Epilepsy is one of the most common neurological conditions affecting people around the world. Characterized by frequent seizures, epilepsy can leave the child paralyzed or even unconscious at any time, making it a serious threat that cannot be ignored.
repertuar.spb.ru tells you about epilepsy in children, how you can recognize it and how it can be treated.
What Is Epilepsy?
The brain follows a synchronous pattern to send electrical signals to control the different functions and senses of the body. Epilepsy is a neurological condition that affects the transmission of these signals. A person can develop epilepsy at any age. However, the incidence rate is known to be higher in children under 20 years (3).
When a person has epilepsy, the brain signals are disrupted, and an epileptic seizure begins in the brain. An epileptic child can experience different types of seizures affecting the entire body or just a particular part. That said, not all seizures are epileptic, which is why it is important to understand what happens to the child during a seizure and what you can do about it.
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Epilepsy affects the individual physically in the form of seizures also referred to as ‘fits’. These occur when the communication of neurons from and to the brain is disturbed. These seizures can be focal or generalized seizures.
Generalized seizures affect neurons or cells on both sides of the brain, and can manifest in convulsions ranging from barely noticeable to severe fits. They may result in loss or impairment of consciousness sometimes. Generalized seizures can be (4):
- Atonic seizures that limp the muscles, causing the patient’s body to crumple down to the floor, often resulting in injuries.
- Absence or Petit Mal are fits that occur suddenly, when the patient becomes motionless and stares straight ahead. These are uncommon and last for at least 15 seconds.
- Myoclonic fits lead to increased muscle tone, causing muscle spasms or jerks in a particular body part.
- Clonic seizures cause the child’s body to spasm and jerk. During this seizure, the legs, hands and elbows first flex and then relax, slowly at first and then at a greater speed.
- Tonic seizures stiffen the muscles first and then result in loss of consciousness. The muscles of the head, chest, and hands contract causing the back to arch and the eyes to roll back into the head. The person has difficulty breathing.
- Tonic-clonic seizures, earlier referred to as Grand Mal seizures, are perhaps the most difficult. They have several phases, starting with loss of consciousness followed by the tonic phase, and then the clonic phase.
Focal seizures are partial seizures that affect only a particular part of the brain. These seizures can be simple focal seizures, which occur in less than 15% of people with epilepsy, and dyscognitive focal seizures, which occur in more than 35% of people having epilepsy (5). Both simple and dyscognitive focal seizures affect only one part of the brain. However, dyscognitive focal seizures cause confusion, loss of memory and awareness, while simple focal seizures do not affect the child’s cognitive abilities. Further categorization of focal seizures is based on where they begin and what they affect.
When the child is awake and aware during the seizure, it is called focal onset aware seizure. When the child is confused or not entirely awake during the episode, it is called focal onset impaired awareness. If the beginning of a seizure is not known or if no one observes the seizure, it is called unknown onset seizure.
This means that not all seizures indicate epilepsy. So, how do you know if it is an epileptic seizure? More importantly, what should you do if you suspect that the child has an epileptic seizure?
Keep reading to find out.
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Symptoms Of Epilepsy In Children
The symptoms of epilepsy depend on where the seizure had begun and which part of the body it has affected, and can be physical or mental. So, what happens during a seizure depends on the type of seizure the child has. Epileptic seizures are usually characterized by the following:
- Severe jerking or convulsions of the body
- Weakness or numbness of the muscles
- Rigid or tensed muscles
- Muscle twitching
- Epileptic spasms
- Repetitive movements such as clapping hands or rubbing hands, chewing, running, or lip smacking indicate focal seizures
- Inability to swallow, drooling
- Difficulty talking
- Losing control of urine or stool suddenly, especially during a seizure
- Biting of tongue
Non-motor or absence symptoms
- Changes in sensations, emotions, or cognition, usually before a seizure – these could include déjà vu (a feeling of having been at a place or experiencing something earlier too, although it didn’t) and jamais vu (a feeling that something is familiar although it isn’t)
- Brief twitches
- Staring spells (Absence fits), which can be mistaken for daydreaming
- Changes in internal functions such as gastrointestinal activity, heat or cold waves, rapid heartbeat, and goosebumps
- Dilation of pupils
- Change in skin color – looks pale or flushed
Unknown onset non-motor seizure symptoms could include behavior arrest, which means that the child suddenly stops what he is doing and stares blankly or becomes still.
