Epileptic encephalopathy: causes, symptoms, prognosis and treatment

Childhood is a time of intense development and maturation of all human internal organs. During this crucial period, the correct course of processes in the central nervous system is especially important.

With various disorders in the formation of brain structures, there is a high risk of the appearance of neurological pathologies such as epileptic encephalopathy. The deviation is accompanied by mental retardation in children, so it must be promptly diagnosed and treated so that the prospects are more favorable.

Characteristics of the disease

Epileptic encephalopathy (EE) is a disease that is diagnosed in childhood. The term “encephalopathy” itself comes from the Greek language and implies a disease of the brain. Due to increased bioelectrical activity, organic damage to the brain occurs, which leads to the development of the disease.

Epileptic encephalopathy in children is characterized by impaired cognitive and behavioral functions caused by neurological disorders and abnormal neural connections. The disease manifests itself in the first months of a child’s life; the frequency of occurrence of this pathology is low and does not occur very often. Medical statistics show that most often pathology is found in male infants.

In school and adolescence, and even more so in adults, the disease is diagnosed in extremely rare cases; this is rather an exception.

Causes of the disease

The very possibility that a child will be given such a diagnosis terrifies future parents. To understand how, where and why epileptic encephalopathy develops in children, it is necessary to study the main causes of the disease.

A number of different factors can serve as catalysts for energy efficiency:

1. The disease can be triggered by genetic changes in the baby's body. Chromosomal abnormalities and genetic mutations often occur when Angelman syndrome is diagnosed.
2. Neoplasms in the brain also provoke the development of epileptic encephalopathy.
3. Disruptions in the formation and development of the baby’s central nervous system. CNS defects at an early age directly affect the manifestation of disease symptoms.
4. A difficult pregnancy for a mother can trigger a future illness in the baby. Risk factors include incorrect gestation period, a complicated birth process, the presence of bad habits in a pregnant woman, even minor head injuries.
5. Mental disorders of future parents (even one parent) often lead to disruptions in the development of the child’s brain, and, therefore, increase the risk of early epileptic encephalopathy.

In addition to hereditary factors that influence the future generation, a woman during pregnancy should be as vigilant as possible about her own health. All possible suspicions and deviations must be reported to the doctor immediately.

Causes and provoking factors

An organic change in the brain with an epileptic component is the result of the negative impact of both external and internal damaging factors. Causes of epileptic encephalopathy:

• genetic changes - mutations in DNA, chromosomal abnormalities;
• metabolic disorders - for example, non-ketotic hyperglycinemia or xanthine dehydrogenase deficiency;
• brain tumors – some tumors have epileptogenic potential and can therefore provoke encephalopathy;
• congenital anomalies and defects of brain structures - epileptic disorder occurs due to structural disorders, for example, porencephaly, cerebral dysgynesia, focal cortical dysplasia;
• injuries to the bones of the skull and brain - during the period of intrauterine formation of the fetus, as well as after the birth of the baby.

Among the provoking factors of encephalopathy, experts indicate the following:

• infections suffered by the expectant mother;
• chronic intoxication – abuse of tobacco and alcohol products;
• injuries to the expectant mother's abdomen and pelvis;
• complicated childbirth - long, with injury to the child, massive bleeding;
• post-term/prematurity of the fetus;
• family predisposition to epileptic disorders.

Sometimes the exact cause of the disease cannot be determined. The diagnosis is made based on the results of examination of the patient.

Pathogenesis of the disease

According to ICD 10, epileptic encephalopathy belongs to section G40 “Epilepsy”. The disease develops against the background of disturbances during the formation of parts of the brain. How the pathology manifests itself in the future depends on the stage of brain maturation at which the disease began.

If the main blow fell on the left hemisphere, then this will affect the development of the child’s speech functions. Damage to the right hemisphere will lead to articulation disorders and abnormal monotony of speech. If the main focus is in the area of ​​the middle parts of the brain, then the child’s behavior suffers first, both in the direction of autism and in the direction of increased aggressiveness.

Epileptic encephalopathy affects the emotional background, as well as memory characteristics.

Diagnosis of epileptic encephalopathies

Today there are a large number of methods that can be used to identify early epileptic encephalopathies. The examination begins with a general examination and checking the child’s reflexes. Since in newborns the disease can be combined with metabolic disorders, additional research is carried out aimed at identifying them. These can be both genetic tests and laboratory tests.

