Epilepsy in children
Epilepsy is a common childhood disorder. It is a condition that is defined by unprovoked recurrent seizures. Seizures are brief, temporary disturbances within the electrical system of the brain. There are more than 20 different seizure disorders. The most easily recognized is the convulsive seizure that is characterized by shaking movements of the body and a period of decreased mental awareness. Other, less apparent forms of seizures may affect a person's awareness, muscle control or sensory perception. Epidemiological data indicate that approximately 5 percent of all children will experience at least a
single seizure. Approximately 1% of children develop epilepsy. It is estimated that about 690,000 children and the womanng adults in the United States have some type of epilepsy. About 55,000 new cases of epilepsy are diagnosed each year in children under age 18. In many cases (50-70%), there is no cause of epilepsy.
Partial seizures take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. If the child does not lose consciousness throughout the seizure, the seizure is classified as a simple partial seizure. If the child loses consciousness or does not respond appropriately, the seizure is classified as a complex partial seizure. Partial seizures may include one-sided jerking movements of the arms or legs, stiffening, eye deviation to one side, or twisting of the body, sometimes preceded by seeing visions, hearing noises, tasting and smelling things, dizziness, a rapid heart rate, dilated pupils, sweating, flushing, stomach fullness and psychic symptoms such as a sense of deja-vu, distortions, illusions and hallucinations. Generalized seizures involve both sides of the brain. As a result, the seizures are less variable than focal seizures. Typically, they may involve brief staring spells; sudden, quick, muscle jerks; generalized and rhythmic jerking of the extremities; generalized stiffening episodes, or generalized stiffness followed by rhythmic jerking of the extremities, or a sudden loss of muscle tone resulting in a head drop or sudden fall to the ground.
The majority of children with epilepsy attend mainstream schools where many of them do well. In fact, epilepsy is compatible with the full range of intelligence and achievements. However, there is evidence that some children with epilepsy may underachieve at school. If underachievement is suspected, careful psychometric assessment is required. If a genuine degree of underachievement has been demonstrated convincingly in a child, various factors need to be considered. Physical possibilities include frequent seizures, underlying structural damage, sleep disorders causing inadequate or poor quality sleep and the side-effects of anti-epileptic medication. Various psychological and social factors include poor motivation, under-stimulation, overprotection, family/ friends / teachers attitudes. It is difficult to say generally what factors are the most important, but the third group is often to the forefront perhaps combined with other influences. The attitude of the teacher towards the child with epilepsy plays an important part in the child's progress. Close communication with the parents will ensure that the teacher will be aware of the child's epilepsy and will be able to deal with a seizure occurring in the classroom. Teachers must not be afraid to push children with epilepsy to their limits just like any other children.
Epilepsy is primarily a clinical diagnosis which depends on a detailed and exact account of the child's paroxysmal episodes. The aim should be to identify accurately the type of seizure, the particular epilepsy syndrome (which has an important bearing on treatment and prognosis), and any underlying cause. If the diagnosis is confirmed clinically, an EEG should be carried out. Neuroimaging, preferably with magnetic resonance imaging, will be indicated for some, but not all children, depending, for instance, upon the seizure type and the syndrome, and any associated clinical (e.g. neurological, developmental, cutaneous) findings.
The prospect of control by means of anti-epileptic drugs is good in most children with epilepsy. In some forms of epilepsy the long term prospects (prognosis) for seizure control are very favourable and it is likely that the seizures will eventually improve with age or stop completely of their own accord. Absences and tonic clonic seizures without a partial onset may well stop by early adulthood. The chance of this happening is even higher in some other types of epilepsy, including some occurring mainly during the night and mostly involving the face and mouth ("benign centrotemporal epilepsy). It is important that these epilepsies with a good prognosis are recognized early and appropriate reassurance is given by the doctor. In most children with epilepsy, the seizures can be completely controlled by one anti-epileptic drug. Once seizure-free for 2-3 years, many children will be able to taper and stop drug therapy, on the advice of a paediatrician.
Management of children with epilepsy, and of their families should be holistic, attending to the social, educational and psychological implications of epilepsy as well as treatment of the seizures. This requires close understanding between the family, and the healthcare (GP and specialist) professionals.
Children with epilepsy have the same range of intelligence and abilities as other children. However, some children with epilepsy will develop learning difficulties. This may be due to a coexisting condition, such as a brain abnormality, or it might be related to the child's epilepsy. Sometimes the medication is a contributing factor as it may cause drowsiness or hyperactivity. When a learning difficulty is identified in a child, there are strategies available - both medical and educational - that can be implemented. The woman’s epilepsy counsellor will be able to advise on this matter.