What to do when your child has an epileptic seizure?
Watching the child have an epileptic seizure is one of the most painful and frightening things for a parent. So what can a parent do to help a child having a fit?
Lack of information is why most parents feel helpless when their child has a seizure. Not anymore. Read on to find out what you should and should not do when the child has an epileptic seizure.
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- Place the child gently on the floor, and remove objects that are around him.
- Slowly turn the child to his side to prevent choking on the vomit or saliva, especially if there is drooling. If the child vomits, clear out the remaining vomit from the mouth using a finger.
- Loosen the clothing around the neck, such as the collar or necktie. Check if the breathing is fine.
- Keep track of how long the seizure lasts.
- Call the doctor once the child is in a safe position.
- Once the seizure ends, the child will probably feel tired or sleepy.
Stay with the kid throughout the seizure and until the child wakes up after resting. Make sure that the kid gets some rest after the episode.
- Try to stop the child’s shaking or convulsions. Holding the child will not stop the seizures but will only make them uncomfortable.
- Put anything in the child’s mouth.
- Give the child any food to eat or drink, medicinal pills, or tonics during the seizure. Wait till the child is awake and alert to give medication.
- Put anything in the child’s mouth or pry open the mouth with your hands when the child has a tonic seizure. Your child will not swallow his tongue. Forcing the teeth apart can cause injuries and even block his airways.
Call the doctor immediately if:
- The seizure lasts for more than five minutes.
- Has difficulty breathing
- The color of the skin, lips, or face turns bluish
- The kid has hit his head due to a fall or any other way before the seizure
- The child has a seizure when in water
Take the child to a doctor if he seems very ill or has any unusual or concerning symptoms. Also get the child an epilepsy bracelet to alert people around, especially paramedics and emergency medical technicians, about the child’s medical condition and provide first aid.
Causes Of Epilepsy
The causes of epilepsy vary by age. In some people, epilepsy is genetic, but in many others, the reason remains unknown (4).
- Some children develop genetic epilepsy, which is caused by one or more genes in the body. How the genes affect the brain and how they cause seizures is not clear yet.
- Developmental disorders such as neurofibromatosis, Down’s syndrome, Angelman’s syndrome, and tuberous sclerosis can also increase the chances of epilepsy.
- Around 3 to 10% of kids with autism disorder may have seizures from time to time.
- In 3 to 10% people, epileptic seizures are caused due to changes in the brain structure. Sometimes, children are born with these structural changes, which can lead to seizures,
- Seizures can also occur due to head injuries, which are common in young adults and children.
- Fever, infections, and brain tumors can also cause epilepsy. Seizures are common when the infection, even though removed by medication, damages the brain to some extent.
- Progressive brain diseases, although rarely, can cause seizures in kids.
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Diagnosing Epilepsy In Children
Every child who has seizures or fits need not necessarily have epilepsy. Hence, knowing about different seizures and differentiating between epileptic and non-epileptic seizures is not easy. Accurate diagnosis of epilepsy is imperative to determine the right course of treatment. To do that, doctors may recommend:
- Blood tests to check for any infection in the brain, genetic conditions, or other medical conditions that could trigger a seizure.
- Neurological tests to check the child’s behavior, motor abilities, cognitive function, and such to determine the type of epilepsy in the child.
- Electroencephalogram (EEG), which is the most commonly prescribed test to diagnose epilepsy. Electrodes are attached to the scalp to study the brain’s electrical activity. The behavior of the brain waves is examined for abnormalities and presence of epilepsy.
- Computerized tomography or CT scan to get cross-sectional images of the brain to determine if abnormalities such as bleeding, cysts, or tumors if any, are causing the seizures.
- Magnetic resonance imaging or MRI to get a detailed view of the brain for abnormalities or lesions in the brain.
- Functional MRI to detect changes in the blood flow when certain parts of the brain are active or functional. This helps in identifying the specific areas of the brain that are affected and prevents surgeons from damaging critical areas of the brain during surgery.
Other tests such as positron emission tomography (PET) and single-photon emission computerized tomography (SPECT) may be needed to detect abnormalities in the active regions of the brain and pinpoint where the seizures are originating.
In some cases, doctors may recommend other tests such as the autonomic reflex study, cardiac Holter monitor, sleep study, and movement disorder physiologic study if they suspect that a medical condition other than epilepsy is causing the seizures.
