Treatment of epilepsy in people with multiple handicap.

Eight years ago, the writer visited a home for severely handicapped children, many of whom were epileptic. As it was school holidays, they were all in the hall of an old manor house used as a children's home. In an hour six of the 40 children had a fit, and six slept on, unrouseable. The experience was memorable. Since then 51 very severely handicapped epileptic children age between 2 and 16 have been managed personally for at least two years. It has been surprising to see how the treatment pattern has changed over the years, and pleasant to see how few children are now having frequent fits, or are heavily sedated. These children are used as illustrations of the principles involved. Multiply handicapped people are well known to have epilepsy that is difficult to treat,' especially severely brain damaged children, children with onset of fits in the first year of life, or children who have had infantile spasms or Lennox-Gastaut myoclonic fits.2 3 All the children described fall into at least one of these categories. Previous papers on epilepsy in people with multiple handicaps have been about adults.' Controlling fits in 'normal' children with one drug can be surprisingly difficult,7 and in those with brain damage, it is likely to be even more difficult. However, it is still better to treat with one drug rather than a cocktail.8