Epilepsy and Other Seizure Disorders in Children: Drug Management John A. Thomas, PhD Glenn R. Knotts, PhD John A . Thomas, PhD, is Professor of Pharmacology and Associate Dean, School of Medicine, West Virginia University, Morgantown, West Virginia. Glenn R. Knotts, PhD, is Professor of Medical Journalism and Head, Department o f Information and Publications, The University of Texas System Cancer Center, Texas Medical Center, Houston, Texas. It is not uncommon for the classroom teacher to have a pupil who has a medical history of epilepsy or some other seizure pattern. It has been estimated that about 2 million persons in this country have some form of epilepsy. While parental responsibility dictates the teacher be made aware of the child’s condition, it is important that certain signs and symptoms of epilepsy be recognized by the teacher. This recognition may be valuable since the school nurse or physician might not be immediately available to the child. In addition to the teacher’s familiarity with some of the subtle as well as overt signs and symptoms of epilepsy, a basic knowledge of the child’s antiepileptic medication is desirable. A teacher possessing some insight into seizure disorders and their therapies is less fearful and has fewer anxieties when a child has a seizure while in the classroom.
Seizure Patterns Seizure disorder or epilepsy has been defined as a symptom complex characterized by abnormal nerve cell discharges and is usually indicative of an underlying dysfunction of the central nervbus system. I t s specific manifestations depend on the area of the brain that it involved. The clinical diagnosis of a seizure is simple if a history of generalized tonic and clonic convulsion with loss of consciousness is evident. Some manifestations of seizure disorders, however, are subtle and often difficult to recognize and establish. The clinical manifestations of seizures are diverse, b u t most can be categorized into four groups: major, minor, psychomotor, and focal. 462
Major Seizure Patterns Major seizures are characterized by a general onset, and no premonitory symptoms are recollected by the child or even recognized by an observer. The typical example is the tonic-clonic (eg, grand mal) spasms of the musculature, at which time consciousness is lost and a generalized tonic muscular stiffening occurs. During this onset period, a guttural cry may be produced by a forced expiration of air through the vocal cords. Incontinence also may occur a t this time. These onset signs may be followed by gradual development of clonic jerking movements, which subsequently slow down and abruptly end. These major seizures may be characterized by increased salivation with frothing at the mouth, as well as sweating and alterations in pupillary size, heart rate, and respiration. The child is often stuporous or confused for a brief period following the seizure. Minor Seizure Patterns Some neurologists subdivide minor seizure patterns into ( 1) petit mal, (2) myoclonic seizures, and ( 3) akinetic seizures. The term “petit mal” originally encompassed all forms of minor seizures; however, we now recognize more than one type of minor seizure pattern. Petit ma1 now describes the brief lapse of consciousness associated with rather specific changes in the electroencephalographic ( EEG ) pattern. This seizure pattern occurs without warning and usually lasts no longer than 30 seconds. The child undergoing this type of seizure pattern may appear to be suddenly immobilized. The eyes may have a vacant look during this period. There is no visible abnormal movement, that is, posture is not ordinarily disturbed. While the episode itself is brief, the seizure may reoccur several times during the course of a day. Petit ma1 occurs principally in children 4 to 12 years of age and is less common than grand mal. Myoclonic seizures consist of sudden involuntary contractions of the muscles of the extremities, trunk, OCTOBER 1976 VOLUME XLVl NO. 8
or face, without apparent loss of consciousness. These seizures are brief and abrupt. There may be a quick jerking of one or more parts of the body, and the child may lose his sense of balance and fall to the floor. Both grand ma1 and petit mal seizures may be associated with myoclonic seizures. EEG patterns can often be used to distinguish myoclonic jerks from habit spasms and from chorea. Still another form of the so-called minor seizures is the akinetic pattern. Akinetic seizures are characterized by a temporary loss of postural tone, a sudden fall, and an arrest of movement. Akinetic seizures occur almost exclusively in childhood and adolescence and are often refractory to medication.
Psychomotor Seizure Patterns Psychomotor seizures are also referred to as temporal lobe seizures and are often confused with petit mal or episodic psychiatric disturbances in children. The psychomotor seizure pattern may be characterized by mental, motor, and sensory signs, which are manifest by abrupt changes in consciousness, illusions, hallucinations, and dream-like states. Loss of speech, incorrect and inappropriate flow of words, as well as chewing and swallowing movements are frequently associated with this seizure pattern.
