Epilepsy in the child
The basic definition of epilepsy in children does not differ from that in adults. The epilepsy disease describes a functional disorder of the brain in which groups of nerve cells synchronize for a short time and discharge very quickly, which then leads to an epileptic seizure. The exact type of epileptic seizure depends on the localization of this group of nerve cells and can either affect the entire brain (generalized) or remain local (focal).
With a share of 0.5%, epilepsy is not a rare disease in children. Mention should be made here of the clear demarcation of fever fights, as these are not automatically assigned to the type of epilepsy. Epilepsy that begins in childhood is associated with a risk of intellectual disability. Around 30% of all affected children will suffer from an intellectual disability in the course of their lives. It is also known that some epilepsy syndromes only develop in childhood and subside to the end, such as Rolando epilepsy or Landau-Kleffner syndrome.
The possible causes of epilepsy in childhood are very diverse and in some cases not yet fully understood. The causes are divided into the following three main groups: structural, genetic, idiopathic.
The term structural causes includes all organic disorders of the brain, such as changes in the anatomy, the condition after a traumatic brain injury, tumors, cerebral haemorrhages, but also rare diseases such as tuberous sclerosis (TSC).
The proportion of patients with a defined genetic predisposition has been broken down more and more in recent years. Individual genes were identified which, if mutated, lead to epilepsy or increase the risk of epilepsy. The group of idiopathic epilepsies is assigned to all forms for which no precise cause could be identified. Depending on the type of epilepsy, this proportion is 70%.
In recent decades there has been increasing understanding that the development of epilepsy is usually not an event that can be traced back to a specific circumstance, but rather that many different favorable factors must come together in order to lead to the development.
Find out all about the topic here: Epilepsy.
The main symptom of epilepsies is always the presence of epileptic seizures. These are clearly different in their severity and range from small twitches to brief twilight states, so-called absences, to grand mal seizures, which are associated with twitching and tension of the muscles, as well as a loss of consciousness, affecting the whole body .
So it is not always easy for parents to be able to identify the epileptic seizures in their children as such. This is particularly the case in very early forms of epilepsy, such as West syndrome. This is accompanied by so-called infantile spasms, in which the arms are folded in front of the chest and the head is tilted forward. It is extremely difficult for the untrained eye to distinguish this movement from normal motor skills.
In addition to these motor seizures, there are also so-called absence epilepsies. These are accompanied by a brief twilight state that those affected cannot remember. These conditions are often noticed in school and the children are described as always rambling and unfocused. However, reaching development stages too slowly or even the loss of what has already been learned can be an indication of certain epilepsy syndromes and should be clarified with regard to this question.
Read more about the topic here: Symptoms of epilepsy.
Is there epilepsy in children while they sleep?
There are numerous forms of epilepsy in children that occur only or frequently during sleep. One of the most common forms of epilepsy in children, so-called Rolando epilepsy, is characterized by cramping and twitching of the throat muscles, the tongue and one half of the face, which can subsequently spread to the entire body.
However, other forms, such as Lennox-Gastaut syndrome, are also associated with various types of nocturnal seizures. Other epilepsy syndromes that are associated with a nocturnal accumulation of seizures are CSWS or Ohtahara syndrome. It is currently assumed that the accumulation of seizures at night is due to a stronger basic synchronization of the nerve cells, which can thus switch more quickly to an excessive synchronization
The diagnosis of epilepsy takes place in the vast majority of cases after an event has occurred, in the sense of an epileptic seizure. Every epilepsy diagnosis begins with a detailed survey of the medical history and the precise description of the attacks by the parents or other observers. In addition, the presence of a familial cluster is checked, which would indicate a genetic cause.
In almost all cases, an electroencephalography, or EEG for short, is then carried out, during which the electrical signals from the nerve cells are recorded. This is often done at night or over several hours. Certain patterns and signal frequencies can provide good information about the basic presence of epilepsy, the possible localization of an epilepsy focus (trigger region) and a specific assignment of the epilepsy syndrome.
In many cases, an MRI is performed to identify structural, i.e. organically manifested, causes. Depending on the medical history, the EEG or the lack of structural abnormalities, the search is in some cases extended to genetic causes.
Find out more about the topic here: Diagnosis of epilepsy.
There are now over 25 different drugs that are used to treat epilepsy. Which drugs are suitable for a child depends largely on the type of epilepsy. Sulitam, for example, is only approved for use in rolando epilepsy. It is not uncommon for the first drug therapy not to completely suppress the occurrence of the seizures. Often the dosage is then increased first or the drug used is combined with other anti-epileptic drugs. In rare cases, this results in patients having to take up to three different anti-epileptic drugs.
Most therapies relate to a long-term treatment that has to be taken over several years. But there are also numerous medications for acute attacks, such as midazolam, which most parents always carry with them as emergency medication.
In recent years other forms of therapy have been added to the classic anti-epileptic drugs. In addition to a special form of diet (ketogenic diet), this includes shock therapy with steroids. These are used in very high concentrations for a few weeks and achieve good results for certain forms of epilepsy. Like all other therapy options, this steroid therapy is associated with significant side effects, such as sleep disorders, weight gain and mood changes.
In some patients with a structural cause, surgical intervention can also be considered as a possible therapy option. In the meantime, special centers have been established in Germany for this specialist area, as sometimes very drastic interventions are necessary.
For more information read also: Drugs for epilepsy.
The exact duration of epilepsy in childhood is difficult to describe because it depends on the one hand on the exact form of epilepsy and on the other hand can be very different from individual to individual. In contrast to epilepsy in adulthood, however, it can be stated that many early forms are limited to childhood and adolescence and subside by themselves.
For example, a very early epilepsy syndrome, West syndrome, usually begins within the first year of life and only lasts until the third year of life. But it is also an example of how early forms of epilepsy can transition into other forms that can then persist into adulthood.
The prognosis - is it curable?
The concept of healing in the treatment of epilepsy first needs a more precise definition. In this context, healing can be understood as a fundamental elimination of the underlying cause, but also as freedom from symptoms, in the sense of successful seizure suppression.
The former is only possible in very few cases, namely when a surgical intervention is possible on the child and the triggering group of nerve cells, called the epilepsy focus, has been removed. However, this can take on large dimensions, so that in rare cases an entire half of the brain has to be removed. Freedom from seizures can usually be achieved through the use of individual anti-epileptic drugs or their combination.
However, by definition, epilepsy is also considered cured if a patient has been free of seizures for over 2 years without therapy. However, it is unclear to what extent the therapy carried out or other treatments have an influence on this development. For epilepsies in childhood it must also be mentioned that, as described above, these are self-limiting in many cases and disappear at the end of childhood and adolescence. After 2 years we can speak of a cure here too.
Find out all about the topic here: Epilepsy.
What can the long-term consequences be?
In many forms of childhood epilepsy, no long-term consequences are to be expected, as is the case, for example, with Rolandic epilepsy. However, several syndromes have also been described which lead to a high proportion of children exhibiting developmental delay. This can take on slight proportions and only lead to a somewhat delayed achievement of the stages of development, but also to the most massive limitations of intelligence that can persist for the rest of life.
To prevent this development, attempts are made to identify and treat these forms of epilepsy as early as possible, but it is unclear whether this has a strong influence on the course of the disease.