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Many relatives of people with epilepsy are naturally concerned as to what may happen during a seizure if they are not present to assist. We have known this anxiety carried to extremes. One of our patients, an epileptic woman of 30, was still sharing her parents’ bedroom, as they were concerned that she might come to harm during a nocturnal seizure, even though she had had none for 15 years! In practice, harm resulting from seizures is exceptionally rare, but there are a few sensible precautions.

Epilepsy as a social weapon-Families must be aware of ways in which epilepsy can be ‘used’. The child or young person with epilepsy, knowing of his parents’ anxiety about him, may manipulate them into granting him unreasonable requests. They may give in to feeling sorry for his difficulties, or they may feel that they should avoid an emotional upset that might precipitate a seizure. There is no reason why a child with epilepsy should not experience the same discipline as his siblings, who will themselves become jealous and unruly if they feel that one member of the family is being spoiled.

The other side of the coin is that parents may use the threat of epilepsy as a means of controlling behaviour which they otherwise cannot control. Examples we have met include limiting the hours of television watched, and the lateness of the hour by which an adolescent with epilepsy must return home.

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It would be more difficult to identify the events or circumstances that might trigger the autoimmune process for rheumatoid arthritis. The macrophage involvement is identical, of course.

So what signs would you look for? It’s well known that rheumatic fever often results in rheumatoid arthritis. We also know that aching joints are often present during several types of flu infections. Nobody seems to have established any connection between the flu and any subsequent appearance of rheumatoid arthritis. But then, I don’t think anybody has investigated that possible connection.

Actually, nobody seems to know what triggers the autoimmune arthritic process so we don’t know what events or circumstances to look for. In the medical dictionaries “rheumatoid arthritis” is simply defined as an inflammation of the joint that causes changes in the connective tissue. Cause unknown.

Our best advice to anyone thinking of CMO as a preventive for rheumatoid arthritis is to be suspicious of any joint pain.

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Symptom

Scaly, red rash

Home care

Apply a nonprescription antifungal ointment to the infected area until the skin is clear. If you do not know which preparation to use, ask your doctor.

Precautions

-    If a rash does not improve with home treatment, see the doctor. The rash may not be ringworm at all.

-    If home treatment seems to make the rash worse, discontinue treatment and see the doctor. The child’s skin may be sensitive to the medication you’re using.

Ringworm is actually a skin infection caused by a fungus. Ringworm spreads by direct contact with an infected person or pet animal, or by indirect contact with contaminated objects such as combs, pillows, towels, clothing, even the floor.

Signs and symptoms

Different funguses prefer different areas of the body. Ringworm of the scalp (tinea capitis) appears as scaly patches with stubs of broken-off hairs on the scalp. Ringworm of the body (tinea corporis) shows up as round or oval red, scaly patches that enlarge while healing proceeds from the center. Ringworm of the groin (tinea cruris) is characterized by a red or brown scaly rash on the crotch and the genital area and has a sharply defined margin of spread. Ringworm of the feet (athlete’s foot, or tinea pedis) affects the feet and sometimes the ankles and legs. The diagnosis of ringworm is based on your child’s history and close inspection of the rash. The diagnosis is confirmed by laboratory tests.

Home care

Antifungal ointments such as haloprogin, chlortrimazole, tolnaftate, and undecylenic acid ointments can be applied to the infected area until the skin clears.

Precautions

• Several other common rashes resemble ringworm. If a rash does not improve after several days of home treatment see your doctor.

• The preparations used to treat ringworm may cause another rash on sensitive skin. If the rash worsens or changes in any way, stop home treatment and see your doctor.

Medical treatment

Your doctor can confirm a home diagnosis of ringworm by examining your child’s rash under ultraviolet light, and by culturing a skin scraping and examining the results under the microscope. The doctor may prescribe an antifungal ointment to be applied to the skin, or a medication such as griseofulvin fungicide for the child to take by mouth.

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