Childhood epilepsy: types, symptoms, causes and treatment

Childhood epilepsy is a neurological disorder that results in dysfunction of neuronal activity of the brain. This disease is characterized by the epileptic seizures that it causes in children, causing severe convulsions that affect the muscles of one or more areas of the body and sometimes cause loss of consciousness and sudden falls.

Here’s what childhood epilepsy is, what types of epilepsy seizures exist and what their symptoms are, along with the causes and treatments available.

    What is childhood epilepsy?

    Childhood epilepsy is a disease of the nervous system characterized by an abnormal discharge of electrical impulses in certain areas of the brain and cerebral cortex. Children with this chronic disorder have recurring fits or convulsions called epileptic fits.

    This disease usually manifests itself in a variety of ways, depending on the brain structure affected and the region of origin of the seizure. These seizures can be simple, without the child losing consciousness, or complex, in which there is loss of consciousness. Seizures can be short and last only a few seconds, or they can be long and last for several minutes.

    The effects of childhood epilepsy on the child and his environment also vary depending on factors such as age, types of seizures, the child’s response to treatment or whether there are other health problems. concomitant.

    The incidence of childhood epilepsy is estimated at 40 to 100 cases per 100,000 boys and girls, And affects more than 10 million children worldwide. 40% of all new cases are detected in children under the age of 15.

      Types of epileptic seizures (and their symptoms)

      The epileptic seizures that occur in a disease such as childhood epilepsy can be classified into two broad groups: those that occur with focal or partial seizures and those that cause generalized seizures. In each category, up to 30 types of epileptic seizures have been described.

      Focal or partial

      About 60% of childhood epilepsies occur with focal or partial seizures. These originate from only one side of the brain and are described according to the area of ​​the brain from which they originate (e.g. frontal lobe or medial temporal lobe). Its duration varies from 1 to 2 minutes.

      During this type of seizure, the child does not lose consciousness and may have strange sensations, such as intense memories, which can be expressed in different ways. Motor symptoms include various automatisms, eye blinking, tics, mouth movements, etc. The child may also experience intense emotions (joy, anger, sadness, etc.) and sensory disturbances.

      In focal seizures there may be a change in the level of consciousness, Which generates in the patient the feeling of being in a cloud or in a dream. In some cases, children experience an “aura” or a prodrome, a sensation that allows them to anticipate the onset of an impending epileptic seizure.

      Symptoms characteristic of focal seizures can confuse clinicians and be misinterpreted as signs of other illnesses, such as narcolepsy, fainting, or even mental illness. This requires a good differential diagnosis and the application of different tests.

      widespread

      In generalized epileptic seizures, abnormal electric shocks occur on both sides of the brain. This type of seizure can cause loss of consciousness, leading to falls and generalized muscle spasms. There are different types:

      • Absence crisis: the child seems to have his gaze lost and fixed on a precise point. Mild muscle spasms may be present. This causes problems with attention and concentration in the child.
      • Clonic seizures: cause repetitive sudden movements on both sides of the body.
      • Tonic seizures: produce muscle stiffness, especially in the back, arms and legs.
      • Myoclonic seizures: cause sudden jerking movements in the upper body, mainly in the arms and legs (and sometimes throughout the body). Its duration is very short, barely a few seconds.
      • Tonic-clonic seizures: cause a mixture of symptoms generated by tonic and clonic seizures, such as muscle stiffness and sudden movements in the arms and legs. These are the most serious crises.
      • Atonic seizures: they generate great hypotonia (decrease in muscle tone), causing the boy to fall suddenly or hit his head when falling by his own weight.

      the causes

      The most common causes of childhood epilepsy can be genetic and hereditary, due to trauma, abnormalities in brain development, infections and diseases, metabolic disorders, tumors and other issues. In fact, anything that disrupts a normal pattern of brain activity can cause epilepsy.

      Genetic factors, such as mutations, play an important role in certain types of epilepsy which have a strong hereditary component. In some cases, gene changes can occur spontaneously and without a family history. For example, mutations affecting ion channels, such as those in the SCN1A gene, responsible for epileptic seizures that occur in severe myoclonic epilepsy in children or Dravet syndrome, have been described.

      Brain damage can also be a determining factor in the onset of childhood epilepsy. this it can come from different stages of growth: during pregnancy, in infancy or adolescence. Blood vessel malformations and cerebrovascular disease can also be factors responsible for the onset of a seizure disorder.

      Other diseases such as cerebral palsy or metabolic disorders such as phenylketonuria may be linked to childhood epilepsy. It is estimated that 20% of epileptic seizures have their origin in neurodevelopmental disorders and the most frequent usually occur in children with autism spectrum disorders and severe intellectual disability.

      treatment

      Doses of antiepileptics are used to treat childhood epilepsy, which are usually given depending on the type of epilepsy, age and weight of the affected child, divided over two or three daily doses. The neurologist is responsible for monitoring pharmacological treatment, Taking into account possible side effects and interactions with other drugs. Correct diagnosis is also essential.

      Most monotherapy treatments (known as monotherapy) are effective in reducing and eliminating the incidence of seizures without any significant side effects. However, periodic checks are usually performed with tests such as electroencephalography, to collect data on the functioning of brain activity; and blood tests, to assess tolerance and levels of the drug in the blood plasma.

      Sometimes a small number of epilepsies can be difficult to control and it is necessary to introduce several drugs at once, which leads to an increased risk of interactions and side effects. In cases where drug treatment does not work and the child resists its effects, surgery may be considered as an alternative.

      Surgery is considered taking into account the area of ​​the brain from which the seizures originate (Epileptic focus). An extirpation of this area can be performed; cutting off several areas of the brain so that the seizures do not spread; a callosotomy can be performed, which involves severing the network of neural connections between the hemispheres; or perform a hemispherectomy, in which half of the cerebral cortex or hemisphere is removed, a drastic technique used only as a last resort.

      Bibliographical references:

      • Cerdà, JM, Argani, MT, Llerda, JM, González, FL, Puig, XS and Rieger, JS (2016). Official guide of the Spanish Society of Neurology for the clinical practice of epilepsy. Neurology, 31 (2), 121-129.
      • Travé, TD, Petri, MEY and Victoriano, FG (2007). Descriptive study of childhood epilepsy. Journal of Neurology, 44 (12), 720-724.

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