How Does Epilepsy Affect Children? Signs, Symptoms, And Treatment

Seizures mean excessive abnormal hypersynchronous (all at one time) discharge of current in the brain resulting in various clinical symptoms, the commonest being a convulsion. i.e. Contraction and jerking of limbs with up rolled eyes and frothing but can also result in other manifestations like staring, lip smacking, head and eye turning, and unawareness of the surroundings.

Epilepsy is a tendency to have seizures. Two or more seizures 24 hours apart OR occurrence of one seizure with a 60% risk of having another one will satisfy the criterion for epilepsy. About 10.5 million children worldwide are estimated to have active epilepsy. In newborns, the symptoms often go unnoticed, as it may seem like they are daydreaming or an epileptic attack may resemble hiccups mistakenly, while actually, the baby may be presenting mild convulsions. However, in older children, the signs may be quite evident. While 70% of children show normal development, frequent seizures do affect children in ways like low self-esteem, poor concentration, and fear of having seizures again.

Consult the best neuro hospital in Millers Road for more information.

What Causes Epilepsy in Children?

Common causes that cause epileptic attacks or childhood seizures are:

• Fever also termed Febrile seizures (seizures triggered by a rise in body temperature above normal) 

• Genetic mutation or familial inheritance 

• Head injury/trauma, called Posttraumatic epilepsy (occurs in 10-20% of children) 

• Hypoxia to the brain (low oxygen levels - common in the neonatal period)

• Hydrocephalus (excess water in the brain cavities causing intracranial pressure)

• Abnormalities in brain development 

• Metabolic abnormalities (Biotin, Pyridoxine deficiency)

• Neuro-infections (Meningitis, encephalitis, brain abscess, TB)

• Autoimmune encephalitis

What Are the Types of Epilepsy Seen in Children?

Childhood epilepsy types include:

Absence Epilepsy

The child loses awareness for a brief period lasting only a few seconds. There is a behavioural arrest (stops ongoing activity transiently), staring, mild twitching of the eyes and eyes, and/or head rollback may also occur. 

Rolandic Epilepsy

This type of epilepsy happens while the child falls asleep or wakes up. The symptoms include: 

• Twitching of the face, arm, or leg.

• Tingling and/or numbness.

• Difficulty in speech and swallowing.

• Drooling of saliva.

Juvenile Myoclonic Epilepsy

Juvenile Myoclonic Epilepsy occurs when the child reaches puberty. The clinical manifestations are twitching and jerking of arms and shoulders which often occurs in the morning just after awakening and sometimes after fatigue or stress. This would result in dropping objects from hands.

Infantile Spasms (West Syndrome)

This is a severe type of epilepsy that usually starts in babies and occur in clusters (frequent attacks back to back) shortly after waking up or while falling asleep. The presentation is sudden Bending and stretching of the whole body (flexor or extensor spasms).

The Course of Epilepsy in Children

The course may vary for children. Different courses have been summarised below:

• In children who have mild types of epilepsy, i.e., rolandic epilepsy and absence epilepsy, the epileptic attacks go away as the child grows with or without any medication.

• For some children, epilepsy remains and the symptoms may get worse in the form of increased frequency or intensity. Such children require medication with which seizures can be controlled. Some patients may require medication for life.

• Infantile spasms can occur in a few children with severe types of epilepsy. In such cases, medication is partially effective and will need steroid course early in the illness which can prevent the effect on the child's development.

• Depending on the type of epilepsy and the effect of medication, the neurologist can give a prognosis and predict the course of epilepsy.

Treatment Plan for Epilepsy in Children

Antiepileptic drugs are the first line of treatment for children with epilepsy symptoms. Other than drugs, there are dietary options, surgical options and of course treatment of the cause like correction of metabolic abnormalities, treatment of neuro-infections and autoimmune encephalitis, and so on.

A keto diet/ketogenic diet is a type of diet primarily focused on fat and avoiding carbohydrates. Many studies conclude that in appropriately selected cases, about half of children have shown a drop in seizure attacks on the keto diet. The basic metabolism behind it is that the body runs on ketones rather than glucose for energy. Fatty acids are considered to affect the signals passed in nerve cells and help reduce the occurrence of epileptic attacks. 

Surgical Approach for Epilepsy

In cases where medication doesn't work, a surgical approach may be required to manage the condition in children for whom epilepsy is shown to affect the quality of life. 
If the seizure occurrence has been associated with a specific part of the brain, surgery can be done to cut/remove that part of the brain. However, in cases, where seizures are associated with the whole brain, they can't be treated surgically.

Workup for surgical candidacy includes: 

• Magnetic resonance imaging (MRI) 

• Video recordings of brain activity measurements (EEG)

• Neuropsychological tests

These scans and examinations are required to help find areas of the brain responsible for seizures before approaching surgery. These tests are the minimum requirements but not enough in all patients where more sophisticated and complex tests like invasive EEG monitoring may be needed.
Neuro-stimulation is another approach that can be used to treat epilepsy in children. In this process, a device is implanted which delivers electric current to the area of the brain where abnormal electrical current is starting.
Epilepsy among children affects their mental development when there are frequent seizure attacks that become worse over time. Medication, surgery, and diet modifications are some of the modalities epileptologists prefer to keep epilepsy under control. 

Consult the best neurologist consultant in Millers Road if your child requires treatment for epilepsy. 

FAQs

• What is the difference between seizures and epilepsy? 

A seizure is a single occurrence while epilepsy is a neurological condition characterized by two or more seizures. 

• At what age do children tend to have febrile seizures?

From 6 months to 5 years old, children with a raised body temperature may tend to get febrile seizures. 

• Do epileptic medications have side effects? 

Yes, the medication has side effects in some, but the benefits outweigh the side effects of the medication. The side effects are generally minimal and may reduce over time. However, some drugs can have severe skin reactions or other severe side effects that should be counselled with parents beforehand. Appropriate selection of drug, dose, and combination and regular follow-up clinically and lab-wise (if needed) can help detect and treat side effects before they become serious.

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