Background
Jessica Wang is a 16-year-old girl who loves playing tennis, hanging out with her friends, and
volunteering at the local animal shelter. She is the oldest of three children in her family. Jacen, her
brother, is 12 years old, and her little sister, Jennifer, is 8 years old. Jessica’s parents are Lian and
Mei Wang. Currently, Jessica is a sophomore in high school and is taking a driver’s education
course to gain experience and hours to get her driver’s license by the time she turns 17. At school,
she is enrolled in honors courses and is a member of several clubs and groups, including the school
newspaper and drama club. Recently, although a quiet and reserved teen, Jessica has been hanging
out more with friends and has even been invited to some weekend parties.
Jessica, along with her siblings, was born and has been raised in the United States. However,
her parents, Lian and Mei, immigrated to the United States when they were in college. When
Jessica was a baby, her paternal grandparents immigrated to the United States, as well. In their
home, the Wangs speak both Mandarin, the official spoken language of China, and English.
Jessica’s grandparents, who live in the Wang home, do not speak much English. Many of the
traditional customs of the Chinese culture are present in the Wang household, because her
grandparents insist that the grandchildren are raised with the knowledge and awareness of their
ancestors. Lian and Mei agree and are much appreciative of the grandparents’ knowledge and
willingness to teach the children the language and customs of their ancestors.
Box 9.1 Epilepsy
Epilepsy is a serious, common neurological disease and seizure disorder that affects males and
females of all races, ethnicities, and ages. Most often, epilepsy presents in early childhood or
older adulthood. Each year, approximately 460,000 children, from newborns to 17-y-olds, are
treated in the United States for epilepsy (Centers for Disease Control, 2016). There are many
types of seizures, but seizures can be separated into two categories, according to whether one
or both sides of the brain are affected. Seizures that affect only one side of the brain are
classified as focal seizures, whereas seizures that affect both sides of the brain are classified as
generalized seizures. Box 9.2 defines each category and gives examples of the types of
seizures that fall into each category. Recall that Jessica has a generalized seizure disorder and,
specifically, has tonic-clonic seizures.
Epilepsy is diagnosed on the basis of one of the following:
•The occurrence of at least two unprovoked seizures more than 24 h apart
•The occurrence of one unprovoked seizure with a high probability of recurrence within the
next 10 y
•A diagnosis of an electroclinical syndrome when evaluated by a neurologist (Fisher et al.,
2014)
At the age of 4, Jessica had her first seizure. She had been ill with an upper respiratory virus and
had been running a fever. Initially, she was treated for a febrile seizure and released from the
hospital emergency department. Several months later, while playing on the playground, Jessica
had another seizure. By the age of 5, she had had six seizures and was being seen by a pediatric
neurologist for epilepsy (Box 9.1). Specifically, Jessica has tonic-clonic seizures, also known as
convulsions (Box 9.2).
She began taking antiepileptic medications after her third seizure and has been on medications
to prevent seizures since then. In the first year after diagnosis, Jessica’s parents were reluctant to
consistently give her the antiepileptic medications. Lian and Mei were torn between listening to
,Lian’s parents and trusting the doctors who were caring for Jessica. In traditional Chinese medicine
(TCM), physical illness is an imbalance in yin and yang (hot and cold). Therefore, Jessica’s
grandparents often thought that Jessica was having an imbalance in harmony and yin and yang
(Healthcare Chaplaincy, 2013). Also, those who practice TCM often stop taking medications when
the symptoms disappear or are not obvious, or if side effects are present (Healthcare Chaplaincy,
2013). Jessica was sleepier at times when she first started her antiepileptic medications, and her
grandparents did not believe that a child should suffer from the side effects of medications. They
often persuaded Lian and Mei to not give Jessica her medication.
Box 9.2 Seizures: Types and Definitions
Focal Seizures
Definition
Episodes of abnormal electrical brain activity in one or more areas on one side of the brain; also
known as partial seizures
Types
•Simple focal: The patient is not likely to lose consciousness, may smell or taste something
strange, and may see flashes of light or feel dizzy; fingers, arms, and legs may twitch briefly.
•Complex focal: It begins as a simple focal seizure and may include lip smacking, gagging, or
rhythmic movements; it progresses to impairment in consciousness.
