Epilepsy in Children

Epilepsy affects over 50 million people worldwide and is characterised by spontaneous seizures that may range from brief, almost undetectable movement to vigorous trembling that continues for a long duration. These seizures may also cause the individual to lose consciousness or experience muscle spasms.

What Is Epilepsy?

Epilepsy is a chronic neurological disorder that causes unprecedented seizures, along with frequent and sudden instances of sensory disruption. It is known to affect people of all ages and is the fourth most prevalent neurological condition.

What Are Epilepsy Seizures In Children And Its Types?

In children, epilepsy seizures can occur in various forms and can also affect any part of the body. Based on which area of the brain is affected, seizures can be of two types– generalised and focal.

Generalised seizures

These seizures affect the neurons on both sides of the brain causing convulsions that can range from mild to severe and can occasionally result in loss of consciousness.

Generalised seizures include:

• Atonic seizures– Here the muscles go limp making the person plummet to the ground.
• Absence seizures – These rare seizures cause the person to remain unusually still and stare blankly ahead.
• Myoclonic fits– These fits cause the body to experience muscle spasms or sudden jerks in a specific part of the body.
• Clonic seizures– These cause sudden jerks and spasms in the child’s body that may be visible as regular and repeated, flexing and releasing of the arms, elbows, and legs.
• Tonic seizures– Tonic seizures can make the body arch back and cause difficulty in breathing and also makes the person lose consciousness.
• Tonic-clonic seizures– These seizures are also called Grand Mal seizures and are the toughest of the lot. They begin with loss of consciousness and further lead to the tonic and the clonic phases.

Focal seizures

These seizures, also called partial seizures, affect the brain cells on only one side of the brain and as a result, affect only a part of the body. Focal epilepsy in children can be classified into four categories

• Focal aware seizures: These are also called simple partial seizures and children stay conscious and aware during these seizures.
• Focal motor seizures: These can cause the child to experience repetitive twitching, spasms or may even cause movements like clapping or rubbing hands.
• Focal impaired aware seizures: These complex partial seizures cause confusion and loss of memory. The children will likely not remember the episode.
• Focal non-motor seizures: These seizures are characterised by intense emotions, goosebumps, a feeling that the heart is racing or abrupt waves of cold or heat.

What Happens During a Seizure?

There are millions of neurons present in the brain that send out electric signals to control the various functions of the human body. An epileptic episode is caused due to disruption in the transmission of these electric signals to and from the brain. A severe burst of electrical signals in the brain hamper their flow causing seizures on the part of the brain affected.

What is Childhood Epilepsy Syndrome?

If a child’s seizures are defined or identified by a specific set of features that take place simultaneously, then it is called a childhood epilepsy syndrome. These particular signs may include their age, the type of seizure, possible learning disabilities and the patterns on the EEG (electroencephalogram).

What Are the Different Types of Childhood Epilepsy Syndromes?

Childhood epilepsy syndromes are of various kinds and vary as per the symptoms prevalent.

1. Childhood and Juvenile Absence Epilepsies

This epilepsy syndrome has an onset age that is between four to ten years and is characterised by sudden stillness and staring spells. Also called as ‘petit mal’ epilepsy, it is usually outgrown.

2. Benign Rolandic Epilepsy

This epilepsy causes focal seizures in the mouth, face and cause speech impairment or drooling. The seizures usually happen while the child is asleep or when he wakes up in the morning. The onset age of this epilepsy is five to ten years and in most cases, it is outgrown.

3. Infantile Spasms

Also called West’s syndrome, these occur within the first year after the baby is born. This epilepsy causes severe jerks in the baby’s body and may cause the baby to fall forward. This kind of epilepsy is considered dangerous as it associated with other epilepsy and cause developmental delays.

4. Temporal Lobe Epilepsy

This kind of epilepsy can occur at any age. These are focal seizures that can include both simple partial seizures and complex partial seizures characterised by staring and confusion or loss of memory.

Research has indicated that these seizures, when prevalent over a long period of time, can cause damage to the hippocampus area of the brain, which is associated with memory and learning. Hence, it is best treated immediately.

5. Juvenile Myoclonic Epilepsy

This form of epilepsy is known to start in the teenage years and give rise to generalised seizures. The seizures may include myoclonic jerks, tonic-clonic seizures or even absence seizures in some cases. These seizures can be controlled with medication and become less severe with age.

6. Frontal Lobe Epilepsy

These seizures happen while the child is asleep and may include short, recurring seizures with severe body movements. They seizures can begin at any age.