Behavioural disturbances can occur in any child, whether or not they have epilepsy, and it can be difficult for parents to know the cause. The factors, which affect learning in a child with epilepsy, may also affect behaviour. In addition, low self-esteem can result from overprotection, lack of discipline or the child feeling different to other children. Parents may find that discussing the issue with teachers or an epilepsy counsellor is helpful. These workers also provide a gateway to additional support services.
Children with epilepsy should be encouraged to participate in, and enjoy, a full school and social life. Teachers and activity supervisors are often concerned about caring for a child with epilepsy. Where an activity carries risk, general restrictions are sometimes wrongly imposed on all children with epilepsy. Risks are best assessed on an individual basis. Video games, for example, will trigger seizures in less than three per cent of children with epilepsy. These children are said to be photosensitive.
More information on epilepsy (seizures)
What is epilepsy? - Epilepsy is a general term that includes various types of seizures. Epilepsy is characterized by unprovoked, recurring seizures that disrupt the nervous system.
What are seizures? - Seizures (or convulsions) are temporary alterations in brain functions due to abnormal electrical activity of a group of brain cells that present with apparent clinical symptoms and findings.
What types of seizures are there? - The two main categories of seizures include partial seizures and generalized seizures. A partial seizure can evolve to a generalized seizure.
What types of epilepsy are there? - There are several types of epilepsy. Epilepsy can be divided into two broad categories: idiopathic epilepsy and symptomatic epilepsy.
What're the common types of epilepsy? - The most common types of epilepsy are absence epilepsy, temporal lobe epilepsy, frontal lobe epilepsy, occipital lobe epilepsy, and parietal lobe epilepsy.
What causes epilepsy? - Epilepsy may be caused by a number of unrelated conditions, including damage resulting from high fever, stroke, toxicity, or electrolyte imbalances.
What causes children epilepsy? - There are many possible causes of epilepsy in children. Seizures in infants and children may be due to birth defects, difficulties during delivery, or poisoning.
What factors will trigger epilepsy? - The triggers of epilepsy include inadequate sleep, food allergies, alcohol and smoking, flashing lights, developmental anomalies, and brain tumours.
What're the symptoms of epilepsy? - There are many forms of epilepsy, each with its own characteristic symptoms. The basic symptom of epilepsy is a brief and abnormal phase of behavior.
How is epilepsy diagnosed? - Making an accurate diagnosis is vital in planning the correct treatment to control seizures. Taking a medical history can help rule out non-epilepsy conditions.
What're the treatments for epilepsy? - For most people with epilepsy, treatment can reduce or prevent seizures and allow many patients to remain free of seizures for the rest of their lives.
What epilepsy medications are available? - Epilepsy is often treated with medication, neurocybernetic prostheses. Medications available for the treatment of seizures include phenytoin, carbamazepine, divalproex.
What epilepsy surgeries are available? - Surgical techniques to remove injured brain tissue may be appropriate for many patients with epilepsy. The most common surgery for epilepsy is temporal lobectomy.
What is vagus nerve stimulation? - Vagus nerve stimulation is a recently developed form of seizure control which uses an implanted electrical device.
What epilepsy diet is suggested? - It is believe that a restricted caloric intake while on a balanced diet can lead to measurable seizure reduction among all age groups.
How to prevent epilepsy? - Effective actions for the prevention of epilepsy include adequate pre-natal and post-natal care, safe delivery, control of fever in children, control of parasitic diseases.
Epilepsy in children - Epilepsy is a common childhood disorder. The prospect of control by means of anti-epileptic drugs is good in most children with epilepsy.
Pregnancy and epilepsy - Women with epilepsy who become pregnant have a higher risk for complications than women who don't have epilepsy.
Difference between seizures and epilepsy - Seizures are a symptom of epilepsy. Epilepsy is the underlying tendency of the brain to produce a sudden burst of electrical energy.
What's a grand mal seizure? - A grand mal seizure is a seizure involving the entire body, usually characterized by muscle rigidity, violent rhythmic muscle contractions, and loss of consciousness.
What's absence seizure (petit mal seizure)? - Absence seizure e - also known as petit mal seizure - is a type of seizure that most often occurs in children.
What is a febrile seizure? - A febrile seizure is a convulsion in a child triggered by a fever. A febrile seizure may be as mild as the child's eyes rolling or limbs stiffening.
What are epileptic seizures? - An epileptic seizure, often referred to as a fit, occurs when there is an abnormal discharge of neurones in the brain.
What is status epilepticus? - Status epilepticus is a continuous seizure state. Status epilepticus is most often caused by not taking anticonvulsant medication as prescribed.
What causes seizures? - Seizures may be caused by many conditions, diseases, injuries, and other factors. Injuries that may cause seizures include choking, head injury.