Focal Seizure Patterns The clinical signs and symptoms of focal-type seizures suggest that abnormal discharge of neuronal activity is localized to a particular area of the brain. Focal seizures may be either motor or sensory. They sometimes consist only of a special aura such as gustatory, masticatory, uncinate, or hallucinatory patterns. The jacksonian seizure, an example of a focal seizure pattern, is characterized by visible or sensed progression ( a so-called march) of either sensory or motor pattern. There may be a progressive march of clonic movements from the face, thumb, or big toe to other parts of the body, or a sensation of numbness and tingling.
Drugs Used in the Treatment of Epilepsy Until the discovery of barbiturates, and later of phenytoin (diphenylhydantoin 1, the bromides were the principal antiepileptic drugs. The bromides are, of course, central nervous system depressants, but their extreme toxicity in amounts necessary to control seizures soon led t o their abandonment. The bromides are therapeutically obsolete and have been replaced not only by the barbiturates and the hydantoins, but also by other newer chemical classes of anticonvulsant drugs (Table 1). Antiepileptic medication is necessary in the majority of children with recurrent seizures. In general, THE JOURNAL OF SCHOOL HEALTH
TABLE 1 Chemical Classification of Commonly Prescribed Anticonvulsant Drugs Chemical Class Generic Name barbiturates
Trademark
phenobarbital mephobarbi t a1
Mebaral
hydan toins
phenytoin
Dilantin
oxazolidines
trimethadione paramethadione
Tridione Paradione
succinamides
methsuximide phensuximide
Celontin Milontin
other
primidone acetazolainide diazepam adrenocorticotropic hormone ( ACTH )
My soline Diamox Valium Acthar
about 50% of patients are seizure-free with anticonvulsant therapy, and partial seizure control can be achieved in approximately 25% more patient,s. Despite the fact that some anticonvulsant drugs are quite effective in suppressing seizures, little is known about how these drugs act, on neuronal cells or on nerve cell circuits t o affect convulsant states. The barbiturates may exert part of their antiepileptic activity by elevating seizure thresholds, but the anticonvulsant phenytoin does not exert its actions by affecting seizure thresholds. Phenytoin somehow suppresses the spreading of abnormal neuronal discharges in the brain. Primidone, another effective anticonvulsant agent, is chemically related to the barbiturates, but its mechanisms of action on central nervous system structures is unknown. The oxazolidines (eg, trimethadione and paramethadione are effective in raising seizure thresholds in laboratory animals that have been injected with toxic chemicals capable of inducing experimental epilepsy. Although there is a lack of definitive information about the exact mechanism of action of the anticonvulsant drugs, many of these agents are nevertheless effective in suppressing seizures. Interestingly enough, some chemical classes of anticonvulsants are more effective in controlling specific seizure patterns than are others, Seizure p at t ern s and the agents most frequently used to control them are listed in Table 2. Phenobarbital is the drug most frequently used for the initial treatment of grand ma1 and focal clonic seizures. This particular barbiturate is of little value in the management of petit ma1 and psycho463
TABLE 2 Seizure Patterns and Drug Therapy Seizure Pattern Drug Therapy grand mal and focal motor
phenobarbital phenytoin primidone
petit mal
acetazolamide ethosuximide trimethadione
psychomotor
primidone methsuximide
minor myoclonic diazepam and akinetic primidone infantile spasm
Adrenocorticotropic hormone diazepam
motor seizures. It has been known to actually enhance hyperkinetic behavior and cause irritability in youngsters with brain damage. Drowsiness is a common side effect of all of the barbiturates, and this can influence a child's classroom performance. This drowsiness can sometimes be counteracted with dextroamphetamine given along with the seizure medication. Phenytoin sometimes can supplement the barbiturate therapy, thereby requiring a lower dose of the barbiturate and, hence, less drowsiness. However, some neurologists prefer to establish antiseizure levels of a drug wi'th only a single medicat,ion, since pharmacologic interactions between two drugs are often complex and less predictable. Mephobarbital, a chemical