Treatment Of Epilepsy In Children
The course of treatment for an epileptic child will depend on the type of epilepsy, the age of the child, response to medication, and other factors such as the child’s overall health. While it is possible that epilepsy symptoms, including seizures, may eventually fade away in some cases, it depends on the type and severity of epilepsy.
Otherwise, the goal of epilepsy treatment is to reduce the frequency of seizures and control them with medications. The doctor may also consider other treatment options ranging from simple dietary changes to brain surgeries to stop the seizures.
Anti-epileptic drugs are the most commonly used medications to minimize the frequency of seizures and to prevent them if possible. There are several brands of anti-epileptic medicinal products, but not all may be the same. Your epileptologist will consider your child’s age, type of seizures and their severity, frequency, lifestyle, side-effects of the drug, and other factors before prescribing an anti-epileptic drug for the child.
Usually, only one anti-seizure medication is enough to control the seizures. The medicines are for at least two years, sometimes three or four years after the seizures stop. They are then tapered and eventually discontinued. There may, however, be a chance that the seizures may return, but most of them can be controlled using the medication. That said, 65% of children who have not had a seizure in two years with the help of medication tend to remain seizure-free after the drug is discontinued (5).
Please note that anti-epileptic medications also have certain side-effects such as weight gain, inability to concentrate, inability to reason, and behavioral problems such as hyperactivity and irritability. Talk to your doctor about the medication’s side-effects before starting the treatment.
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The doctor may recommend a change in the diet depending on the child’s age and if the epilepsy is medication-resistant. A high fat, low carbohydrate ketogenic diet triggers a state of ‘ketosis’, wherein the body breaks down the fat instead of the carbs. Ketosis can prevent seizures, although it works only for some types of epilepsy in children.
Studies show that 50% of epileptic patients on a ketogenic diet have more than 50% improvement in controlling seizures and a 10% more chance of living a seizure-free life (6). The child may also be free of seizures after transitioning to a normal diet, with the help of a trained healthcare specialist.
Note that it is not easy for children to adhere to dietary restrictions with little or no carbohydrates in the food. Keeping the child away from carbohydrate rich foods such as bread, rice, sugars, and sweets, may not be easy.
Surgery is recommended when the seizures are persistent and not responding to medications or dietary changes, or when the doctors identify a brain lesion that is causing seizures. If the preliminary examination and tests deem that the child is fit for surgery, experts suggest that it should be done as early as possible.
Vagus nerve stimulation or VNS therapy uses a pacemaker like device to send electrical impulses to the brain via the vagus nerve, to prevent seizures. The device is implanted under the skin near the chest, and is ideal for epilepsy patients who are not responding to medications and are not fit for surgery. While the efficiency of this has been tested extensively on adults, the effect of VNS device on pediatric epilepsy patients is still being studied.
Alternative therapies such as Ayurveda may have some treatment options for people with epilepsy. While there isn’t any detailed research on Ayurveda and epilepsy, studies talk about personalized courses of the treatment for epilepsy (7). So, not all epilepsy will get the same treatment in Ayurveda. Also, note that the traditional medicines and procedures are not clinically tested or proven to work.
Prevent Epileptic Seizures
Epileptic seizures cannot be stopped using medications. But if you know what kind of seizures the child has and what triggers them, you can prevent situations which lead to the seizures. While the triggers may vary based on the type of epilepsy that the child has, here are a few commonly reported triggers that must be avoided.
- Sleep deprivation is a common trigger for seizures. Ensuring that the child gets enough sleep every night can help reduce the chances of a seizure.
- Prevent head injuries with protective gear such as helmets while biking or skateboarding.
- Teach your children to walk and step carefully to avoid falls, which can cause head injuries.
- Keep the child away from over-stimulants such as bright lights or loud noises to prevent a seizure.
- Make sure that the child does not skip the anti-seizure medication, and ensure that he takes it at the same time every day.
- Teach the child stress-management techniques and create a stress-free environment, as stress and strain can also trigger seizures in some cases.
- Follow a healthy diet with more protein and fewer carbohydrates. However, talk to the doctor before making any drastic changes to the kid’s diet.
Epilepsy is not easy to live with. That said, an epileptic child need not lose out on the little pleasures of life. Use of medications and following seizure-preventive measures, can improve your child’s and your quality of life. Talk to and seek the guidance of a medical practitioner, preferably an epileptologist, to learn more about how you can help the epileptic child.
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