Epilepsy in childhood

Epilepsy occupies a special place among neurological diseases. It most often occurs in children, but can appear suddenly in adulthood. It is a chronic, incurable disease, but with effective treatment, attacks may become infrequent or disappear altogether. Patients with epilepsy need constant monitoring by their attending physician - a neurologist or epileptologist.

What is epilepsy?

Epilepsy is a common psychoneurological disease that has a chronic latent course. Despite this, sudden epileptic seizures are typical for the disease. They are caused by the appearance of numerous foci of spontaneous excitation (nerve discharges) in certain areas of the brain.

Clinically, such attacks are characterized by a temporary disorder of sensory, motor, mental and autonomic functions.

The detection rate of this disease averages 8-11% (classic full-blown attack) among the general population of any country, regardless of climatic location and economic development. In fact, every 12th person sometimes experiences some microsigns of epilepsy.

The overwhelming number of people believe that epilepsy is an incurable disease and is a kind of “divine punishment”. But modern medicine completely refutes this opinion. Antiepileptic drugs help suppress the disease in 63% of patients, and in 18%, significantly reduce its clinical manifestations.

The main treatment is long-term, regular and constant drug therapy with a healthy lifestyle.

The causes of epilepsy are different; WHO has grouped them into the following groups:

Idiopathic – these are cases when the disease is inherited, often through tens of generations. The brain is not organically damaged, but there is a specific reaction of neurons. This form is not permanent, and attacks occur without an explainable reason;
Symptomatic – there is always a cause for the development of foci of pathological impulses. These could be the consequences of injury, intoxication, a tumor or cyst, developmental defects, etc. This is the most “unpredictable” form of epilepsy, since an attack can be triggered by the slightest irritant, for example, fear, fatigue or heat;
Cryptogenic – it is not possible to accurately determine the true cause of the occurrence of uncharacteristic (untimely) impulse lesions.

Symptomatic form

This type of pathology is of a secondary nature. The reasons for the appearance may be:

head injuries;
brain tumors;
poisoning;
neuroinfections;
consumption of alcohol, drugs;
dehydration;
hypothermia or overheating;
stroke;
emotional stress.

As a result of exposure to unfavorable factors, partial destruction of brain neurons occurs.

Seizures may appear immediately or after some time. EEG and MRI detect organic brain lesions.

Symptoms depend on the location of the lesion and the degree of death of brain structures. The patient has:

generalized seizures with loss of consciousness;
seizures with or without partial loss of consciousness.

The disease may also be accompanied by mental disorders (depression, hallucinations, memory impairment, attention, paranoia), and other symptoms (headaches, dizziness, spatial orientation disorders).

Treatment is aimed primarily at eliminating the cause of the disease.

An operation is performed to remove the tumor, drugs are prescribed for detoxification and resorption of intracranial hematomas. Often the attacks stop when the provoking factors are removed.

However, if cells die irreversibly due to infection or injury, the disease cannot be cured. Then the patient is prescribed antiepileptic drugs, and the issue of disability is resolved.

Read about other types of the disease:

epilepsy of Jackson and Kozhevnikov;
about absence and cryptogenic;
about generalized and partial forms;
about myoclonic and temporal;
about pharmacoresistant, focal and alcoholic.

When does epilepsy occur?

Seizures in many cases are observed in newly born children with high body temperature. But this does not mean that the person will continue to have epilepsy in the future. This disease can develop in any person and at any age. But still, children and teenagers encounter it more often.

75% of people with epilepsy are under 20 years of age. As for people over twenty, various types of injuries or strokes are usually to blame. The risk group is people over sixty years of age.

Myth. A person with epilepsy cannot lead a normal life

In fact . Properly selected treatment can completely relieve epileptic seizures in 60–70% of patients. However, there are few restrictions for patients with epilepsy. Only three factors can provoke an attack: skipping a drug dose, lack of sleep and alcohol. But smoking, physical activity or poor diet do not affect the course of the disease. Therefore, the lifestyle of a person with epilepsy may be no different from the usual: you can play sports, work, travel, eat any food.

Symptoms of epilepsy

The manifestations of epilepsy attacks may differ from patient to patient. First of all, the symptoms depend on those areas of the brain where the pathological discharge occurs and spreads. In this case, the symptoms will be directly related to the functions of the affected parts of the brain. Movement disorders, speech disorders, an increase or decrease in muscle tone, and dysfunction of mental processes can occur, both in isolation and in various combinations.

The severity and set of symptoms will also depend on the specific type of epilepsy.

