space in the lower chamber of the heart and hence, the room for adequate blood supply is reduced. This may lead to heart failure.

Echocardiogram-
The initial test that is recommended for patients with symptoms of valvar aortic stenosis is doppler echocardiography. This test enables the doctor to estimate the aortic valve region, peak or mean transvalvular gradients and the maximum aortic velocity. These primary measures are required to assess the severity of the disease. Echocardiography provides important information on the valve function, left ventricular filling pressure and disruptions in other valves.

Other major tests which help in the diagnosis of valvar aortic stenosis include:
 Mri or magnetic resonance imaging, which provides images of internal body structures with great detail.
 Ct scan or computed tomography where three-dimensional images are extracted.
 Chest x ray
 Cardiac catheterization where a dye is used to highlight blockages, if any, in the heart.

Treatment-
Usually, there are no medicines for fixing valvar aortic stenosis as the disease is not reversible. Medicines can be used to treat the problems, which are caused by the condition.

Replacement of the damaged valve by surgery is the best treatment for valvar aortic stenosis. The surgery performed is called valvuloplasty. This is a cardioscopic surgery where a tube with a small balloon is inserted into a vein. The tube is guided into the heart, and the balloon is inflated. The balloon and tube are removed after the valve is opened. The damaged valve is replaced by mechanical valve or the valve of a cow or pig by an open-heart surgery.

Valvar aortic stenosis is a severe heart condition in children, and the only permanent remedy for this disease is a valve replacement surgery.

Diagnosis and Treatment of Valvar Aortic Stenosis in Children

Cleft palate or palatoschisis is a common genetic abnormality that leads to a horde of problems and is presently a growing challenge to medicine practitioners. The major developmental stages affected due to this particular irregularity include feeding, speech development, dentition and maxillofacial growth which are rather important to the normal overall developmental pace of an individual. Even though the cleft palate deformity was defined centuries ago, no fixed management algorithm exists for patients suffering from the condition in the present day scenario.

Cleft palate may be successfully fixed using reconstructive surgery. Multiple specialists are involved in the reconstruction surgery including plastic surgeons, otolaryngologists, nutritionists, oromaxillofacial surgeons and speech pathologists. Some hospitals also consider psychological therapy for the patient and the family to help get through the emotional trauma and the issues faced due to developmental backlogs.

The treatment for cleft palate usually begins around 9 to 12 months of age. If left untreated, it may cause major deformities. It takes about some years before the whole procedure is completed although it depends on the type and severity of the deformity.

The process involves the administration of anaesthesia after which the palate repair closes the inner, middle and final layers and at the same time realigning of the palatal muscles in a technique called anintravelarveloplasty is conducted. This ensures that the muscles are adjusted in a normal position which facilitates the best functioning of the palate during feeding, swallowing and speaking. It is possible that the child might require more than one surgery to completely close the palate.

Some of the risks involved during the process include:
1. Abnormal reactions to the medications
2. Bleeding
3. Problems in breathing
4. Need for more surgery
5. Infection

Although complicated and time consuming, cleft palate must be given immediate attention to avoid serious developmental issues. The reconstruction surgery and therapy combined ensures a normal development for the child in the longer run, given the surgery was done at the correct time. The child would be required to remain at the hospital for about 5-7 days. Complete recovery takes a time period of 4 weeks. Keeping the wound of the surgery clean is of the utmost importance and it should not be strained.

How to Surgically Treat Cleft Palate

Infantile spasm is a seizure-related disorder that is witnessed among infants and young children. The average age for getting affected with infantile spasm is four months, but some kids might experience this disorder within a month of the birth. This disease can have a subtle appearance, and as such it is difficult to recognize as a serious condition. While a full seizure in an adult is scary, the one observed among infants can be as little as a minor head drop, along with minor body shakes. This might appear to be that serious, but infantile spasm is more serious as compared to a full body convulsion in adults. Unfortunately, an infant suffering from infantile spasm is at great risk of developmental disability, if the condition is not detected and treated early.

Anticonvulsant Medication:
There are very few medicines that are approved by the FDA for treating infantile spasms. The two medicines that are widely used by doctors include Adrenocorticotropic hormone (ACTH) and Vigabatrin.

ACTH: This is the oldest approved medicine by the FDA that was first discovered in the year 1958. This injection needs to be pushed twice in a day. Children tend to gain weight and feel hungry when this injection is injected.
Vigabatrin: Vigabatrin is very well tolerated by young kids and has a successful track record of treating infantile spasms. Studies have proven that Vigabatrin can tackle tuberous sclerosis and plays an important role in improving developmental outcome.
Second line therapies:

Pyridoxine: Dependency on Pyridoxine as a cause of infantile spasm is very rare. High dosage of oral administration of pyridoxine has fetched good results for patients, who do not suffer from pyridoxine related seizures.
Valproic acid: Valproic acid has the best anecdotal rate of success. However, doctors do not recommend this medicine for kids less than 2 years of age because of possible complications.
Clonazepam: This is one of the earliest non-steroid medicine for the treatment of infantile spasm. Some of the popular medicines used are nitrazepam, benzodiazepines, and clonazepam.
Ketogenic Diet: This is a decade old practice that has come back to popularity again. Studies have shown that ketogenic diet can help 20-35 % patients of infantile spasm to keep the condition under control.
IVIG: High dosage of IVIG has been reported to be very helpful in tackling infantile spasms. The dosage ranges from 100-200 mg/kg/dose ranging for about 2-3 weeks at stretch.
Surgery: The final part of the therapy includes a surgery that removes the abnormal part of the brain. It should only be considered for patients who have not responded to therapies including Vigabatrin and ACTH. It should also be investigated whether the patient has any structural abnormalities of the brain.