7. Lennox-Gastaut Syndrome

This difficult to treat epilepsy has an onset age of one to eight years. The seizures are known to be resistant to epileptic drugs and often require alternate treatments and surgery. These are generalised seizures that are characterised by a combination of different seizures and often cause development delays and behavioural issues.

What Are the Causes of Epilepsy in Kids?

The causes of epilepsy may be different in different children and tend to differ by age. While some forms of epilepsy are genetic, there are many idiopathic epilepsies that have unknown causes.

• Certain children develop epilepsy due to genetic reasons by the transfer of genes. However, the exact cause of seizures due to genes is not known as yet.
• Head injuries may result in seizures.
• Conditions that may cause damage to the brain, like some fevers, brain tumours and infection may also result in epilepsy.
• Some developmental disorders like Angelman’s syndrome, neurofibromatosis, Down’s syndrome, and tuberous sclerosis may also raise the possibility of epilepsy.
• Changes in the brain structure are the cause of epilepsy in about three to ten percent of the cases. Children born with such structural changes may develop epilepsy.
• Children with autism may also experience epilepsy seizures in three to ten percent of the cases.
• Congenital disorders and chemical imbalances in the body may also cause seizures in infants.

Epilepsy Symptoms and Signs

Symptoms of epilepsy depend on the area of the brain that is affected. Epilepsy triggers in children may vary and can cause symptoms that can be characterised by motor and non-motor symptoms

Motor symptoms

These include:

• Sudden jerks
• Abrupt twitching of the muscles
• Numbness or weakness in the muscles
• Spasms
• Stiffening of muscles
• Loss of bladder and bowel control
• Issues with breathing
• Speech impairment
• Repeated actions like clapping or rubbing hands
• Loss of consciousness

Non-motor or absence symptoms

These include:

• Sudden and intense emotional changes
• Loss of awareness
• Blank stares and rapid eye blinks
• Lack of response
• Sudden confusion

How is Epilepsy Diagnosed?

The diagnosis Epilepsy diagnosis includes complete medical evaluation paired with a diagnostic testing regimen. The doctors may also take information on the medical history of the family and details of when the seizure occurred.

Diagnostic tests include

• Electroencephalogram (EEG): This is a procedure where the electrical activity in the brain is recorded with the help of electrodes that are attached to the child’s scalp. This test provides a wave pattern that can indicate the presence of epilepsy.
• Magnetic Resonance Imaging (MRI): This test is done if there is suspicion of lesions in the brain to get a detailed image of the brain.
• Blood tests: Blood tests can point to any infections that may be present in the brain that may possibly cause seizures
• Neurological tests: The doctor may conduct a neurological test to map the cognitive functions, motor abilities and the behavioural patterns of the child to verify the type of epilepsy.
• Computerised Tomography (CT or CAT): These scans provide a cross-sectional image of the brain and point out to any tumours, bleeding or cysts in the brain that may be the cause of seizures.
• Lumbar Puncture or Spinal Tap: This test is used to extract a small amount of the cerebral spinal fluid, which is then tested for infections.
• Functional MRI: This test identifies the changes in the flow of blood to various parts of the brain and can indicate the area of the brain that is affected.

Epilepsy Treatment

Epileptic treatment for the child will be determined keeping in mind the age, type of seizures, medical history, overall health and extent of the condition. Some of the usual courses of treatments used as a cure for epilepsy in children include:

Anti-epileptic Medicines

Anti-epileptic drugs are used to control and minimise the frequency of the seizures. Very often these medications are effective in controlling seizures and are usually recommended to be continued for at least two years after the seizures stop.

These drugs are prescribed by the doctors bearing in mind the age of the child, the type, and severity of the condition, apart from other factors. Anti-epileptic drugs have been successful in 80 percent of the cases in helping the patients become free of seizures.

Ketogenic Diet

Children who are resistant to medications may be placed on a ketogenic diet. This is a high fat-low carb diet that breaks down fat instead of carbs, inducing a state of ketosis. This is found to reduce the occurrence of seizures.

Surgery

When the child does not respond to medications or diet changes, surgery may be recommended. Immediate surgery can also be conducted if the child has seizure causing lesions in the brain.

Vagus Nerve Stimulation or VNS Therapy

Children who do not respond to the above courses of treatment and are not cleared for surgery may be suggested the VNS therapy. This therapy is usually used for children over 12 years.

In this procedure, an electronic pulse generator is surgically placed in the chest wall. This device sends electric impulses through the vagus nerve to the brain every few minutes to control seizures. The impulses can be activated during a seizure episode by holding a magnet over the device.

