Epilepsy is a disorder of the central nervous system (CNS). This neurological dysfunction arises due to disruption in nervous activity in the CNS that causes seizures or periods of highly unusual sensations, behavior and, at times, a loss of consciousness.
It may begin at any age, but it is most frequently seen in children younger than 5 years old. Fortunately, most children with the condition have seizures that generally respond well to therapy. This enables those affected to enjoy an active and relatively normal childhood. Furthermore, some children with the disorder may also outgrow it.
Signs and Symptoms
It is not always easy to recognize seizures in children when they first occur, because they can be short and subtle. An example would be a brief episode of decreased responsiveness and awareness in a child experiencing an absence seizure. In addition to this, there are many childhood phenomena that can be easily confused with seizures, such as psychological problems, fainting spells, daydreaming, sleep jerks and night terrors.
Epileptic seizures can be generally classified as focal or generalized depending on the manner in which the abnormal activity within the brain starts. These two general categories have different signs and symptoms. Focal, also called partial seizures, result from abnormal activity in just one part of the brain and can be subdivided into simple and complex partial seizures.
In simple partial seizures there is no loss of consciousness, but sensations such as sound, taste, smell, feeling and look may be altered along with emotions. Complex seizures cause a loss of consciousness and abnormal repetitive behaviors like walking in circles.
Generalized seizures can be subdivided into 6 forms, namely, absence, tonic, atonic, clonic, myoclonic and tonic-clonic seizures. Absence seizures can cause a brief loss of awareness and the child stares into space or have subtle behaviors, such as lip smacking or eye blinking. In tonic seizures there is a stiffening of muscles, while atonic seizures cause a loss of muscle control and may cause the patient to fall down.
Clonic seizures present with rhythmic muscle jerking affecting usually the face, neck and arms. Myoclonic seizures cause twitches of the arms or legs. Tonic-clonic seizures are the most dramatic of all and can cause violent shaking, bodily stiffening and loss of conscious and bladder control.
Diagnosis and Treatment
The condition is considered in children who have experienced multiple seizures. After referral to a specialist, the child and parents are questioned to gather information on what transpired before, during and after experiencing the seizure. If the parents are able to capture a seizure on video, this would be a great asset to diagnosing the child.
General investigations, which include blood tests and electrocardiograms, are conducted to rule out other conditions. A neurological examination is also conducted to test motor abilities, behavior and mental function among others. Further tests such as magnetic resonance imaging (MRI), CT scans and electroencephalograms are conducted too in order to detect brain abnormalities.
There are drugs that can prevent seizures from recurring, but these are not routinely prescribed to every child who experiences a seizure. The decision to prescribe drugs or not depends on several factors, such as the child’s age, type of epilepsy, risk of further seizures and presence of any behavioral or developmental problems.
Most parents are often concerned about starting a child on medication and this is the reason why the decision to treat children is always heavily weighted against sound clinical findings. Alternatives to drug therapy include vagal nerve stimulation and surgery. In addition to these, a diet high in fat and low in carbohydrates, called a ketogenic diet, may also be tried.
The condition and its associated therapies may affect the child in many ways. Some children may experience learning difficulties despite having the same intellectual capacity as their peers. These patients can also have behavioral disturbances and issues with self-esteem, because of their condition. Hence, counsellors and other support services may be necessary.
Sports such as swimming, cycling or climbing should be carefully supervised in children with a history of epilepsy, but not discouraged. There should be a balance between protection and the fostering of the child’s independence. This is especially important, because accurate diagnosis with the proper treatment and support, will enable most children with epilepsy to enjoy their childhood like all other children would.
Reviewed by Afsaneh Khetrapal, BSc (Hons)