The term "epilepsy" experts call a chronic brain disease, which is characterized by disordered outbreaks of activity of its cells. In children, this disease occurs more often than in adults. In most cases, it manifests itself in the form of convulsive seizures.
Possible reasons
It is not always possible to determine exactly why a child suffers from epilepsy. But this does not mean that there is no point in examining the kids. Depending on what are the causes of epilepsy in a child, the types of this disease are distinguished.
Many call the trigger mechanism injuries, infectious lesions. They also say that this is an autoimmune disease. This version is confirmed by the fact that autoantibodies to neuroantigens are found in the blood of patients.
In children, the following causes can provoke the onset of the disease.
1. Heredity. But scientists say it is not true to say that epilepsy is transmitted. By inheritance, one can only get a predisposition to its appearance. Each person has a certain level of convulsive activity, but whether epilepsy will develop depends on a number of other reasons.
2. Brain disorders. Malfunctions in the central nervous system arise due to the effect on the fetus of harmful substances, diseases of the mother during pregnancy. They are also caused by genetic disorders.
3. Infectious lesions. The disease can occur after suffering meningitis or encephalitis. Moreover, the younger the child was, the higher the likelihood of developing epileptic seizures in the future, the harder they will be. True, if the baby has a high congenital level of convulsive activity, then any infection can provoke the disease.
4. Injuries. Any strokes can trigger the onset of epilepsy. But the relationship is not always possible to establish, because the disease does not start immediately.
Knowing what are the causes of epilepsy in a child, you can determine the tactics of further examination and treatment.
Disease classification
Specialists distinguish several subspecies of this disease, depending on what caused the onset of seizures.
If the problem has developed due to structural defects of the brain, then we will talk about symptomatic epilepsy. It can occur due to the formation of a cyst, tumor, or hemorrhage in this organ. Idiopathic epilepsy is involved in cases where there are no visible changes in the brain, but the child has a hereditary predisposition to the development of this disease.
But there are cases when the symptoms of epilepsy in a child are pronounced, and the cause of this condition cannot be determined. This type of disease is called cryptogenic.
Also, experts distinguish localized and generalized forms of the disease. In the first case, foci of activity in the brain are strictly limited. They are always formed in the same areas of the brain tissue. And with generalized forms , almost the entire cerebral cortex is involved in the pathological process.
Separately, a mixed version is distinguished. Initially, epileptic seizures begin as localized, but the focus of excitement quickly spreads to the entire cortex.
First calls
All parents should know what are the signs of epilepsy in a child. After all, this problem is detected in 3% of babies under the age of 9 years. In infants, it can be confused with normal motor activity. The child turns his head, actively moving his arms and legs. The convulsive component is not always present in them.
Attacks can occur at any age. But most often they arise when the brain and nervous system are not fully ripe. Pathological foci of excitation in such cases appear easier.
Some attacks may not be visible to others. Even parents may not pay attention to them. They appear in āfreezeā states that last only a few seconds. The most common form of the disease in children is abscess epilepsy (pycnolepsy). During an attack in a child, consciousness disappears, retrospulsive movements of the head are noticeable, eyes can roll up. At the end of the attack, automatic pharyngo-oral movements often appear. It can be a licking of lips, smacking, sucking. Such attacks usually last no more than 30 seconds. But they can be repeated many times, even during one day.
Parents should be aware that these are symptoms of epilepsy in a child. Attacks can be caused by a sleep disorder, decreased or, conversely, too active brain activity, photostimulation.
Forms of the disease
Specialists distinguish not only localized and generalized types of epilepsy. Depending on the factors that provoke the onset of the disease, these forms are distinguished:
- primary: occurs against a background of increased convulsive activity of the brain;
- secondary: appears as a result of an infectious or traumatic lesion;
- reflex: arises as a reaction to an irritant, it may be a certain noise, flickering light, smell.
Depending on the age at which the first signs of the disease appeared, and the characteristic clinical signs, these types of seizures are distinguished:
- propulsive insignificant, they are characteristic of infancy ;
- myoclonic is an early childhood form;
- impulsive, occur during puberty;
- psychomotor - they can be accompanied by convulsions or pass without them, it can be sensory, auditory, reverse attacks, fits of laughter.
Depending on the frequency of occurrence and the rhythm of seizures, the following types of epilepsy are distinguished:
- with rare (less than 1 time per month), frequent (up to several times a week) seizures;
- With irregular and increasing seizures.
By the time of appearance, such forms of epilepsy are distinguished:
- night;
- awakening;
- generalized (seizures appear at any time).
Foci of excitation can be in the occipital, cortical, temporal, diencephalic and other areas of the brain.
Main symptoms
Depending on the site of the underlying lesion, the signs of epilepsy in a child will vary. After all, the disease is not always manifested by convulsions. Alert should be a temporary loss of consciousness, motor disorders, disorientation in space, impaired perception (taste, sound or visual), aggressiveness, sudden changes in mood. Also,
older children can say about numbness in certain parts of the body.
These symptoms of epilepsy in a child are not always noticeable, so parents do not always pay attention to them. In older children, they can take them for ordinary distraction. But there are signs that attract attention. This is respiratory arrest, muscle tension in the body, which is accompanied by the fact that the child is bent and unbent limbs, there are convulsive contractions, involuntary defecation, urination. The patient can bite his tongue, some scream during attacks.
Sometimes, during seizures, people can only observe trembling of the eyelids, tipping their heads back, looking at one point. They do not respond to external stimuli. But many are not able to recognize epileptic seizures if they are not accompanied by convulsions and rocking on the floor.