Jacksonian attacks

Thus, during Jacksonian attacks, pathological irritation covers a certain area of the brain without spreading to neighboring ones, and therefore the manifestations concern strictly defined muscle groups. Typically, psychomotor disorders are short-lived, the person is conscious, but it is characterized by confusion and loss of contact with others. The patient is not aware of the dysfunction and rejects attempts to help. After a few minutes the condition is completely normalized.

The twitching or numbness starts in the hand, foot, or leg, but can spread to the entire side of the body or develop into a grand mal seizure. In the latter case, they speak of a secondary generalized attack.

A grand mal seizure consists of successively alternating phases:

Precursors - several hours before the onset of an attack, the patient is seized by an anxious state, characterized by an increase in nervous excitement. The focus of pathological activity in the brain gradually grows, covering more and more new sections;
Tonic convulsions - all muscles tense sharply, the head is thrown back, the patient falls, hitting the floor, his body is arched and held in this position. Due to respiratory arrest, the face turns blue. The phase is short, about 30 seconds, rarely up to a minute;
Clonic convulsions - all the muscles of the body contract rapidly rhythmically. Increased salivation, which looks like foam at the mouth. Duration – up to 5 minutes, after which breathing is gradually restored, the cyanosis disappears from the face;
Stupor - in the focus of pathological electrical activity, strong inhibition begins, all the patient’s muscles relax, and involuntary passage of urine and feces is possible. The patient loses consciousness and there are no reflexes. The phase lasts up to 30 minutes;
Dream.

After waking up, the patient may suffer from headaches, weakness, and movement disorders for another 2-3 days.

Minor attacks

Minor attacks are less pronounced. A series of twitching of facial muscles, a sharp drop in muscle tone (as a result of which a person falls) or, conversely, tension of all muscles when the patient freezes in a certain position may occur. Consciousness is preserved. There may be a temporary “absence” – absence. The patient freezes for a few seconds and may roll his eyes. After the attack, he does not remember what happened. Minor seizures often begin in preschool age.

Status epilepticus

Status epilepticus is a series of seizures following each other. During the intervals between them, the patient does not regain consciousness, has reduced muscle tone and lack of reflexes. His pupils may be dilated, constricted, or of different sizes, and his pulse may be rapid or difficult to feel. This condition requires immediate medical attention, as it is characterized by increasing brain hypoxia and swelling. Lack of timely medical intervention leads to irreversible consequences and death.

All epileptic seizures have a sudden onset and end spontaneously.

On the subject: All forms of epilepsy

First aid

A patient with epilepsy should be turned on his side. Do not put any foreign objects into the patient's mouth. A common misconception is that the patient's tongue can block the airway. This is not so: during an attack, all muscles come into motion, including the tongue, which is also a muscle. The tongue will not block the airway, but putting a spoon or other hard objects into the patient’s mouth can damage his teeth. If the patient has not regained consciousness 5 minutes after the onset of the seizure, it is necessary to urgently call an ambulance.

Epilepsy requires qualified treatment and constant medical supervision. The disease imposes some restrictions on life, for example, epileptics cannot drive or work in dangerous places. Nevertheless, with a favorable course and timely treatment, this disease allows you to lead a completely full life.

Causes of epilepsy

There is no single common cause of epilepsy that could explain its occurrence. Epilepsy is not a hereditary disease in the literal sense, but still in certain families where one of the relatives suffered from this disease, the likelihood of the disease is higher. About 40% of patients with epilepsy have close relatives with this disease.

There are several types of epileptic seizures. Their severity varies. An attack in which only one part of the brain is to blame is called partial or focal. If the entire brain is affected, then such a seizure is called a generalized one. There are mixed attacks: they begin in one part of the brain and later cover the entire organ.

Unfortunately, in seventy percent of cases the cause of the disease remains unclear.

The following causes of the disease are common: traumatic brain injury, stroke, brain tumors, lack of oxygen and blood supply at birth, disorders of the brain structure (malformations), meningitis, viral and parasitic diseases, brain abscess.

Is epilepsy inherited?

Undoubtedly, the presence of brain tumors in ancestors leads to a high probability of transmitting the entire complex of the disease to descendants - this is in the idiopathic variant. Moreover, if there is a genetic predisposition of CNS cells to hyperreactivity, epilepsy has the maximum possibility of manifestation in descendants.

At the same time, there is a dual option – symptomatic. The decisive factor here is the intensity of the genetic transmission of the organic structure of brain neurons (property of excitability) and their resistance to physical influences. For example, if a person with normal genetics can “withstand” a blow to the head, then another, with a predisposition, will react to it with a generalized seizure of epilepsy.