A characteristic picture can be seen on the electroencephalogram. Early epileptic encephalopathy is characterized by the appearance of burst-suppression patterns, during which no physiological rhythm can be traced. This sign is usually recorded during sleep, but may be absent during wakefulness.

For older children, diagnostics are supplemented by psychological tests that help identify disorders of the psyche, thinking, memory, speech and other functions. If it is necessary to establish the cause of epileptic encephalopathy and the characteristics of its inheritance, the doctor will prescribe genetic tests aimed at searching for mutations in certain genes. You can undergo such a study in medical genetics.

Types of disease

Medicine has been studying the described disease for a long time in order to reduce the risk of its development. During this time, scientists have identified several main syndromes that are considered types of EE:

1. Aicardi syndrome. This disease manifests itself in early infancy, during the neonatal period (up to 28 days from birth). It is considered a rare manifestation of this pathology, affecting girls in most cases.
2. West syndrome. Epileptic encephalopathy is characterized by infantile spasms and appears between the ages of 3 months and 1 year.
3. Dravet syndrome. It is considered a severe infantile pathology, characterized by myoclonic seizures, as well as focal seizures.
4. Ohtahara syndrome. Develops at an early age and is characterized by mental disorders in the development of the child.
5. Lennox-Gastaut syndrome. Accompanied by atonic and tonic convulsions. Children experience delays in neuropsychological development.

Based on medical clinical data, experts identify Vesta epileptic encephalopathy as the most common type of EE pathology in infants. A similar diagnosis is made in 40% of cases of the disease in question. In addition to disturbances in mental development, the appearance of seizures and spasms, the disease can affect the child’s motor abilities.

Over time, West syndrome disease can progress to another stage, often transforming into Lennox-Gastaut syndrome. This occurs between the ages of one and seven years of the child.

Modern principles of treatment of epileptic encephalopathy in children

 The article presents a literature review of modern principles of treatment of epileptic encephalopathy. The main indicator of the correct choice of drug, dose and treatment success is the normalization of neurophysiological data. Clinical improvement in most cases is manifested by a certain, often significant lag relative to electroencephalography data. As has already been reported, another opportunity to improve the effectiveness and tolerability of antiepileptic therapy is the creation of new dosage forms of drugs that already exist in certain dosage forms, most often tablets.

The article presents a review of the literature of modern principles of treatment of epileptic encephalopathy. The main indicator of the correctness of the choice of drug, dosage and treatment success is normalization of neurophysiological data. Clinical improvement in most cases manifested a certain, often significant delay relative to the data of electroencephalography. As previously reported, another opportunity for improvements in the efficacy and tolerability of antiepileptic therapy — development of new dosage forms of drugs that already exist in certain dosage forms, more often — in the tablets.

The search for opportunities to increase the effectiveness of antiepileptic drugs (AEDs) includes: the synthesis of new drug formulas or modification of already synthesized molecules, the identification of new indications for use, the search for new dosage forms, new rational combinations of drugs, and others. Modern methods for solving the problem of side effects of AEDs include: prevention (prescribing AEDs taking into account the general somatic and mental health of the patient and his immediate family), correction of side effects, monitoring of the condition: timely examinations, consultations with specialists [7. 29].

The positive effect in most patients of antiepileptic therapy aimed at suppressing epileptic activity on the EEG, as well as the close temporal relationship between the regression of such epileptic activity and clinical symptoms confirm the key role of epileptic brain activity in the development of stable psychiatric and behavioral symptoms [4].

The failure of the use of neuroleptics and antidepressants for psychoses associated with epileptic discharges in the limbic-reticular system, as noted in the literature [6], as well as the effectiveness of antiepileptic drugs for them, are determined in 80% of patients, which corresponds to our data. By lowering the threshold of convulsive readiness and, accordingly, activating epileptic activity, antidepressants and antipsychotics not only have no effect, but even, as was the case in our patients, aggravate symptoms [12].

It should be noted that mental disorders (anxiety, aggressiveness, disorientation, memory and thinking disorders) regress much faster, usually on the 3rd–5th day with a stable therapeutic dose of the antiepileptic drug, which is apparently determined by the normalization of the limbic neuronal systems -reticular complex after the cessation of epileptic activity. Restoration of speech, cognitive processes, and social adaptation occur gradually over weeks, months and years, since these skills require learning in the course of everyday life [14].

