Most people with frequent seizures are looked after at home by devoted parents or partners. Sometimes a fragile situation breaks down and it is clear that a person with epilepsy cannot cope at home. Obviously if it is believed that this is a purely temporary setback likely to be improved by modification of anti-epileptic medication, then the family doctor will arrange a short stay in a neurological unit or in a special centre for epilepsy. Occasionally, however, it is obvious that neither the domestic situation of the person with epilepsy, nor their epilepsy, is going to improve in the foreseeable future, and long-stay care has to be arranged. The precipitating factor is very often the illness or death of the last surviving supporting relative.

In the middle of the last century, an increasing social commitment to those less fortunate than the majority resulted in the establishment of ‘colonies’ for people with epilepsy. The general plan of such colonies in Europe was of a totally self-contained institution. During the day, the people with epilepsy would work in the open air, in arable and stock farming, and at night they would return to dormitories, or, in the more advanced colonies, to small houses in which some semblance of a family circle was maintained. Many people with severe epilepsy spent the greater part of their lives in such institutions. Unfortunately there is still a need for such long-term care. In the UK there are approximately 2000 people with epilepsy in the former colonies, now called centres for epilepsy, and perhaps another 3000 in other types of residential accommodation supported by local authorities.

An intriguing fact is that about one sixth of those in the epilepsy centres have rare

seizures—less often than once a year. Some of these epilepsies have, as it were, burnt themselves out, but the subject has been so long in the institution that they have no base or family circle to which they may return, and the centre is a much-loved home. The other explanation is that epilepsy, although a ‘required’ disorder for admission to the centres for epilepsy, may not be in itself a great problem—the major reasons for admission being associated impairment of intellect or major physical disability due to brain damage, of which epilepsy is only one symptom. By and large, those in special centres for epilepsy have what has been termed ‘epilepsy plus’—epilepsy plus some other major handicap.

The role of the former colonies has gradually changed over the years. First, the word colony, with its implications of dependency, has been dropped, and the name ‘centre for epilepsy’ has been adopted. Secondly, the centres have established much closer links with university departments of neurological sciences. Indeed much of the best research work in epilepsy in Europe emanates from the former colonies. Thirdly, the centres have taken a greater role in the assessment of patients with severe epilepsy, admitting them for neurological and occupational evaluation for a short period of a few weeks. Fourthly, they are more outward-looking in the employment of people with epilepsy. Sometimes the centre is used as a hostel to which people with epilepsy who can almost, but not quite, manage on their own can return at night.

All this activity does mean that the primary role for which the colonies were established—a sheltered residential home for those people with epilepsy unable to cope outside—is in danger of being submerged. We can tell when this is happening to a centre, because my letter requesting admission for a patient received a reply that the patient ‘would not benefit’ from residence in the centre. In a small proportion of cases, one has to accept that benefit is not likely to occur, and all that is wanted is a clean, quiet, and kind place to live.

*86\188\2*

Body odor is a common, distressing, and embarrassing problem that is not always easy to prevent, correspondence in the Western Journal of Medicine (146:367) reports.

In one case, an extremely foul body odor had suddenly developed and had persisted in spite of all attempts to control it with special soaps, extra bathing, and frequent changes of antiperspirant and deodorant.

On carefully reviewing this man’s routine, his doctor discovered that he had recently started using Fresh Start laundry detergent, and suggested that he try another one. The man did so and was pleased to find that his odor problem immediately went away. Furthermore, now that he understood the problem, he was able to explain why his body odor returned not long after he had put on clothing which had been laundered with Fresh Start.

Obviously, the odor was produced by some kind of reaction occurring between his skin chemistry and the detergent residue in his clothes. Others with stubborn cases of B.O. might also wish to try using another detergent brand.

*201\143\2*

Precautions

-    Sickle cell trait and sickle cell dig occur most often in those of African descent. Children of black parent other parents with a family history sickle cell disease should be tested before the age of one year.

-    A child with sickle cell disease may get frequent infections and illness Treat all infections immediately.

-    If a child with sickle cell disease r a high fever, call the doctor.

-    A child with the disease should ha frequent checkups.

-    A child with the disease may need special treatment before surgery î dental work.

-    No special treatment is needed if the child has sickle cell trait.

Sickle cell anaemia, also called sickle cell disease, is an inherited blood disease. It is caused by an abnormality in the hemoglobin, which is a form of protein that helps the red blood cells to carry oxygen through the bloodstream. The abnormal hemoglobin makes the red blood cells become rigid and sickle-shaped (hence the name hemoglobin S). The deformed blood cells have difficulty passing through the blood vessels. In addition, normal blood cells are constantly destroyed and replaced by the body, but these abnormal cells are destroyed more quickly than normal ones. The replacement process cannot keep up with the destruction of the sickled cells, and this causes recurrent anaemia.

Sickle cell trait and sickle cell disease are most common among people of African descent. The disease is also found in people from certain areas of India, Greece, Italy, and the Middle East.

A child may be born with sickle cell trait or sickle cell disease. A child with the trait has about 40 percent hemoglobin S and 60 percent normal hemoglobin. The child will function normally and will show no signs of the disease. However, the child carries the trait in his or her genes and either the trait or the disease may appear in the next generation. If the child marries someone who also has the trait, the chances of their child having the disease are greatly increased.

*188/84/5*