As for the cryptogenic form, it has been little studied, and the reasons for its development are not well understood.

Is it possible to drink if you have epilepsy?

The clear answer is no! In any case, if you have epilepsy, you should not drink alcoholic beverages, otherwise, with a 77% guarantee, you can provoke a generalized convulsive seizure, which could be the last in your life!

Epilepsy is a very serious neurological disease! If all recommendations are followed and the “correct” lifestyle is followed, people can live peacefully. But if you violate the medication regimen or ignore prohibitions (alcohol, drugs), you can provoke a condition that will directly threaten your health!

Is there any treatment?

The prognosis of the disease is determined by the degree of damage to brain cells. This applies equally to both types of illness.

Patients with benign idiopathic epilepsy, which is not accompanied by generalized seizures, have a better chance of recovery.

Often the disease goes away on its own by adolescence, when the brain structures reach maturity.

In case of a complex form of the disease, with the help of adequate therapy it is possible to achieve long-term remission of 50%.

Treatment involves lifelong use of antiepileptic drugs.

In especially severe cases, surgical intervention is resorted to. Surgical treatment is indicated for resistance to anticonvulsants and frequently recurring seizures; in 80% of cases, the frequency of seizures is reduced to 5% during the first year after surgery.

In the case of the acquired form, everything depends on the cause of the pathology. If extensive organic cell damage has not occurred, after eliminating the provoking factors, the attacks disappear.

The situation is worse with post-traumatic or post-stroke epilepsy. Such patients, along with other medications, should take anticonvulsants.

What examinations are needed?

In order to diagnose the disease, the doctor examines the medical history of the patient himself, as well as his relatives. It is very difficult to make an accurate diagnosis. The doctor does a lot of work before this: checks the symptoms, the frequency of seizures, the attack is described in detail - this helps determine its development, because the person who suffered a seizure does not remember anything. Subsequently, electroencephalography is performed. The procedure does not cause pain - it is a recording of your brain activity. Techniques such as computer, positron emission and magnetic resonance imaging can also be used.

Symptoms

How does epilepsy begin and what symptoms is it accompanied by? It should be noted that there are two types of attacks: focal and generalized. Each of them has its own symptoms.

Focal attacks

Typically, seizures of epilepsy, called focal, occur due to an electric charge striking an area of the brain, and manifest themselves, firstly, with convulsions, and secondly, numbness of some parts of the body, for example, arms, legs, face. Also, an epileptic focal attack manifests itself with the following symptoms: visual, olfactory, auditory, taste hallucinations (short flashes, no more than 30 seconds at a time), preservation of consciousness (the patient can describe his feelings and sensations).

Generalized seizures

How does epilepsy begin in this case? Attacks of this type of epilepsy occur due to a discharge affecting the two cerebral hemispheres. Generalized seizures are divided into two types: convulsive and absence seizures (non-convulsive). Seizures usually look more frightening. The tonic phase (initial) is characterized by tension in all muscles, breathing stops for a short period of time, the person may scream heart-rendingly, shrilly, perhaps the patient bites his tongue.

The next phase is clonic. It comes after 10-20 seconds. Here the muscles either contract or relax. A person is unable to control the urge to urinate, so the clonic phase is also characterized by urinary incontinence. The period of cessation of convulsions lasts from two to five minutes. This is followed by the post-attack period: the person experiences drowsiness, headaches, foggy consciousness and falls asleep.

Absence seizures, in turn, are characterized by the fact that either young children or adolescents are susceptible to them. Of course, the main question for parents is: how does epilepsy begin? Can you notice it in your child? A sharp freezing of the child, a gaze fixed on one point, seemingly abstract, absent - characteristic signs of absence seizures. Rolling back of the eyelids, closed eyes, and trembling eyelids are also indicators of this type of epilepsy. Duration of attack: five to ten seconds. You need to be attentive to children at an early age, because often, due to the short duration of absence seizures, they go unnoticed.

What's the forecast?

If epilepsy is properly treated, then in eighty percent of cases, people with this disease live without any seizures and without restrictions in activity.

Many people have to take antiepileptic drugs throughout their lives to prevent seizures. In rare cases, a doctor may stop taking medications if a person has not had a seizure for several years. Epilepsy is dangerous because conditions such as suffocation (which can occur if a person falls face down on a pillow, etc.) or falls lead to injury or death. In addition, epileptic seizures can occur in a row over a short period of time, which can lead to respiratory arrest.

As for generalized tonic-clonic seizures, they can be fatal. People who experience these attacks need constant monitoring, at least from relatives.