You must also know that the immunity of epileptics is rather weak. They often suffer from various psycho-emotional disorders. They may have anxiety and depression. They differ in petty and quarrelsome nature, they often have attacks of aggression. People with epilepsy are characterized by excessive pickiness, revenge, vindictiveness. Specialists call this an epileptic character.
Diagnosis of the disease
Noticing the childās periods of fading or jerky movements, you should immediately go to the doctor. Only a full examination and the selection of the right treatment can return a person to a normal life.
Special laboratory and instrumental examinations are needed in order to make a diagnosis of epilepsy with 100% certainty. A disability group is established once until adulthood. After the eighteenth anniversary, a re-commission will be necessary.
One of the main examination methods is electroencephalography. True, almost half of the patients in the period between attacks on it may not have any changes. During functional tests (hyperventilation, sleep deprivation, photostimulation) in 90% of patients characteristic symptoms of epilepsy appear.
In addition to EEG, neuroimaging is also used. This study allows you to identify brain damage, establish a diagnosis, determine the prognosis and further treatment tactics. These methods include computed tomography and magnetic resonance imaging. Also, patients take urine and blood for analysis. The level of immunoglobulins, transaminases, albumin, electrolytes, calcium, alkaline phosphatase, magnesium, glucose, iron, prolactin, thyroid hormones and others is determined.
Additional studies include ECG monitoring, dopplerography of brachiocephalic vessels, and cerebrospinal fluid analysis.
The choice of treatment tactics
Normalize the condition of the child and reduce the frequency of seizures, or even completely eliminate them in the case of well-chosen therapy. True, you should not count on getting rid of problems in the first month. Sometimes you have to drink pills for several years, so that mental epilepsy recedes, and the attacks completely stop.
Therapy should be comprehensive. In addition to the mandatory intake of prescribed medications, in some cases neurosurgical treatment is necessary. It is also difficult to do without psychotherapeutic support. With the right approach, persistent remission can be achieved in 75% of small patients.
In addition to drug therapy, doctors advise the child to establish a clear daily regimen and transfer him to a special diet. Such a lifestyle should become a habit. After all, the mode minimizes the likelihood of foci of excitation in the brain. Doctors also note that a ketogenic diet gives good results. Its essence is that you need to eat foods high in fat. At the same time, it is necessary to reduce the amount of carbohydrates.
Features of drug therapy
Determine how to treat epilepsy in each case, should only a doctor with sufficient experience. After all, it is important to choose medicines so that they bring maximum benefit with a minimum of undesirable consequences. Treatment begins only after the diagnosis is established. To prescribe a particular drug, the doctor must determine the nature of the seizures, take into account the features of the course of the disease. The role is played by the age at which the seizures began, their frequency, the patientās intelligence, the presence of neurological symptoms. The toxicity of drugs and the likelihood of side effects are also taken into account. When choosing drugs (for epilepsy, anticonvulsants are mainly prescribed), the doctor should pay more attention to the nature of the attacks, and the form of the disease is less important.
For therapeutic purposes, patients are prescribed the usual age-related dose. True, the doctor should paint a regimen. After all, antiepileptic drugs begin to be drunk with a lower dose. If the effect of their administration does not appear, or it is barely noticeable, it is necessary to gradually increase the dosage. A feature of the treatment of this disease is that it is undesirable to change the drugs. If the body does not respond, you just need to increase the amount of one-time taken funds. Although in about 1-3% of patients, remission can be achieved by using a reduced average age dosage.
Drug Selection
There are times when the prescribed drug does not help. This is evidenced by the lack of improvement over the course of a month, provided that the maximum age dosage is reached. In such a situation, it is necessary to change the drug. But this is not so simple. There is a special scheme for treating epilepsy with various medications.
To replace the funds, the second prescribed drug is started to be administered gradually, while the previous one is also canceled. But this is done smoothly. Sometimes a drug change is delayed for several weeks. If the patient has a pronounced withdrawal syndrome, then it is advisable to give benzodiazepines and barbiturates as a complex therapy.
In the vast majority of cases, epilepsy can be cured. The doctor individually selects anticonvulsant and anticonvulsants. Often prescribed "Diazepam", "Phenobarbital", "Carbamazepine." Preference is preferably given to agents in which the active substances are released slowly. After all, their use reduces the risk of side effects. Such medicines include derivatives of valproic acid and carbamazepine. These include tablets āValparin XPā, āConvulsofinā, āEncoratā, āConvulexā, āDepakin Enteric 300ā, āFinlepsinā, āApo-carbamazepineā.
Possible complications
Properly selected therapy can completely eliminate the symptoms of epilepsy in a child in a few years. In some cases, consecutive monotherapy does not stop attacks. This is possible with drug resistance. Most often, it is observed in those patients in whom seizures started early, there are more than 4 seizures per month, there is a decrease in intelligence and brain dysgenesis. In such cases, epilepsy of the brain should be treated in a slightly different way. The doctor may prescribe the simultaneous administration of two drugs.
Treatment according to the selected scheme should be carried out for several years and even after the complete cessation of seizures. Depending on the forms of epilepsy, this period can be from 2 to 4 years. But premature withdrawal of drugs can cause deterioration. Attacks may resume again. Even after the end of the specified period, the withdrawal of funds should be carried out gradually over a period of 3-6 months. It is important to regularly monitor the condition using EEG. In some cases, therapy is carried out throughout life.
You must understand that the earlier the disease started, the more serious the consequences of epilepsy can be. This is due to the fact that at an early age in humans, the brain is still immature and, as a result, more vulnerable. Parents need to be serious about the prescribed treatment, because if you do not adhere to the selected treatment regimen, skip taking the pills or cancel them yourself, the child may resume attacks until the status of the epilepticus appears. This condition is characterized by the fact that the child has seizures one after another without interruptions, the consciousness between them does not clear up.