Infantile Spasms - How They Can Be Treated?

A child s tantrums, especially during teens, are quite common. However, there could be some children who could be exhibiting an extreme version of these symptoms. This is known as oppositional defiant disorder.
Children with this disorder become easily irritable, angry, argumentative, defiant and feel vindictive against most elders (parents, teachers, and others). While this is something very common and can be ignored to be a part of teenage tantrums, the issue is when these symptoms do not seem to end. If they persist for beyond 6 months, it is time to worry. These may then begin to interfere with their daily activities including schooling, where they may not be easy for the teacher to manage.

Diagnosis of ODD: With the changing behaviour of teenagers, it is often difficult to pinpoint and say there is ODD. However, some guidelines for diagnosis are listed below. Angry/irritable, argumentative, defiant and vindictive. If these symptoms are seen for more than 6 months with no inducing reason, happens with non-siblings, and is affecting learning and playing, it is highly likely the child has ODD.

These symptoms can occur at home, at school, or in other settings   seen respectively in one, two, or more settings. Some of the symptoms are listed below.

Repeated temper tantrums
Anger bursts, swearing, using obscene language
Extremely argumentative, especially with people in authority (teachers, parents, etc.)
Annoying others and getting annoyed easily
Noncompliance to rules and regulations at school and institutions
Defending one s mistakes and blaming others for it
These result in poor academic performance, antisocial behavior, substance abuse, and higher suicidal tendencies.
Treatment

Treatment depends on the presenting symptoms, the age of the child, and supportive care available. The child should be able to actively take part in psychotherapy to reap good benefits. It would otherwise be a task with no results.

Psychotherapy will help the child improve its cope and express and control anger. This also improves problem-solving skills.
Cognitive-behavioural therapy tries to mould the behaviour.
If required, the parents also would be involved to improve family s involvement in the treatment. Caretakers are given special training if required so that they can support in long-term medical care.
The child also needs to be trained for appropriate behaviour under different circumstances.
Rewards for positive behaviour and punishments for negative behaviour are useful ways.
Prevention: Early identification can help in minimizing distress to the family and help in the early arrest of the disease. The family is also taught basic and simple steps which can help in supporting therapy. Early rejection at school and loss of learning, can happen which can be managed with early intervention. A nurturing and supportive family can help manage the child very well.

Oppositional Defiant Disorder in Kids - How to Deal with it ?

Pregnancy is a journey in itself where you tend to go through physical changes, psychological changes and social changes as well. While the body struggles to cope with the hormonal and other major changes, the mind also tries continuously to adapt and cope with emotional as well as mental stress. Teenagers are considered to still be in a maturing stage when they have difficulty dealing with factors such as peer stress, emotional ups and downs, identity issues, personality building challenges and psychological barriers. 

So, getting pregnant at this stage can be very traumatizing. Issues such as postpartum depression have become very common among teenagers. 

Psychological Barrier in Teenage Pregnancy
As per the Pediatrics Journal, teenage mothers tend to have higher rate of depression compared with adult women who experience pregnancy. This may be due to various reasons like difficulty to face the society, unplanned pregnancy, immaturity to deal with pregnancy and related symptoms, own social involvements, which come between pregnancy and a whole lot of reasons.

However, the psychological effects and stress, which account for these barriers are sometimes quite severe and according to researchers, teen mothers often show symptoms of Post Traumatic Stress Disorder, which may sometimes lead to suicidal tendencies.

Signs and Symptoms of Stress and Trauma
1. Some of the major stress signs in teenage pregnancy either in the prepartum or postpartum period may include anxiety, depression, concentration difficulties, eating disorders, insufficient sleep, sadness or mood swings.

2. Already teenage pregnancy leads to excessive mental stress and if there is a complication in delivery or premature birth before 37 weeks, the level of depression tends to get higher.

3. There is a distinct difference between postpartum depression and baby blues. While baby blues are similar to stress and sleep problems, eating troubles, mood fluctuations seem the same as postpartum depression, they tend to go off within two to three weeks, while depression lasts.

4. Excessive fatigue resulting into a brittle mood.

5. Sudden attacks of panic are also quite common.

6. Difficulties in bonding with baby or having patience with baby's demands.

This type of stress and trauma may lead to child abuse, neglecting children or depression. Lowered self-confidence and irritated state of mind are also some of the common complaints. Therefore, to avoid the postpartum stress and major difficulties, teenage pregnant moms can consult psychiatrists for help and advice.

Stress and Trauma Related to Teenage Pregnancy

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