Epilepsy in children: symptoms, causes, treatment

Epilepsy is one of the most common chronic neurological diseases in childhood. This disease affects approximately 0,5-1% of children. It is true that you can develop this disease at any age. However, the greatest peak incidence occurs in infancy. Another increase in the incidence of epilepsy is seen in adolescents, and the next large increase in epilepsy occurs in elderly patients.

Epilepsy in a child: diagnosis 

Epilepsy means that you are permanently susceptible to seizures. The doctor recognizes this disease in three situations:

• after the occurrence of two unprovoked seizures more than 24 hours apart in 5 years;
• after one seizure occurs and a high probability (60% or more) is maintained in the next 10 years *;
• in the case of diagnosis of epilepsy syndrome.

* the risk is determined, inter alia, by based on the EEG test.

Epilepsy in a child: causes

The most common cause of epilepsy is genetics. Less frequently, it results from structural changes in the nervous system, which may be caused by previous infections, injuries, strokes and metabolic diseases. Immune disorders may be an even rarer cause. Often times, several factors contribute to the development of epilepsy. However, there are situations where it is not possible to establish the exact cause of this condition in a patient.

Epilepsy in a child: symptoms

The symptoms of epilepsy, which include seizures, can be conscious as well as with its disorders. Sometimes children have a premonition of the seizure in advance, which we call aura.

The most commonly associated with epilepsy is the occurrence of tonic-clonic seizures, i.e. seizures that resemble seizures and tensions. The patient becomes unconscious, may experience drooling and bruising, may release urine and / or stools, and then fall asleep.

Seizures can, however, take a very different and sometimes discreet course. They can appear in the form of immobility, freezing - sometimes reminiscent of a simple stare.

The symptoms also include:

• eyeball turns;
• looking at one point;
• rhythmic blinking of the eyelids;
• drooling, nausea, vomiting;
• facial expressions;
• twitching, trembling, or straining a limb or more of the body;
• tension;
• feeling strange, often unpleasant smells that are not really there.

There may also be a sudden, inexplicable change in behavior, e.g. a shrill scream, fear. The child may talk about the things he seems to see. It also happens that patients with seizures associate pleasant sensations. It should be emphasized that this is not a closed catalog of symptoms and, apart from the listed ones, many other behaviors can also be observed in patients.

Patients may have several different types of seizures. In some rare epilepsy syndromes, no obvious seizures are seen, but the child's functioning is deteriorated.

Epilepsy in a child at night

Night seizures should not be confused with night terrors or sleepy myoclones, which are single muscle spikes that occur in many people and are a natural phenomenon. It should be remembered that, unlike epileptic seizures, they do not wake up from sleep, are usually single, and the child has his eyes closed during the seizures.

The first symptoms of epilepsy in a child

In fact, the first symptoms of epilepsy can appear at any time. The onset of seizures is then observed. Fever, infection, sleepless night, stress, exposure to strobe light, and many others may be factors when the first epileptic seizure occurs. However, as is apparent from the definition of epilepsy, to find it, seizures should be unprovoked, i.e. they should also occur regardless of other factors.

If epilepsy is suspected, you should see a doctor urgently. Before the visit, it is also worth preparing properly, that is:

• write down the circumstances in which the seizure occurred;
• describe his exact course and duration;
• if possible, it's worth it record a video.

Of course, in the event of the first seizure, especially one in which you are unconscious, you should seek medical attention immediately. If left untreated, seizures can be life and health-threatening and their occurrence can negatively affect the child's functioning and mood.

Epilepsy and child development

Not all epilepsy is associated with a decline in a child's development. However, it should be remembered that the child's brain is developing very intensively. During this period, connections between neurons are formed. The child is constantly learning, acquiring many new skills and remembering a large amount of information. Unfortunately, the occurrence of seizures can significantly hinder these processes. In more severe forms of epilepsy, its course may even lead to a decline in development.

