| CNS issues are
often the most apparent and prevalent of the medical problems faced by adults
with DD. Up to 50% of adults with DD
have a seizure disorder. The majority
of these individuals have complex partial seizures but the entire spectrum of
seizure types may be seen. Myoclonus
may be present and difficult to diagnose and treat. Lennox-Gasteaux syndrome poses additional problems when the
individual has concomitant osteopenia and is therefore at higher risk for
fracture during falls. |
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| Occasionally the
clinician is faced with the diagnostic dilemma of differentiating behavioral
episodes from seizure. Careful
descriptions from observers, logs and video clips of the behavior often
clarify the issue. Input from a
skilled epileptologist can be helpful.
Certain diagnostic procedures such as video-EEG monitoring are
essential in complex cases. |
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| Brief seizures
are rarely harmful but status epilepticus can be a life-threatening event
that demands both an immediate intervention and prospective care
planning. Families and direct care
staff should have a clear understanding of the appropriate steps to be taken
when a seizure is prolonged. Issues
such as positioning of the patient during the seizure as well as the
components of after-seizure care, such as monitoring symptoms for potential
occult aspiration and subsequent pneumonia, should be addressed with clear
and specific instructions. Directions
should be given as to who and when to call for outside medical assistance. It is highly advisable that the patient
receive a thorough medical evaluation after any prolonged seizure
episode. When anticonvulsants have
been prescribed for psychiatric reasons in an individual with a seizure
disorder, a common occurrence, very clear and open communication between the
different specialists and between specialist and PCP must be maintained. In particular there should be an explicit
and clear decision made as to who will be prescribing which medications and
monitoring their levels and side effects. |