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Diagnostics

The attending physician begins making a diagnosis by collecting anamnesis and questioning the patient’s relatives. Need to know:

when did the first seizure occur?
personal feelings of the patient during an attack;
whether seizures occur regularly;
what were the muscle spasms?

The patient's relatives will tell you what the seizure looked like, and the doctor will be able to get an idea of the disease and even find out in which part of the brain the epilepsy focus is located.

After this, an electroencephalogram is performed, which will accurately determine the epiactivity, focus and all signs of the disease. An EEG taken during a seizure will provide additional information.

If a patient is at high risk of epilepsy and feels weakness in the legs and arms, headaches, and lack of coordination, he may undergo an MRI of the brain.

Once the diagnosis is made, the doctor prescribes medications that reduce the frequency of seizures. These medications must be taken for life and checked regularly. If the cause of the disease is injury or tumor, the patient undergoes surgery. In case of severe epilepsy, the patient may be assigned a disability group.

What consequences?

People with epilepsy often find that their seizures frighten other people. Children may suffer from being avoided by their classmates. Also, young children with this disease will not be able to participate in sports games and competitions. Despite the correct selection of antiepileptic therapy, hyperactive behavior and learning difficulties may occur.

The person may have to be limited in some activities, such as driving a car. People who are seriously ill with epilepsy must monitor their mental state, which is inseparable from the disease.

How to treat epilepsy?

Despite the seriousness and danger of the disease, with timely diagnosis and proper treatment, epilepsy is curable in half of the cases. And it is possible to achieve stable remission in approximately 80% of patients. If the diagnosis is made for the first time, and a course of drug therapy is immediately administered, then in two thirds of patients with epilepsy, seizures either do not recur at all during their lifetime, or die out for at least several years.

Treatment of epilepsy, depending on the type of disease, form, symptoms and age of the patient, is carried out surgically or conservatively. They often resort to the latter, since taking antiepileptic drugs gives a lasting positive effect in almost 90% of patients.

Drug treatment of epilepsy includes several main stages:

Differential diagnosis - allows you to determine the form of the disease and the type of attacks in order to choose the right drug;
Establishing the causes - in the symptomatic (most common) form of epilepsy, a thorough examination of the brain is necessary for the presence of structural defects: aneurysms, benign or malignant neoplasms;
Prevention of attacks - it is advisable to completely eliminate risk factors: overwork, lack of sleep, stress, hypothermia, alcohol intake;
Relief of status epilepticus or single seizures is carried out by providing emergency care and prescribing one anticonvulsant drug or a set of medications.

It is very important to inform those closest to you about the diagnosis and correct behavior during a seizure, so that people know how to protect a patient with epilepsy from injuries due to falls and convulsions, and to prevent the tongue from sinking and biting and stopping breathing.

Drug treatment of epilepsy

Regularly taking prescribed medications allows you to confidently count on a quiet life without attacks. It is unacceptable for a patient to start taking medications only when an epileptic aura appears. If the pills had been taken on time, most likely there would have been no warning signs of an upcoming attack.

During the period of conservative treatment of epilepsy, the patient should adhere to the following rules:

Strictly follow the medication dosage schedule and do not change the dosage;
Under no circumstances should you self-prescribe other medications on the advice of friends or a pharmacist;
If there is a need to switch to an analogue of the prescribed drug because it is not available in the pharmacy chain or the price is too high, notify your doctor and get advice on choosing a suitable replacement;
Do not stop treatment after achieving stable positive dynamics without the permission of your neurologist;
Promptly notify the doctor about any unusual symptoms, positive or negative changes in condition, mood and general well-being.

More than half of patients, after initial diagnosis and prescription of one antiepileptic drug, live without seizures for many years, constantly adhering to the chosen monotherapy. The main task of the neurologist is to select the optimal dosage. Drug treatment for epilepsy is started with small doses, while the patient’s condition is carefully monitored. If the attacks cannot be stopped immediately, the dosage is gradually increased until a stable remission occurs.

Patients with partial epileptic seizures are prescribed the following groups of drugs:

Carboxamides - Carbamazepine (40 rubles per package of 50 tablets), Finlepsin (260 rubles per package of 50 tablets), Actinerval, Timonil, Zeptol, Karbasan, Targetol (300-400 rubles per package of 50 tablets);
Valproates - Depakine Chrono (580 rubles per pack of 30 tablets), Encorat Chrono (130 rubles per pack of 30 tablets), Convulex (in drops - 180 rubles, in syrup - 130 rubles), Convulex Retard (300-600 rubles per pack 30-60 tablets), Valparin Retard (380-600-900 rubles per pack of 30-50-100 tablets);
Phenytoins – Difenin (40-50 rubles per pack of 20 tablets);
Phenobarbital - domestic production - 10-20 rubles per pack of 20 tablets, foreign analogue Luminal - 5000-6500 rubles.