derivative of phenobarbital, causes less drowsiness but also is less effective as an anti seizure agent. Primidone is often used in the management of grand mal seizures resistant to the anticonvulsant activities of phenobarbital or phenytoin or both. I t also is widely used for the treatment of focal and temporal lobe epilepsies. Primidone can produce drowsiness, dizziness, double vision (diplopia), and nystagmus (rapid movement of the eye balls), all of which might influence a child's classroom performance. Phenytoin is of particular value in the treatment of grand mal seizures and is sometimes effective in psychomotor and focal motor seizures. Phenytoin is of no value in petit ma1 seizure. Unlike the barbiturates (ie, phenobarbital and mephobarbital) or primidone, phenytoin has little or no hypnotic or sedative activity; therefore, drowsiness is not ordinarily a troublesome side effect in the child receiving pheny464
toin. Its most common adverse side effects are ataxia, nystagmus, diplopia, dizziness, and gingival hypertrophy, or overgrowth of the gums. Trimethadione was the first drug found to be effective in controlling petit ma1 seizure patterns. Trimethadione is somewhat more potent than paramethadione in controlling petit mal. The oxazolidines (ie, trimethadione and paramethadione) may improve the control of psychomotor and akinetic seizure patterns; conversely, they may actually exacerbate grand mal seizure patterns. Toxic side effects of the oxazolidines are rare but may include serious blood disorders; therefore, the oxazolidines are seldom the first choice of therapy for petit mal. The succinamides (ie, methsuximide and ethosuximide) are also used in the treatment of petit mal. Methsuximide may be effective in controlling psychomotor seizures. Ethosuximide can produce a variety of undesirable side effects such as loss of appetite, nausea, vomiting, and occasionally, drowsiness. The succinamides are also capable of producing serious blood disorders (eg, leukopenia and agranulocytosis) and must be used with discretion. Other drugs of value in the control of petit ma1 include meprobamate ( Miltown@, Equanil@), diazepam (Valium@),and quinacrine ( Atabrinee). These particular drugs, however, are often reserved for cases of petit ma1 t h a t are resistant t o the oxazolidines and the succinamides. Acetazolamide (Diamox@)is a drug with a wide spectrum of pharmacologic actions. While it is perhaps best known as a diuretic, it is nevertheless an effective anticonvulsant. When acetazolamide is used as an anticonvulsant, it is frequently used along with other antiepileptic agents. It is frequently administered with the barbiturates or with primidone. Acetazolamide may be of value in controlling infantile spasms, akinetic seizures, and major seizure patterns that have become refractory to other anticonvulsant drugs. Adrenocorticotropic hormone (ACTH)is another agent used in the management of infantile seizure patterns. Obviously, anticonvulsant therapy is the responsibility of the child's physician. The teacher, however, can be valuable in aiding the recognition of seizure patterns and in providing further insight into possible side effects of anticonvulsant therapy, which might occur to the child in the classroom. Drug therapy of seizures is only part of the overall treatment of children with a history of epilepsy. Attention must also be given to the psychologic and social needs of the child. Teachers should be made aware of the fact that excessive fatigue, overexposure to heat or sunlight, and situations that OCTOBER 1976 VOLUME XLVl NO. 8
cause emotional disturbances can affect the seizure threshold in children with epilepsy, thus increasing the incidence of attacks.
Gutrecht .JA. Fakadej A\’: The treatment of seizure disorders. W Va Meti .J 69:246-249. 1973. Millichap JG: Drug treatment of con! ulsi1.e disorders. .V I.’ngl .I hfcd ZXfi:.l(i4-.1RX. 19’72. Posner CM: Epilepsy and I h c primary physician. G P 37.101-1 12, 1968.
BIBLIOGRAPHY Eadie M.J: Management of epilepsy. Mrd .I A ~ s t2:49. 1975. Forman PM: Therapy of seizures in children. Am Fani Physicinn 10:144. 1974.
Garrettson L K : Pharmacology of antic.on\wlsant\. I’rdintr (’lin N o r / h jlni l 9 : I i % ~ : ) l ,1972.
The corresponding author of this article is John A. Thomas, PhD, Professor of Pharmacology and AssoO f Medicine, West Virginia uniciate Dean, versity, Morgantown, W V 26506.
