There is some evidence to suggest that certain dogs might be able to sense the onset of a seizure.
POSITIVE FACTS:
Beneficial effect of dogs on human health (i.e positive influence on seizure frequency).
Improved quality of life (i.e more freedom to get out and about).
Psychological and social benefits.
NEGATIVE FACTS:
Untrained dogs can react badly.
FURTHER READING
1. Should people with epilepsy have untrained dogs as pets - V.Strong et al., Seizure., (96):427-430, 2000
2. The use of seizure alert dogs - V.Strong et al., Seizure., 10:39-41 2001
3. Seizure-alert dogs fact or fiction - V.Strong et al., Seizure., 8:62-65 1999
4. Companion animals and human health: an overview - A.T.B Edney., Journal of the Royal Society of Medicine., 88:704-708 1995
5. Social acknowledgements for children with disabilities: effects of service dogs - B. Mader et al., Child Development., 60:1529-1534 1989
6. Dogs and human epilepsy - A.T.B Edney., Veterinary Record., 132:337-338 1993
INFORMATION ON THE WEB
Support Dogs is a UK charity dedicated to improving the quality of life for people with epilepsy and people with disabilities by training dogs to act as efficient and safe assistants.
Web: SUPPORT-DOGS.ORG.UK
Sleep Safe pillows are specially designed pillows that can help prevent suffocation.
These pillows are available from:
Chester Mobility Centre, 18 Knutsford Way, Sealand Industrial Estate, Chester, CH1 4NS
Tel: 01244 377363
If your child is getting Disability Living Allowance at the higher rate for help getting around (mobility component), you can get an blue badge for a vehicle. This means the vehicle can be parked in some no-parking areas. It does not have to be your vehicle, but it must be used only for your childs needs.
How can I find out more?
You can find out more about the blue badge scheme from your local council or from the Social Services.
This article originally appeared in the Prescriber on the 19th of february 2002.
In general practice there is a major difference between the way we treat pain in children, as compared to adults. Both have the benefit of paracetamol and ibuprofen but only adults are allowed to have the medium strength opiates such as codeine, dextropropoyphene and dihydrocodeine. Children being treated in hospices have a wide variety of medium and strong opiates available but in general practice there are none.
Children regularly suffer from moderate pain with such conditions as otitis media, fractured limbs and burns yet all we give is simple paracetamol or ibuprofen. We deem these as sufficient and no one seems to question this status quo. Imagine the outcry if all moderate pain relief in adults was similarly limited. I can well remember the deep aching pain of a greenstick fracture when I was 8 years old and how little relief the paracetamol or aspirin gave. Fortunately I was given an equagesic tablet, which had a remarkably beneficial effect, and thus my personal experience is that moderate opiates help in paediatric pain extremely well. I have three boys, now in their teens, but when they were young, like so many others they suffered otitis media with distressing pain that would typically come on a few hours after going to sleep. Paracetamol even in combination with ibuprofen did little to help and we had a few terrible sleepless nights. Then I discovered a source of codeine and paracetamol that I could give to infants from the age of two up, and from then on, otitis media was no longer a problem and even the afflicted child would sleep well.
When pain is no longer a problem there is little pressure to use antibiotics. Sometimes the drum gives way and there is no need for grommets. The Cochrane review on antibiotics and otitis media recommends far less use of antibiotics. However, how can we as GPs tell parents we are not prescribing antibiotics when the child is crying in pain? With effective pain control however, this is an acceptable option. I have been treating my patients this way for the last ten years with a lot of parental gratitude, no problems and a low demand for grommets. Although this analgesia is readily available and very safe it is not licensed for children under age 12 and few GPs seem to use it.
The preparation that I use is the effervescent formulation of paracetamol and codeine marketed as Tylex or Solpadol. It is only available on prescription and the large tablets are readily and accurately broken up into quarters or halves to give an appropriate paediatric dose. The piece is then dissolved in a small amount of water or juice and swallowed. The recommended dosage of codeine in children is 1mg/kg body weight.
An average 2 year old will weigh at least 10 kg so ¼ tablet is well within recommended range. A five year old is at least 20kg so ½ tablet is appropriate and from 7 years on ¾ tablet is fine until the age of 10 when a whole tablet is needed. These give excellent pain control and the doses of both paracetamol and codeine are well within recommended guidelines. The Bandolier meta analysis of common analgesics in adults showed a remarkable effectiveness of the paracetamol/codeine combination with an NNT of 2. This was far more effective than either ingredient alone or other combinations. There have been almost no good trials of analgesics in children in the community either in this country or abroad. The limited research tends to come from surgical and oncology units and they tend to prefer the use of morphine.
We are not the only nation that ignores paediatric pain relief. I've checked out with some of our colleagues abroad and they seem to do the following:-
Germany. Tramadol is popular in hospitals, but in the community it is paracetamol and ibuprofen only.
France. Although there is a syrup of codeine with 1mg /ml called 'Codenfan' ('codeine pour enfants') it is not much used and there is no mention of it during the GPs training. When I drew attention to it the GPs I spoke to were amazed at its existence and keen to give it a try.
Holland Like the UK there is no use of codeine in children.
USA. Again, no use of codeine in children.
My partners and I in our group practice of 13,500 patients have had excellent results from using this analgesic in children, and my investigations so far show no good reason why it should not be more widely used. I doubt that the pharmaceutical industry will be able to do provide a licenced formulation as in France but there is nothing to stop us as caring GPs from prescribing below the indicated age when it is so evidently safe and effective. I would be interested to hear the views of other GPs and Paediatricians on this subject. In particular I would like to know if there are any good reasons why it shouldn't be a more widespread and accepted practice.
If you would like to contact Dr Heatley regarding his article you can email him at: enquiries@holbrooksurgery.com
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TYPES OF SEIZURE
DIAGNOSIS
ANTICONVULSANTS IN GENERAL
OTHER TREATMENTS
MISCELLANEOUS
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