The drug of first choice in the treatment of epileptic non-paroxysmal disorders and encephalopathies is valproic acid (Depakine Chrono, Depakine Chronosphere) [2, 10, 18, 23]. It suppresses epileptic activity in the brain. Normalization of the EEG begins already at subtherapeutic doses, which makes it possible on the 3rd–5th day of selecting a therapeutic dose to verify the correctness of the choice of drug, and subsequently, based on the dynamics of the EEG, adjust the dose and monitor the success of treatment [15]. Normalization in the EEG correlates with clinical improvement, which is especially important since patients do not have seizures, the dynamics of which could be used to monitor their effectiveness, and clinical normalization of mental and behavioral symptoms usually lags behind EEG normalization [3. 21]. In addition to its antiepileptic effect, valproic acid has its own antipsychotic effect.

In the USA, valproic acid accounts for 35% of all drugs prescribed for schizophrenia [22]. The main mechanism of action of valproic acid is an increase in GABAergic inhibition. By suppressing excessive discharge activity in the brain, it prevents excitotoxic neuronal death, which is one of the mechanisms of its neuroprotective action. The normalizing effect on kinases, gene expression and transcription leads to the normalization of plastic neuronal processes, which contributes to the interruption of the epileptic process and the patient’s recovery [20].

When applied to the treatment of childhood and infant epileptic encephalopathies, which are based on brain immaturity, it is important that valproic acid activates the growth of dendrites and axons in neuroblasts and the formation of a well-organized neural network from them, thereby facilitating the maturation of functional systems [13]. These data are in good agreement with the accelerated maturation of EEG parameters observed during the treatment of non-paroxysmal epileptic disorders with valproic acid [27]. The condition for effective treatment of epileptic encephalopathies is the stability of suppression of epileptiform activity, achieved by consistently maintaining the effective concentration of the drug in plasma.

Fejerman N. et al. [23], based on a synthesis of material from four clinics, came to the conclusion that levetiracetam is the most effective first-choice drug for this form. Accordingly, levetiracetam has been shown to be effective in the treatment of epileptic disorders of speech, behavior, memory and psyche, and general developmental disorders in patients without seizures [31]. The experiment demonstrated the ability of levetiracetam to counteract kindling in the amygdala, which determines its potential effectiveness in preventing the progression of epileptic encephalopathy [16].

Lamotrigine (Lamictal) is recommended for the treatment of infant and childhood catastrophic epileptic syndromes: West, Lennox-Gastaut, with persistent spike-wave complexes in slow-wave sleep and other non-paroxysmal epileptic disorders. Its use in non-paroxysmal epileptic disorders and epileptic encephalopathies is determined by the fact that it suppresses epileptiform activity in the EEG [17]. Limitations of lamotrigine as a first-line drug for the treatment of epileptic encephalopathies are due to its slow titration so that therapeutic concentrations are achieved weeks after initiation of treatment, and the fact that it may in some cases worsen seizures, epileptiform EEG activity, and cognitive and behavioral impairment. [1].

The effectiveness of topiramate has been shown in catastrophic epileptic encephalopathies - Lennox-Gastaut and West syndrome. Data on the successful treatment of epilepsy with electrical status epilepticus in slow-wave sleep indicate the possibility of its use in cognitive and mental disorders caused by this condition. There are also isolated reports of its use in epileptic disorders with autistic regression and learning disabilities [9]. However, the main side effect of topiramate is its negative impact on mental, behavioral and cognitive functions in some patients, which requires caution regarding the possibility of its use in mental and behavioral epileptic disorders, especially in patients with impaired verbal functions, which it itself can cause [10].

Benzodiazepines (clonazepam, clobazam, diazepam) and ethosuximide (Suxilep) are used as additional therapy for epileptic encephalopathies in cases resistant to monotherapy [12]. In severe forms of epileptic encephalopathies and non-paroxysmal mental, behavioral and neuropsychological epileptic disorders (West, Lennox-Gastaut, Landau-Kleffner syndromes, epilepsy with constant spike-wave complexes in sleep, opercular status epilepticus, epileptic speech dyspraxia), hormonal therapy is used, most often adrenocorticotropic hormone (ACTH) drugs. Both natural ACTH and its synthetic analogue Synacthen Depot, as well as prednisolone, are used. Drug dosages vary widely as individual patients respond to different treatment regimens [8, 19].