Let’s Teach Our Children What They Want to Know National Family Sex Education Week October 10-16, 1976 Parents are the sex educators of their own children, whether they do it well or badly. Silence and evasiveness are just as powerful teachers as are the facts. Everybody says that parents should be the primary sex educators, but who is preparing the parents for this role? Indeed, in terms of the values and spiritual life of the child, no outside group or agency could replace the family. Thus, we see education for sexuality taking place within the context of the family’s value system which hopefully strives toward a family life free of racism, sexism and prejudices against people with other values. Most churches and educators officially s u p port this position, but few are doing anything about it. Studies consistently have revealed that children do not acquire the information they need from parents. I t is time for parents to assume this responsibility. Parents, of course, cannot be the sole educators; if they wanted to be, they would have to prevent their children from reading books, newspapers and magazines, keep them away from television, movies and public bathrooms, and certainly prohibit them from having any friends a t all. Parents are the main educators, with schools, religious and community groups as partners in a life long process. Society consistently underestimates the capabilities of parents and their children. You can’t tell a child too much: Knowledge doesn’t stimulate inappropriate behavior, ignorance does. If you tell children more than they can understand, they will ask another question or turn you off. Parents must work toward being ASKABLE. We know most parents want to educate their children, but they are often uncomfortable and don’t know how. Obviously, parents who find it difficult to talk to their children about any important issue will not be ready to talk about sex. However, it seems that most parents are ready, but want some support. I t is essential for parents to be alert to extremist propaganda and political maneuvering, especially by those groups claiming to have a monopoly on the Judeo-Christian ethic. Censorship in the schools and media is one method used by extremist groups who want to impose their views on everybody. Parents should not be intimidated by scare tactics used as subterfuges for acquiring power on school boards or i n churches. In support of these principles, PTA’s, foundations, church and synagogue related groups and community organizations can develop ongoing institutes, workshops, seminars and media presentations, and put together bibliographies and library and bookstore displays, to get the public involved (continuing education is more effective than oneshot lectures). I t is expected that religious groups in particular will develop programs based on their own moral beliefs. Community minded groups should discover opportunities for getting their message heard via public service options on TV and radio, as well as in newspapers and magazines. We must counter the propaganda that information is harmful or constitues license for irresponsible behavior. It’s time that the “silent” majority expressed itself vigorously, visibly and vocally. The Institute for Family Research and Education was established in 1970 for the purpose o f improving the quality of individual and family life through operations in three mutually supportive areas: Education, communications, and research. The Institute is a program of Syracuse University’s College for Human Development. The Institute’s activities are based on the philosophy that groups and individuals will be most receptiue to communication which they perceive as attempting to meet their particular needs. Primary emphasis has been placed on reduction of unwanted pregnancy and venereal disease, and helping parents to assume their role as the primary sex educators of their children.
THE JOURNAL
OF SCHOOL HEALTH
465
Seizure Patterns Seizure disorder or epilepsy has been defined as a symptom complex characterized by abnormal nerve cell discharges and is usually indicative of an underlying dysfunction of the central nervbus system. I t s specific manifestations depend on the area of the brain that it involved. The clinical diagnosis of a seizure is simple if a history of generalized tonic and clonic convulsion with loss of consciousness is evident. Some manifestations of seizure disorders, however, are subtle and often difficult to recognize and establish. The clinical manifestations of seizures are diverse, b u t most can be categorized into four groups: major, minor, psychomotor, and focal. 462
Major Seizure Patterns Major seizures are characterized by a general onset, and no premonitory symptoms are recollected by the child or even recognized by an observer. The typical example is the tonic-clonic (eg, grand mal) spasms of the musculature, at which time consciousness is lost and a generalized tonic muscular stiffening occurs. During this onset period, a guttural cry may be produced by a forced expiration of air through the vocal cords. Incontinence also may occur a t this time. These onset signs may be followed by gradual development of clonic jerking movements, which subsequently slow down and abruptly end. These major seizures may be characterized by increased salivation with frothing at the mouth, as well as sweating and alterations in pupillary size, heart rate, and respiration. The child is often stuporous or confused for a brief period following the seizure. Minor Seizure Patterns Some neurologists subdivide minor seizure patterns into ( 1) petit mal, (2) myoclonic seizures, and ( 3) akinetic seizures. The term “petit mal” originally encompassed all forms of minor seizures; however, we now recognize more than one type of minor seizure pattern. Petit ma1 now describes the brief lapse of consciousness associated with rather specific changes in the electroencephalographic ( EEG ) pattern. This seizure pattern occurs without warning and usually lasts no longer than 30 seconds. The child undergoing this type of seizure pattern may appear to be suddenly immobilized. The eyes may have a vacant look during this period. There is no visible abnormal movement, that is, posture is not ordinarily disturbed. While the episode itself is brief, the seizure may reoccur several times during the course of a day. Petit ma1 occurs principally in children 4 to 12 years of age and is less common than grand mal. Myoclonic seizures consist of sudden involuntary contractions of the muscles of the extremities, trunk, OCTOBER 1976 VOLUME XLVl NO. 8
or face, without apparent loss of consciousness. These seizures are brief and abrupt. There may be a quick jerking of one or more parts of the body, and the child may lose his sense of balance and fall to the floor. Both grand ma1 and petit mal seizures may be associated with myoclonic seizures. EEG patterns can often be used to distinguish myoclonic jerks from habit spasms and from chorea. Still another form of the so-called minor seizures is the akinetic pattern. Akinetic seizures are characterized by a temporary loss of postural tone, a sudden fall, and an arrest of movement. Akinetic seizures occur almost exclusively in childhood and adolescence and are often refractory to medication.