Some types of seizures also carry additional risks to the health of your baby, as the loss of consciousness or a sudden drop in muscle tone may result in injury.

In some patients, epilepsy coexists with other disabilities. However, much more often the occurrence of this disease is observed in children born prematurely, as well as in the family history of this condition or after a stroke (including bleeding into the central nervous system in the perinatal period). Epilepsy may also occur in children diagnosed with autism spectrum disorders and intellectual disabilities.

Other causes of epilepsy in children

The so-called traumatic epilepsy in children. It may be caused by serious injuries suffered by the child. Epilepsy can also be a complication of a severe infection involving the nervous system that can occur in utero as well as after birth. Therefore, it is very important to prevent infections - by avoiding infections and vaccination, as well as prompt and effective treatment of infections.

The causes of epilepsy also include the following diseases:

• autoimmune;
• metabolic;
• proliferative within the nervous system.

If epilepsy is suspected, the child should be looked after by a pediatric neurologist who will decide on diagnosis and treatment.

Epilepsy and normal EEG in a child

It is an important test in the diagnosis of epilepsy and its treatment electroencephalographic examination (abbreviated as EEG). The principle of operation is similar to the EKG test, except that The electrical potentials analyzed during this examination are generated in the brain (primarily in the cortex) and electrodes used to read them are placed on the patient's head.

EEG testing is painless. Instead, it requires basic cooperation with the patient. The test can be performed in both sleep and wakefulness because the brain works differently in and between these two states. It is the doctor who should decide under what conditions this test should be performed.

In addition, during the EEG test, the so-called provocative attempts. Most often it is:

• sleep deprivation, i.e. performing a test after a sleepless night;hyperventilation, that is, regular, minimum 3 minutes of deep breathing;
• photostimulation, i.e. the use of flashes of light with specific flashing frequencies.

Diagnosing epilepsy in a child: additional tests

Due to the fact that epilepsy can be caused by a variety of changes, including cancerous changes in the brain. Most patients undergo brain imaging, usually MRI. Additionally, some patients require tests for metabolic diseases, autoimmune diseases and genetic tests. Sometimes patients with epilepsy require multi-specialist care, both during diagnosis and treatment.

Epilepsy in a child and a certificate of disability

Not every patient diagnosed with epilepsy requires a certificate of the degree of disability. Many children get good seizure control and can function normally. In this case, children do not require any additional specialist care.

Unfortunately, about 30% of epilepsy is drug-resistant and, despite proper treatment, it is not possible to completely avoid seizures. In some cases, seizures that occur frequently, even multiple times a day, exclude children from attending school and participating in other activities.

Epileptic encephalopathy

It also occurs in some children epileptic encephalopathy, i.e. a condition in which the onset of epilepsy is associated with a progressive intellectual disability. These children require additional care and then the disability certificate is justified in order to enable their guardians to obtain additional systemic help.

Epilepsy in children: treatment

Various medications are used to treat epilepsy, sometimes surgery or treatment with a ketogenic diet is necessary and very effective. The treatment should be decided by a physician who, in consultation with parents and the patient, will select the optimal treatment. In addition to the medications that children should take every day, medication is sometimes necessary to stop prolonged seizures. Patients with epilepsy should have them with them at all times.

Is epilepsy a lifelong disease?

For many patients, epilepsy is not a lifelong disease. With well-chosen treatment, both in terms of drugs and duration of treatment, the seizures go away, the EEG becomes normal, and then it is possible to stop the treatment. In some types of childhood epilepsy, patients simply "grow out" of the seizures and, after puberty is over and over the years, they stop having seizures. Still, in such patients prophylactic treatment is usually required to minimize the risk of further seizures which, as mentioned above, may pose a risk of injury or adversely affect quality of life.

Epilepsy is a complex problem and has many faces. Sometimes its occurrence is associated with a significant impairment in the functioning of the child. Fortunately, many patients manage to treat it successfully, allowing children and their families to lead a normal life.

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