New AED formulas with new mechanisms of action are widely represented on the pharmaceutical market.

In Russia in 2010, lacosamide (Vimpat) was registered for the treatment of focal epilepsies in patients over 16 years of age in combination therapy. Lacosamide has a new antiepileptic mechanism. The drug selectively enhances slow inactivation of sodium channels without affecting fast inactivation, resulting in: stabilization of hyperexcitable neuronal membranes, normalization of activation thresholds and inhibition of repetitive neuronal discharges. Currently, both a tablet form of lacosamide and an intravenous solution are available, which is an alternative for patients temporarily unable to take the drug orally [11].

Other newer antiepileptic drugs are currently under registration: zonisamide (Zonegran) capsules as an additional drug in adults for the treatment of partial epileptic seizures with and without secondary generalization and rufinamide (inovelon) tablets as an additional drug in the treatment of epileptic seizures associated with Lennox-Gastaut syndrome in patients over 4 years of age. Zonisamide's mechanism of action is complex, but not fully disclosed. It is thought to act on voltage-gated sodium and calcium channels and also reduce neuronal activity via gamma-aminobutyric acid.

Rufinamide is a natium channel modulator. It was registered in the USA in 2004, in Europe - 2007. Clinical studies have convincingly proven its effectiveness in Dropatak therapy (reduces them by 42.5%, and the effect becomes noticeable in the first 2 weeks). Recently, it was shown that rufinamide can be effective in the complex treatment of epileptic encephalopathies and epileptic syndromes, in addition to Lennox-Gastaut syndrome, Dravet syndrome, malignant migratory partial seizures of infancy and others [24].

New indications for the use of certain AEDs have been approved. For example, for levetiracetam (Keppra) oral solution (1 ml contains 100 mg of levetiracetam). The drug is indicated as monotherapy (drug of first choice) in the treatment of partial seizures with or without secondary generalization in adults and adolescents over 16 years of age with newly diagnosed epilepsy and as part of complex therapy: in the treatment of partial seizures with or without secondary generalization in adults and adolescents older than 1 month suffering from epilepsy; myoclonic seizures in adults and adolescents over 12 years of age suffering from juvenile myoclonic epilepsy; primary generalized convulsive (tonic-clonic) seizures in adults and adolescents over 12 years of age suffering from idiopathic generalized epilepsy.

Phenobarbital as a side effect causes sedation, in children - irritability, dysphoria, hyperkinetic disorders, decreased memory and intelligence, i.e., what are the main symptoms of the disorders in question. That is why treatment with phenobarbital is considered one of the factors in the development of epileptic psychoses, and the transition from it to valproate is the main condition for treatment [25]. The same is true for phenytoin. As for carbamazepine, it is widely used as a behavior corrector and anxiety disorders, in particular for attention deficit hyperactivity disorder, panic attacks, and also as a prophylactic for addiction disorders (it was on this basis that one of our patients received it).

The use of carbamazepine in epileptic encephalopathy as a first-choice drug is contraindicated, since the main task is to suppress epileptic brain activity, and carbamazepine often causes its intensification or appearance [26]. In this regard, the failure of treatment with finlepsin in sufficient doses of the patient, in whom both electroencephalographic and clinical improvement was achieved when switching to valproate, is characteristic, and the gradual withdrawal of finlepsin against the background of an already stabilized dose of depakine chrono was associated with further improvement in the EEG. This additional improvement associated with finlepsin withdrawal may be explained by the elimination of its facilitative effect on epileptiform discharges and its pharmacokinetic activation of liver enzymes that degrade valproate [5].

The duration of treatment and dose vary depending on the form of the disease and are determined empirically. If unsuccessful, topiramate, lamotrigine, and felbamate are used [32]. If ineffective, steroids are used in patients with speech disorders associated with Landau-Kleffner syndromes and electrical status in slow-wave sleep.

Antipsychotics and tricyclic antidepressants, nootropics, carbamazepine, phenytoin, and phenobarbital are contraindicated in this group of patients. Only if psychotic symptoms or depression persist, despite the complete suppression of epileptiform activity on the EEG (which was not the case in our observations), is it permissible to use antipsychotics of the group pimozide, sulpiride and antidepressants that block the reuptake of serotonin, such as Prozac (fluoxetine), fevarin (fluvoxamine ), to a lesser extent influencing the threshold of convulsive readiness of the brain. At the same time, intensive rehabilitation therapy should be carried out (with the participation of psychologists, speech therapists and other specialists) [30].