Psychomotor Seizure Patterns Psychomotor seizures are also referred to as temporal lobe seizures and are often confused with petit mal or episodic psychiatric disturbances in children. The psychomotor seizure pattern may be characterized by mental, motor, and sensory signs, which are manifest by abrupt changes in consciousness, illusions, hallucinations, and dream-like states. Loss of speech, incorrect and inappropriate flow of words, as well as chewing and swallowing movements are frequently associated with this seizure pattern.
Focal Seizure Patterns The clinical signs and symptoms of focal-type seizures suggest that abnormal discharge of neuronal activity is localized to a particular area of the brain. Focal seizures may be either motor or sensory. They sometimes consist only of a special aura such as gustatory, masticatory, uncinate, or hallucinatory patterns. The jacksonian seizure, an example of a focal seizure pattern, is characterized by visible or sensed progression ( a so-called march) of either sensory or motor pattern. There may be a progressive march of clonic movements from the face, thumb, or big toe to other parts of the body, or a sensation of numbness and tingling.
Drugs Used in the Treatment of Epilepsy Until the discovery of barbiturates, and later of phenytoin (diphenylhydantoin 1, the bromides were the principal antiepileptic drugs. The bromides are, of course, central nervous system depressants, but their extreme toxicity in amounts necessary to control seizures soon led t o their abandonment. The bromides are therapeutically obsolete and have been replaced not only by the barbiturates and the hydantoins, but also by other newer chemical classes of anticonvulsant drugs (Table 1). Antiepileptic medication is necessary in the majority of children with recurrent seizures. In general, THE JOURNAL OF SCHOOL HEALTH
TABLE 1 Chemical Classification of Commonly Prescribed Anticonvulsant Drugs Chemical Class Generic Name barbiturates
Trademark
phenobarbital mephobarbi t a1
Mebaral
hydan toins
phenytoin
Dilantin
oxazolidines
trimethadione paramethadione
Tridione Paradione
succinamides
methsuximide phensuximide
Celontin Milontin
other
primidone acetazolainide diazepam adrenocorticotropic hormone ( ACTH )
My soline Diamox Valium Acthar
about 50% of patients are seizure-free with anticonvulsant therapy, and partial seizure control can be achieved in approximately 25% more patient,s. Despite the fact that some anticonvulsant drugs are quite effective in suppressing seizures, little is known about how these drugs act, on neuronal cells or on nerve cell circuits t o affect convulsant states. The barbiturates may exert part of their antiepileptic activity by elevating seizure thresholds, but the anticonvulsant phenytoin does not exert its actions by affecting seizure thresholds. Phenytoin somehow suppresses the spreading of abnormal neuronal discharges in the brain. Primidone, another effective anticonvulsant agent, is chemically related to the barbiturates, but its mechanisms of action on central nervous system structures is unknown. The oxazolidines (eg, trimethadione and paramethadione are effective in raising seizure thresholds in laboratory animals that have been injected with toxic chemicals capable of inducing experimental epilepsy. Although there is a lack of definitive information about the exact mechanism of action of the anticonvulsant drugs, many of these agents are nevertheless effective in suppressing seizures. Interestingly enough, some chemical classes of anticonvulsants are more effective in controlling specific seizure patterns than are others, Seizure p at t ern s and the agents most frequently used to control them are listed in Table 2. Phenobarbital is the drug most frequently used for the initial treatment of grand ma1 and focal clonic seizures. This particular barbiturate is of little value in the management of petit ma1 and psycho463
TABLE 2 Seizure Patterns and Drug Therapy Seizure Pattern Drug Therapy grand mal and focal motor
phenobarbital phenytoin primidone
petit mal
acetazolamide ethosuximide trimethadione
psychomotor
primidone methsuximide
minor myoclonic diazepam and akinetic primidone infantile spasm
Adrenocorticotropic hormone diazepam
