The brain is made up of a lot of nerve cells that use electrical signals to control the body’s functions. If these signals are disrupted, a person may have an epileptic seizure. Epilepsy is a neurological disorder characterized by unprovoked seizures which are due to a general increase in neuronal hyperexcitability.
Epileptic seizures come in different types. The type of epileptic seizure a child has depends on which area of their brain is affected. There are two main types of seizure: focal seizures (or partial seizures) and generalised seizures. Focal seizures affect only one side of the brain and generalised seizures affect both sides of the brain. Adults and children have the same types of seizure, although some may be more common in childhood than adulthood. For example, absence seizures, which can be very brief and are often mistaken for ‘daydreaming’ or not paying attention. other types of generalized seizures include clinic, tonic, atonic, myoclonic and generalised tonic-clonic seizures.
What Causes Epilepsy in Children
In about half of children with epilepsy, the cause may not be identifiable, however, the other half may be due to an underlying cause such as:
- Genetics – there may be a genetic tendency which is inherited from parents or due to a change in the child’s genes. Research has linked some types of epilepsy to a certain genes but these genes may just make a person more sensitive to environmental conditions that trigger seizures.
- Head trauma – this may be due to a road traffic accident or any other form of trauma causing injury to the brain.
- Brain conditions – brain conditions that cause injury to the brain such as a tumour or stroke can cause epilepsy.
- Infectious diseases – infections such as meningitis, viral encephalitis and HIV/AIDS may also cause epilepsy.
- Developmental disorders – epilepsy has been seen to be associated with some developmental disorders like neurofibromatosis and autism.
- Prenatal Injury – factors such as maternal infections, poor nutrition and oxygen deficiencies puts a child at risk of developing epilepsy.
How To know If a Child is About to Have a Seizure
Signs and symptoms of seizures depend on the part of the brain involved and hence the type of seizure the child may be experiencing. An epileptic child will go through 3 phases when suffering a seizure attack.
There is generally an aura phase in which there is an alteration in smell, taste, visual perception, hearing and emotional state of the child. Then an ictal phase in which the seizure mainly takes place and finally a postictal phase in which drowsiness and confusion are mainly experienced by the child. This is the phase where by the brain is recovering from what it went through.
In a focal seizure, the child may have an aura, or signs that a seizure is about to occur. This is more common with a complex focal seizure. The most common aura involves feelings, such as deja vu, impending doom, fear, or euphoria. The child may also experience the other aura symptoms as described earlier. On the other hand, in a generalised seizure, the child will lose consciousness and be tired after the seizure (postictal state).
Generally signs and symptoms may include:
- Jerking movements of the arms and legs.
- Stiffening of the body.
- Loss of consciousness.
- Breathing problems or stopping breathing.
- Loss of bowel or bladder control.
- Falling suddenly for no apparent reason, especially when associated with loss of consciousness.
- Not responding to noise or words for brief periods.
- Appearing confused or in a haze.
- Nodding head rhythmically, when associated with loss of awareness or consciousness.
- Periods of rapid eye blinking and staring.
Diagnosing Epilepsy in Children
It is not every seizure a child has that is due to epilepsy. There are a number of others things that can cause seizures in children and so a proper clinical diagnosis for epilepsy in children is very important. If a child has been having seizures, he or she should be taken to a health care provider. The doctor will examine the child properly for any injuries during the seizure attack. In addition, the doctor will also try to ascertain the possible cause of the child’s seizures. This will involve several questions and investigations.
The child’s medical history will be taken which may include information about:
- Recent fever or infection.
- Head injury.
- Congenital health conditions.
- Preterm birth.
- Recent medicines.
The following investigations may also be required:
- A neurological exam.
- Electroencephalogram to check the electrical activity of the brain.
- Lumbar puncture to check for infections like meningitis and also to measure the pressure in the brain and the spinal canal.
- MRI or CT scan of the brain.
- Blood sugar.
Treatment of Epilepsy in Children
The aim of treatment is to control, stop, or reduce how often seizures occur. Treatment is most often done with medicine. The healthcare provider will need to identify the type of seizure the child is having. Medicines are selected based on the type of seizure, age of the child, side effects, cost, and ease of use.
Other forms of treatment include surgery to remove the part of the brain where the seizures are occurring. Surgery is a complex option and is done when the seizures are hard to control.
Vagus nerve stimulation is another option and it is done for children 12 years and older with partial seizures that are not well controlled. Here, small pulses of energy are sent to the brain from one of the vagus nerves.