The first-line drugs in the treatment of epilepsy include valproates and carboxamides; they provide a good therapeutic effect and cause a minimum of side effects. The patient is prescribed 600-1200 mg of Carbamazepine or 1000-2500 mg of Depakine per day, depending on the severity of the disease. The dosage is divided into 2-3 doses during the day.

Phenobarbital and phenytoin drugs are considered outdated today; they give a lot of dangerous side effects, depress the nervous system and can be addictive, which is why modern neurologists refuse them.

The most convenient to use are the prolonged forms of valproates (Depakine Chrono, Encorat Chrono) and carboxamides (Finlepsin Retard, Targetol PC). It is enough to take these medications 1-2 times a day.

Depending on the type of seizures, epilepsy is treated with the following drugs:

Generalized seizures – a complex of valproate with Carbamazepine;
Idiopathic form - valproate;
Absence seizures – Ethosuximide;
Myoclonic seizures - only valproate, Phenytoin and Carbamazepine have no effect.

The latest innovations among antiepileptic drugs - the drugs Tiagabine and Lamotrigine - have proven themselves in practice, so if the doctor recommends it and finances allow, it is better to opt for them.

You can consider stopping drug therapy after at least five years of stable remission. Treatment of epilepsy is completed by gradually reducing the dosage of the drug until complete withdrawal within six months.

Removal of status epilepticus

If the patient is in a state of status epilepticus (the attack lasts many hours or even days), he is administered intravenously one of the drugs of the sibazone group (Diazepam, Seduxen) at a dosage of 10 mg per 20 ml of glucose solution. After 10-15 minutes, the injection can be repeated if status epilepticus persists.

Sometimes Sibazon and its analogues are ineffective, and then they resort to Phenytoin, Gaxenal or sodium thiopental. A 1-5% solution containing 1 g of the drug is administered intravenously, making three-minute pauses after every 5-10 ml to prevent fatal deterioration of hemodynamics and/or respiratory arrest.

If no injections help bring the patient out of status epilepticus, it is necessary to use an inhaled solution of oxygen with nitrogen (1:2), but this technique is not applicable in case of difficulty breathing, collapse or coma.

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Surgical treatment of epilepsy

In cases of symptomatic epilepsy caused by an aneurysm, abscess, or brain tumor, doctors must resort to surgery to eliminate the cause of the seizures. These are very complex operations that are usually performed under local anesthesia so that the patient remains conscious, and based on his condition it is possible to monitor the integrity of the areas of the brain responsible for the most important functions: motor, speech, visual.

The so-called temporal lobe epilepsy also responds well to surgical treatment. During surgery, the surgeon either performs a complete resection of the temporal lobe of the brain, or removes only the amygdala and/or hippocampus. The success rate of such interventions is very high – up to 90%.

In rare cases, namely, children with congenital hemiplegia (underdevelopment of one of the cerebral hemispheres), a hemispherectomy is performed, that is, the diseased hemisphere is completely removed in order to prevent global pathologies of the nervous system, including epilepsy. The prognosis for the future of such children is good, since the potential of the human brain is enormous, and one hemisphere is enough for a full life and clear thinking.

For the initially diagnosed idiopathic form of epilepsy, the operation of callesotomy (cutting the corpus callosum, which provides communication between the two hemispheres of the brain) is very effective. This intervention prevents the recurrence of epileptic seizures in approximately 80% of patients.

Prognosis and possible complications

In general, the prognosis for treatment of epilepsy is favorable. Even if it is impossible to completely get rid of the disease, it is possible to stop attacks or reduce their frequency. Many patients benefit from modern medications that stabilize brain activity. However, it is almost impossible to cure the disease itself forever.

If treatment is refused and epileptic seizures are uncontrolled, various complications and serious consequences appear:

Status epilepticus occurs, in which attacks occur one after another. As a result, a serious disruption of brain function occurs. Each severe seizure that lasts longer than half an hour irreversibly destroys a huge number of neural connections, which leads to personality changes. Often epilepsy in adulthood changes the patient’s character and causes problems with memory, speech, and sleep;
If a patient falls, he or she may receive life-threatening injuries.

If a person managed to stop seizures and stop taking anticonvulsants, this does not mean that he is absolutely healthy. To remove the diagnosis, it will take at least five years, during which stable remission is maintained, there are no complications, mental abnormalities, and encephalography does not reveal convulsive activity.