Generalized Seizures
Definition
Episodes of abnormal electrical brain activity in both sides of the brain with loss of
consciousness and a postictal state afterward
Types
•Absence: The patient stares blankly, does not remember, and does not respond during the
episode; the seizure lasts a few seconds.
•Atonic: The patient’s muscles suddenly go limp; the patient is at high risk of injury from
falling or dropping items.
•Generalized tonic-clonic (formerly known as grand mal): The patient’s body shakes, stiffens,
and jerks. The seizure may last 133 min or longer. The patient may lose consciousness or
control of bowel or bladder.
•Tonic: The patient’s muscles in the arms, legs, and trunk tense up; the seizure often occurs
during sleep.
•Clonic: The patient’s muscles spasm and jerk rhythmically in the arms, face, neck, or legs;
the seizure may last several minutes.
•Myoclonic: The patient’s muscles suddenly jerk.
Adapted from Beaumont Health. (n.d.). Types of seizures in children . Retrieved
from https://www.beaumont.org/conditions/types-of-seizures-in-children
Adherence to antiepileptic medication therapy is essential and has been shown to have an impact
on both short-term and long-term outcomes for children with epilepsy. According to a study by
Modi, Rausch, and Glauser (2014), 31% of children who were nonadherent with antiepileptic
medications after initial diagnosis continued to have seizures 4 years after diagnosis vs. only 12%
of those with near-perfect adherence to their medication regimen. Jessica has had about one or two
seizures a year since the age of 7. Most of these have been associated with missed doses of
, medication or additional stressors. Jessica has been on several antiepileptic medications since
being diagnosed, including phenytoin, carbamazepine, and phenobarbital, all of which made her
sleepy. For the past 5 years, Jessica has been taking levetiracetam and divalproex (The Pharmacy
9.1).
Anticonvulsants
The Pharmacy 9.1
CNS, central nervous system; GABA, gamma-aminobutyric acid; IM, intramuscular; IV, intravenous; OTC, over-
the-counter; PO, by mouth; SJS, Stevens3Johnson syndrome; TEN, toxic epidermal necrolysis.
Adapted from Taketomo, C. K. (2018). Pediatric & neonatal dosage handbook (25th ed.). Hudson, OH:
Lexicomp.
Jessica Wang is a 16-year-old girl who loves playing tennis, hanging out with her friends, and
volunteering at the local animal shelter. She is the oldest of three children in her family. Jacen, her
brother, is 12 years old, and her little sister, Jennifer, is 8 years old. Jessica’s parents are Lian and
Mei Wang. Currently, Jessica is a sophomore in high school and is taking a driver’s education
course to gain experience and hours to get her driver’s license by the time she turns 17. At school,
she is enrolled in honors courses and is a member of several clubs and groups, including the school
newspaper and drama club. Recently, although a quiet and reserved teen, Jessica has been hanging
out more with friends and has even been invited to some weekend parties.
Jessica, along with her siblings, was born and has been raised in the United States. However,
her parents, Lian and Mei, immigrated to the United States when they were in college. When
Jessica was a baby, her paternal grandparents immigrated to the United States, as well. In their
home, the Wangs speak both Mandarin, the official spoken language of China, and English.
Jessica’s grandparents, who live in the Wang home, do not speak much English. Many of the
traditional customs of the Chinese culture are present in the Wang household, because her
grandparents insist that the grandchildren are raised with the knowledge and awareness of their
ancestors. Lian and Mei agree and are much appreciative of the grandparents’ knowledge and
willingness to teach the children the language and customs of their ancestors.
Box 9.1 Epilepsy
Epilepsy is a serious, common neurological disease and seizure disorder that affects males and
females of all races, ethnicities, and ages. Most often, epilepsy presents in early childhood or
older adulthood. Each year, approximately 460,000 children, from newborns to 17-y-olds, are
treated in the United States for epilepsy (Centers for Disease Control, 2016). There are many
types of seizures, but seizures can be separated into two categories, according to whether one
or both sides of the brain are affected. Seizures that affect only one side of the brain are
classified as focal seizures, whereas seizures that affect both sides of the brain are classified as
generalized seizures. Box 9.2 defines each category and gives examples of the types of
seizures that fall into each category. Recall that Jessica has a generalized seizure disorder and,
specifically, has tonic-clonic seizures.