motor seizures. It has been known to actually enhance hyperkinetic behavior and cause irritability in youngsters with brain damage. Drowsiness is a common side effect of all of the barbiturates, and this can influence a child's classroom performance. This drowsiness can sometimes be counteracted with dextroamphetamine given along with the seizure medication. Phenytoin sometimes can supplement the barbiturate therapy, thereby requiring a lower dose of the barbiturate and, hence, less drowsiness. However, some neurologists prefer to establish antiseizure levels of a drug wi'th only a single medicat,ion, since pharmacologic interactions between two drugs are often complex and less predictable. Mephobarbital, a chemical derivative of phenobarbital, causes less drowsiness but also is less effective as an anti seizure agent. Primidone is often used in the management of grand mal seizures resistant to the anticonvulsant activities of phenobarbital or phenytoin or both. I t also is widely used for the treatment of focal and temporal lobe epilepsies. Primidone can produce drowsiness, dizziness, double vision (diplopia), and nystagmus (rapid movement of the eye balls), all of which might influence a child's classroom performance. Phenytoin is of particular value in the treatment of grand mal seizures and is sometimes effective in psychomotor and focal motor seizures. Phenytoin is of no value in petit ma1 seizure. Unlike the barbiturates (ie, phenobarbital and mephobarbital) or primidone, phenytoin has little or no hypnotic or sedative activity; therefore, drowsiness is not ordinarily a troublesome side effect in the child receiving pheny464
toin. Its most common adverse side effects are ataxia, nystagmus, diplopia, dizziness, and gingival hypertrophy, or overgrowth of the gums. Trimethadione was the first drug found to be effective in controlling petit ma1 seizure patterns. Trimethadione is somewhat more potent than paramethadione in controlling petit mal. The oxazolidines (ie, trimethadione and paramethadione) may improve the control of psychomotor and akinetic seizure patterns; conversely, they may actually exacerbate grand mal seizure patterns. Toxic side effects of the oxazolidines are rare but may include serious blood disorders; therefore, the oxazolidines are seldom the first choice of therapy for petit mal. The succinamides (ie, methsuximide and ethosuximide) are also used in the treatment of petit mal. Methsuximide may be effective in controlling psychomotor seizures. Ethosuximide can produce a variety of undesirable side effects such as loss of appetite, nausea, vomiting, and occasionally, drowsiness. The succinamides are also capable of producing serious blood disorders (eg, leukopenia and agranulocytosis) and must be used with discretion. Other drugs of value in the control of petit ma1 include meprobamate ( Miltown@, Equanil@), diazepam (Valium@),and quinacrine ( Atabrinee). These particular drugs, however, are often reserved for cases of petit ma1 t h a t are resistant t o the oxazolidines and the succinamides. Acetazolamide (Diamox@)is a drug with a wide spectrum of pharmacologic actions. While it is perhaps best known as a diuretic, it is nevertheless an effective anticonvulsant. When acetazolamide is used as an anticonvulsant, it is frequently used along with other antiepileptic agents. It is frequently administered with the barbiturates or with primidone. Acetazolamide may be of value in controlling infantile spasms, akinetic seizures, and major seizure patterns that have become refractory to other anticonvulsant drugs. Adrenocorticotropic hormone (ACTH)is another agent used in the management of infantile seizure patterns. Obviously, anticonvulsant therapy is the responsibility of the child's physician. The teacher, however, can be valuable in aiding the recognition of seizure patterns and in providing further insight into possible side effects of anticonvulsant therapy, which might occur to the child in the classroom. Drug therapy of seizures is only part of the overall treatment of children with a history of epilepsy. Attention must also be given to the psychologic and social needs of the child. Teachers should be made aware of the fact that excessive fatigue, overexposure to heat or sunlight, and situations that OCTOBER 1976 VOLUME XLVl NO. 8
cause emotional disturbances can affect the seizure threshold in children with epilepsy, thus increasing the incidence of attacks.