The prognosis of the disease depends on the etiology. In the absence of significant structural disorders of the brain and its congenital pathology, with proper treatment, favorable. With insufficiently persistent treatment aimed at suppressing epileptic activity on the EEG, the progression of psychocognitive disorders with the likelihood of severe social disorders. The addition of seizures and the occurrence of convulsive status is possible [28].

Conclusion: it should be emphasized once again that the main indicator of the correct choice of drug, dose and treatment success is the normalization of the EEG. Clinical improvement in most cases is manifested by a certain, often significant lag relative to EEG data. As has already been reported, another opportunity to improve the effectiveness and tolerability of antiepileptic therapy is the creation of new dosage forms of drugs that already exist in certain dosage forms, most often tablets.

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Main symptoms in children

The symptoms of the disease in children can be different, much depends on the age of the child, the stage and type of pathology, as well as on the area of ​​the brain in which the main focus is localized.

Such a pathology requires early diagnosis and timely treatment to avoid the development of complications. For this reason, it is extremely important not to ignore warning signs.

In infants under one year of age, symptoms may include:

• causeless prolonged crying;
• unnatural reaction to light and sounds;
• frequent tilting of the head;
• unstable heart rhythm;
• disturbances in the baby's sucking reflex.

Doctors also pay attention to increased muscle tone and frequent, causeless shudders. It is important to understand that such manifestations do not always indicate illness; such reactions can also appear in healthy children, be irregular or regular. Diagnosis is very difficult; it is for this reason that the baby must undergo regular medical supervision in the first months of life.

Signs of the disease in children over three years of age are as follows:

• disturbance of sleep patterns, frequent daytime sleepiness;
• hearing and vision impairment;
• memory impairment;
• asymmetry of reflexes;
• regular headaches.

At this age, epileptic encephalopathy becomes a consequence of another disease, for example, measles, chickenpox or scarlet fever. EE acts as a complication against the background of another disease. In some cases, the disease is accompanied by a sharp increase in temperature.

The disease can also develop during school age, although such cases are rare. With such prognosis, the disease will be characterized by a sudden loss of interest in knowledge, increased irritability, apathy or depression. It is important to pay special attention to the child’s health after a tick bite.

The symptoms of the disease are quite vague and may indicate completely different pathologies or simply fatigue. For this reason, the child’s condition requires careful and competent diagnosis.

Symptoms of epileptic encephalopathy

The clinical picture of the disease depends on its severity, the age of the child, and the presence or absence of additional pathological changes. For example, early epileptic encephalopathy can manifest itself in the form of an inadequate reaction of a child to bright light or loud sounds, increased muscle tone, causeless crying, etc. As the child grows up, the symptoms become more distinct. Abnormalities of muscle tone can range from myoclonus and epileptic spasms to severe tonic or atonic type seizures.

The clinical picture necessarily includes a delay in psychomotor or psycho-speech development, dementia, which is prone to progression. Manifestations of the disease may be supplemented by focal neurological symptoms.

Consequences and complications

Leaving a child’s uncharacteristic behavior unaddressed is dangerous at any age. Of course, in any manifestation of care it is necessary to know when to stop, but systematic deviations should alert parents.

Without proper treatment, epileptic encephalopathy can lead to serious impairments in the mental and physical development of a child, including disability at an early age.

The extent of possible complications for future health depends on the number of neurons that die in the child's brain.

Prognosis and prevention

A favorable prognosis in the case of epileptic encephalopathy is possible for the second variant of the disease - the number of attacks decreases, then the cognitive functions of the brain improve, behavioral and emotional disorders weaken.

In the case of the formation of encephalopathy according to the first option, the prognosis is not so favorable - an acceptable level of social adaptation of the child is practically unattainable.