Epilepsy is diagnosed on the basis of one of the following:
•The occurrence of at least two unprovoked seizures more than 24 h apart
•The occurrence of one unprovoked seizure with a high probability of recurrence within the
next 10 y
•A diagnosis of an electroclinical syndrome when evaluated by a neurologist (Fisher et al.,
2014)
At the age of 4, Jessica had her first seizure. She had been ill with an upper respiratory virus and
had been running a fever. Initially, she was treated for a febrile seizure and released from the
hospital emergency department. Several months later, while playing on the playground, Jessica
had another seizure. By the age of 5, she had had six seizures and was being seen by a pediatric
neurologist for epilepsy (Box 9.1). Specifically, Jessica has tonic-clonic seizures, also known as
convulsions (Box 9.2).
She began taking antiepileptic medications after her third seizure and has been on medications
to prevent seizures since then. In the first year after diagnosis, Jessica’s parents were reluctant to
consistently give her the antiepileptic medications. Lian and Mei were torn between listening to
,Lian’s parents and trusting the doctors who were caring for Jessica. In traditional Chinese medicine
(TCM), physical illness is an imbalance in yin and yang (hot and cold). Therefore, Jessica’s
grandparents often thought that Jessica was having an imbalance in harmony and yin and yang
(Healthcare Chaplaincy, 2013). Also, those who practice TCM often stop taking medications when
the symptoms disappear or are not obvious, or if side effects are present (Healthcare Chaplaincy,
2013). Jessica was sleepier at times when she first started her antiepileptic medications, and her
grandparents did not believe that a child should suffer from the side effects of medications. They
often persuaded Lian and Mei to not give Jessica her medication.
Box 9.2 Seizures: Types and Definitions
Focal Seizures
Definition
Episodes of abnormal electrical brain activity in one or more areas on one side of the brain; also
known as partial seizures
Types
•Simple focal: The patient is not likely to lose consciousness, may smell or taste something
strange, and may see flashes of light or feel dizzy; fingers, arms, and legs may twitch briefly.
•Complex focal: It begins as a simple focal seizure and may include lip smacking, gagging, or
rhythmic movements; it progresses to impairment in consciousness.
Generalized Seizures
Definition
Episodes of abnormal electrical brain activity in both sides of the brain with loss of
consciousness and a postictal state afterward
Types
•Absence: The patient stares blankly, does not remember, and does not respond during the
episode; the seizure lasts a few seconds.
•Atonic: The patient’s muscles suddenly go limp; the patient is at high risk of injury from
falling or dropping items.
•Generalized tonic-clonic (formerly known as grand mal): The patient’s body shakes, stiffens,
and jerks. The seizure may last 133 min or longer. The patient may lose consciousness or
control of bowel or bladder.
•Tonic: The patient’s muscles in the arms, legs, and trunk tense up; the seizure often occurs
during sleep.
•Clonic: The patient’s muscles spasm and jerk rhythmically in the arms, face, neck, or legs;
the seizure may last several minutes.
•Myoclonic: The patient’s muscles suddenly jerk.
Adapted from Beaumont Health. (n.d.). Types of seizures in children . Retrieved
from https://www.beaumont.org/conditions/types-of-seizures-in-children
Adherence to antiepileptic medication therapy is essential and has been shown to have an impact
on both short-term and long-term outcomes for children with epilepsy. According to a study by
Modi, Rausch, and Glauser (2014), 31% of children who were nonadherent with antiepileptic
medications after initial diagnosis continued to have seizures 4 years after diagnosis vs. only 12%
of those with near-perfect adherence to their medication regimen. Jessica has had about one or two
seizures a year since the age of 7. Most of these have been associated with missed doses of
, medication or additional stressors. Jessica has been on several antiepileptic medications since
being diagnosed, including phenytoin, carbamazepine, and phenobarbital, all of which made her
sleepy. For the past 5 years, Jessica has been taking levetiracetam and divalproex (The Pharmacy
9.1).
Anticonvulsants
The Pharmacy 9.1
CNS, central nervous system; GABA, gamma-aminobutyric acid; IM, intramuscular; IV, intravenous; OTC, over-
the-counter; PO, by mouth; SJS, Stevens3Johnson syndrome; TEN, toxic epidermal necrolysis.
Adapted from Taketomo, C. K. (2018). Pediatric & neonatal dosage handbook (25th ed.). Hudson, OH:
Lexicomp.