Effects of Childhood Epilepsy on Your Kid’s Life

Children with epilepsy can and should be encouraged to take an active part in activities. In instances where certain Epilepsy triggers in children like stress or excitement may pose a challenge, general precautions can be taken. It is important to understand that,

• A child with epilepsy has the same abilities and intelligence as other children unless epilepsy has caused learning disabilities.
• Behavioural issues in the child can be caused due to epilepsy and it is recommended to seek the help of an epilepsy counsellor to overcome these. Here are some tips.
• While a child with epilepsy can enjoy most sports and games, it is best to take necessary precautions based on the seizures of the child and ensure adult supervision at all times.

How May Your Child Feel Due to Epilepsy?

A child whose seizures are difficult to control may experience loss of energy, fatigue and develop attention and behavioural issues. The social skills and learning abilities of the child may also get hampered causing him to have low self-esteem. Children with controlled seizures are also often prone to emotional difficulties and have issues with behaviour and learning. It is important for the family to provide ample support to their children in these aspects and to help them overcome these challenges.

Changes in Epileptic Seizures as a Child gets Older

Some children experience what is called a ‘spontaneous remission’ as they get older where their seizures cease and they outgrow epilepsy. Others may see a change in the frequency and type of their seizures. Children who have been taking anti-epileptic drugs may also turn seizure-free and be recommended to discontinue the medication.

Dos And Don’ts When Your Child Has an Epileptic Seizure

Epilepsy can be challenging to take care of and control and hence it is essential to prepare yourself to manage your child when he has a seizure. These are the dos and don’ts that can help you get through the episode:

Dos:

• Lay your child on the floor carefully and remove any objects around him to prevent injury.
• Turn the child on his side to prevent choking due to vomit or saliva.
• Loosen any collar or tie around the neck to help with the breathing.
• Track the duration of the seizure
• Call the doctor after the seizure or if the seizure lasts longer than three minutes.
• Stay with the child throughout the duration of the seizure.

Don’ts:

• Do not panic.
• Don’t try to stop the shaking or restrict the movement of the child’s body while he’s having a seizure, it may result in injuries or make him uncomfortable.
• Don’t put anything in the child’s mouth as he may choke on it.
• Don’t give the child food, medicine or fluids when he’s having a seizure to prevent choking.
• Don’t force open the mouth during a tonic seizure as it may cause injury to your child or block his airways.

What is Ketogenic Diet and What it Includes?

A ketogenic diet is a high fat-low carb diet where about 90% of the calories come from fat. This fat is burned to make ketones, which is used as an alternate source of energy from the brain and heart functioning. It is important to limit carbohydrates in the diet very strictly, as it may hamper the progress of the diet.

Keto diet includes high-fat food items like butter, cheese, bacon, among others. You can also include the ground vegetables, meat, nuts and seeds, avocados, in addition to other high-fat foods.

How Long Can the Ketogenic Diet be Followed?

A ketogenic diet is usually prescribed for two years after which the child can be slowly transitioned back to a normal diet with the help of a dietician.

How to Prevent Epileptic Seizures in Your Child?

It is essential that you recognise triggers of seizures in your child and exercise caution to avoid these triggers.

• Ensure that your child is rested well as sleep deprivation can be a cause of seizures.
• Prevent injuries to the head with protective gears such as helmets when riding or using a skateboard.
• Remind your child to walk and step with caution to prevent falls.
• Avoid bright lights and loud noises as they may trigger seizures.
• Do not miss giving anti-seizure medication to your child at the same time every day.
• As stress may trigger seizures, teach your child some techniques to manage stress.

When to Consult the Doctor?

Consult your doctor immediately if,

• The child has a seizure that lasts over three minutes. This is because the child may have entered a prolonged life-threatening seizure called status epilepticus.
• The child is not breathing for more than 30 seconds
• If a head injury resulted in a seizure because there may be damage to the brain during the process.
• There is no response from the child for over an hour and if your child is confused, nauseous or has fever and vomiting.

Things to Remember

It is essential to keep these things in mind if your child is diagnosed with epilepsy:

• Epilepsy can be confused with other conditions. Hence it is important to get an accurate diagnosis.
• The extent and type of epilepsy seizures are different for different children. Always keep in mind the specifics of your child’s condition
• Most seizures can be controlled with anti-epileptic drugs and the children can live a normal and healthy life.

Epilepsy in children differs from child to child and it is crucial to understand the specifications of your child’s condition thoroughly before administering treatment.