It is easier to prevent any disease than to treat it later. Preventive measures to help prevent this disease:

• a thorough assessment of the health of the expectant mother - laboratory and instrumental identification of possible threats to the unborn baby;
• preparation for pregnancy even at the planning stage - administration of various vaccinations, treatment of chronic pathologies;
• giving up bad habits - consuming tobacco and alcohol products;
• proper nutrition for a pregnant woman - the predominance of foods with vitamins and microelements in the diet;
• absence of severe stress, toxic effects, infectious diseases;
• early start of doctor's monitoring of the course of pregnancy - implementation of prescribed procedures, doctor's recommendations literally from the very first days after the woman found out that she would become a mother.

Of course, the above preventive measures do not provide a complete guarantee that the baby will be born absolutely healthy - without signs of epileptic brain damage. However, if a woman follows a healthy lifestyle, the chances that encephalopathy will not develop will be as high as possible. Responsibility for the health of the unborn baby lies entirely with the parents.

Competent diagnostics

As mentioned above, diagnosing the disease is time-consuming and complex. The child must undergo a complex of laboratory procedures and clinical studies.

For a correct diagnosis you need:

1. A visit to a neurologist, who should take a primary medical history. This happens during a conversation with the parents and the child (if he is of the appropriate age). The doctor also evaluates basic reflexes and the speed of reaction to external stimuli.
2. To determine the nature of the functioning, blood supply and structure of the brain, a whole range of procedures is prescribed: EEG, MRI, ultrasound.
3. A visit to a psychiatrist who focuses on the patient's behavioral and emotional characteristics.
4. For children over the age of 5, it is also recommended to undergo psychological tests to identify possible deviations in the emotional perception of the world.
5. A number of laboratory tests are prescribed that help determine the state of the patient’s metabolism, identify possible concomitant pathologies, and also specify the syndrome of epileptic encephalopathy.

Only after undergoing a wide range of examinations is the doctor able to make a diagnosis and begin to formulate a treatment regimen.

Diagnostics

Modern diagnostic methods help identify epileptic encephalopathy at an early stage of its appearance:

• measuring blood pressure - to determine the tendency to hypertension, which can lead to deterioration of brain nutrition;

• various blood tests to detect metabolic disorders;
• study of cerebrospinal fluid - to study inflammatory processes in brain structures, to identify surges in intracranial pressure;
• electroencephalography - to study electrical impulses of the brain, foci of epistatus;
• computed tomography – diagnostics of focal brain formations, determination of their size, location and quantity;

• magnetic resonance imaging - a detailed examination of brain tissue, allows for differential diagnosis between several similar pathologies;
• Ultrasound Dopplerography of intracranial vessels - identifies existing blockages that prevent the flow of nutrients and create the preconditions for encephalopathy.

The specialist will definitely ask the child’s parents about his behavior, the functioning of his memory, and clarify in what time frame and how his cognitive skills and movements developed. Family heredity plays an important role - cases of similar deviations in past generations, among close blood relatives.

Only based on the results of a thorough analysis of all the information received, the doctor will be able to make a full diagnosis, as well as select the optimal treatment regimen for the disease.

Treatment methods

In most cases, the disease develops slowly, which allows medicine to take the necessary measures in a timely manner. With early diagnosis, treatment begins in the maternity hospital.

First of all, medications are prescribed that normalize cerebral circulation and intracranial pressure. At older ages, the list of recommended drugs expands.

If we talk about treatment in general, the following groups of medications are used:

1. Tranquilizers.
2. Antiepileptic drugs.
3. Nootropic drugs.
4. Vasodilator drugs.
5. Amino acids and vitamin complexes.
6. Sedatives.

For a complete recovery, drug therapy is not enough; it is important to resort to physiotherapeutic treatment methods:

1. Massage.
2. Breathing exercises.
3. Reflexology.
4. Acupuncture.
5. Swimming.

Competent comprehensive treatment of epileptic encephalopathy in children will allow a full recovery. After treatment, it is recommended to visit a neurologist twice a year to monitor your health.

Prognosis for recovery

With epileptic encephalopathy in children, the prognosis for recovery depends on several factors:

1. Timely diagnosis.
2. The degree of disease at which it is detected.
3. Compliance with all instructions of the attending physician.

If the disease is mild, then the chances of recovery are almost 100%. In the case of an acute form of pathology, treatment becomes more complicated. The disease rapidly destroys brain neurons, which without proper treatment can cause swelling and coma.

Speaking about statistical forecasts of epileptic encephalopathy, experts recommend not to panic; about a third of children fully recover. The main thing is to pay attention to the symptoms in time and consult a doctor.