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Three interlocking circles, the area of which is roughly proportional to the frequency of occurrence of various types of seizure. The central circle incorporates tonic-clonic (grand mal) seizures. The left-hand circle contains partial seizures, many of which become secondarily generalized, as indicated by the considerable overlap between the two circles. Most partial seizures arise from some focal area of structural abnormality within the brain. These seizures can be said to be symptomatic of some underlying problem—so-called symptomatic epilepsy.

The right-hand circle indicates typical absences (petit mal seizures). About 30 per cent of children with petit mal also have grand mal seizures, as is indicated by the overlap between right hand and centre circles. Such primary generalized epilepsy is not symptomatic of underlying structural brain disease, and may be said to be constitutional or idiopathic epilepsy.

The area of the centre circle that is not overlapped by the left and right hand circles contains those subjects who only have tonic-clonic (grand mal) seizures. Such cryptogenic epilepsy (epilepsy of hidden cause), less common since the advent of sophisticated investigations, should not be called idiopathic. Two possibilities exist—either the petit mal trait was not obvious in childhood, and grand mal seizures are the only manifestation of idiopathic epilepsy, or the seizure discharge from a small lesion becomes generalized so quickly that its initial partial phase is overlooked. It is often difficult to distinguish between the two possibilities even with prolonged EEG recording, unless a seizure actually occurs during the record.

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Symptoms: feeling of breathing difficulty, when the child is actually getting many fall breaths of air; tingling or numbness in hands and feet; muscle spasms; fainting.

Home care:

Remain calm and reassure the child.

Have the child breathe into a paper bag placed loosely over the mouth and nose.

Precaution

Rapid, deep breathing that causes fainting has become a party stunt in some circles. Discourage

this kind of game.

Hyperventilation is a breathing difficulty in which too-rapid or too-deep breathing causes a marked loss of carbon dioxide from the blood. There are many physical illnesses that cause difficulty in breathing, including asthma, diphtheria, colds, croup, hay fever, and pneumonia. Hyperventilation, however, is not a physical illness at all. It causes the sensation of difficult breathing or air hunger, but there is no physical condition preventing the person from taking in or letting out air.

Hyperventilation is common in older children, teenagers, and young adults. The person complains, often bitterly or fearfully, of being unable to “get enough air,” while at the same time taking deep breaths in and out with no visible difficulty. The rate of breathing may be rapid or normal. There is no abnormal sound to the breathing as in croup, bronchitis, or asthma. Temperature and color are both normal, and there is no cough. In fact, the deep breathing can be recognized as sighing, one sigh right after another, and lasting for minutes or hours. The cause is essentially the same as that of sighing: nervous tension, fear, anxiety, or depression.

If hyperventilation continues long enough, the person will experience tingling and numbness in the hands and feet, followed by spasms of the muscles that control the hands, fingers, ankles, and toes. This is caused by breathing out too much carbon dioxide. If hyperventilation continues long enough, fainting can occur. Unconsciousness temporarily cures the condition, and the person recovers.

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