Gutrecht .JA. Fakadej A\’: The treatment of seizure disorders. W Va Meti .J 69:246-249. 1973. Millichap JG: Drug treatment of con! ulsi1.e disorders. .V I.’ngl .I hfcd ZXfi:.l(i4-.1RX. 19’72. Posner CM: Epilepsy and I h c primary physician. G P 37.101-1 12, 1968.
BIBLIOGRAPHY Eadie M.J: Management of epilepsy. Mrd .I A ~ s t2:49. 1975. Forman PM: Therapy of seizures in children. Am Fani Physicinn 10:144. 1974.
Garrettson L K : Pharmacology of antic.on\wlsant\. I’rdintr (’lin N o r / h jlni l 9 : I i % ~ : ) l ,1972.
The corresponding author of this article is John A. Thomas, PhD, Professor of Pharmacology and AssoO f Medicine, West Virginia uniciate Dean, versity, Morgantown, W V 26506.
Let’s Teach Our Children What They Want to Know National Family Sex Education Week October 10-16, 1976 Parents are the sex educators of their own children, whether they do it well or badly. Silence and evasiveness are just as powerful teachers as are the facts. Everybody says that parents should be the primary sex educators, but who is preparing the parents for this role? Indeed, in terms of the values and spiritual life of the child, no outside group or agency could replace the family. Thus, we see education for sexuality taking place within the context of the family’s value system which hopefully strives toward a family life free of racism, sexism and prejudices against people with other values. Most churches and educators officially s u p port this position, but few are doing anything about it. Studies consistently have revealed that children do not acquire the information they need from parents. I t is time for parents to assume this responsibility. Parents, of course, cannot be the sole educators; if they wanted to be, they would have to prevent their children from reading books, newspapers and magazines, keep them away from television, movies and public bathrooms, and certainly prohibit them from having any friends a t all. Parents are the main educators, with schools, religious and community groups as partners in a life long process. Society consistently underestimates the capabilities of parents and their children. You can’t tell a child too much: Knowledge doesn’t stimulate inappropriate behavior, ignorance does. If you tell children more than they can understand, they will ask another question or turn you off. Parents must work toward being ASKABLE. We know most parents want to educate their children, but they are often uncomfortable and don’t know how. Obviously, parents who find it difficult to talk to their children about any important issue will not be ready to talk about sex. However, it seems that most parents are ready, but want some support. I t is essential for parents to be alert to extremist propaganda and political maneuvering, especially by those groups claiming to have a monopoly on the Judeo-Christian ethic. Censorship in the schools and media is one method used by extremist groups who want to impose their views on everybody. Parents should not be intimidated by scare tactics used as subterfuges for acquiring power on school boards or i n churches. In support of these principles, PTA’s, foundations, church and synagogue related groups and community organizations can develop ongoing institutes, workshops, seminars and media presentations, and put together bibliographies and library and bookstore displays, to get the public involved (continuing education is more effective than oneshot lectures). I t is expected that religious groups in particular will develop programs based on their own moral beliefs. Community minded groups should discover opportunities for getting their message heard via public service options on TV and radio, as well as in newspapers and magazines. We must counter the propaganda that information is harmful or constitues license for irresponsible behavior. It’s time that the “silent” majority expressed itself vigorously, visibly and vocally. The Institute for Family Research and Education was established in 1970 for the purpose o f improving the quality of individual and family life through operations in three mutually supportive areas: Education, communications, and research. The Institute is a program of Syracuse University’s College for Human Development. The Institute’s activities are based on the philosophy that groups and individuals will be most receptiue to communication which they perceive as attempting to meet their particular needs. Primary emphasis has been placed on reduction of unwanted pregnancy and venereal disease, and helping parents to assume their role as the primary sex educators of their children.
THE JOURNAL
OF SCHOOL HEALTH
465
