Epilepsy in Children
This is the most common neurological disorder affecting children, and may be characterized by sudden, recurrent episodes of uncontrolled motor activity and, in some cases, impaired consciousness (seizures). Any condition that triggers disruptive electrical discharges in the brain can produce epilepsy. Although the underlying abnormality may not be correctable, seizures themselves can usually be controlled through drug therapy. There are a number of relatively benign genetic epilepsies of childhood, some but not all of which may be outgrown.
Common Causes of Epilepsy
Seizures may develop as a result of a head injury, brain infection, brain tumor, drug or alcohol withdrawal or intoxication, stroke, birth trauma or metabolic imbalance. In most cases, the underlying cause of a child’s epilepsy is never discovered.
Types of Epileptic Seizure
Epileptic seizures fall into two broad categories: generalized and partial. Generalized seizures, which involve the whole brain, fall into several subtypes. The least dramatic of these are absence seizures (also known as petit mal seizures), which consist of brief episodes of altered awareness during which the child may appear to be daydreaming. During an absence seizure, all motor activity stops, and the child stares blankly or blinks rhythmically and does not respond when touched or called by name. Absence seizures may last five to ten seconds and recur many times a day.
At the other extreme are generalized tonic-clonic seizures (also known as grand mal seizures) during which the child abruptly ceases activity, falls and loses consciousness. During the initial phase of the seizure, lasting only a few seconds, the muscles stiffen. In the subsequent phase, the muscles undergo rhythmic, alternating contractions and partial relaxations, causing uncontrollable jerking motions (tonic-clonic seizures). Breathing may become irregular. After the seizure, which usually ends in less than five minutes, muscles relax, and the child may be confused and sleepy.
Partial seizures are categorized as simple or complex. A simple partial seizure may involve abnormal twitching, tingling and sensory hallucinations. Consciousness is preserved and the child can often recount details of the seizures, which generally last several minutes. Complex partial seizures have a variety of manifestations, including staring, complex involuntary movements and hallucinations. They may involve a loss of consciousness.
Tonic-clonic seizures are impossible to miss. Some of the more subtle types of seizures, however, may occur several times before parents or teachers recognize them. If the child occasionally seems unaware of his surroundings or experiences involuntary muscle contractions in one area of the body, he may have a seizure disorder.
It is important to note that the seizures some children have in association with fever do not constitute epilepsy. In addition, febrile seizures in early childhood are not usually associated with the later development of epilepsy.
Diagnosis of Epilepsy
After an initial seizure, the pediatrician (or pediatric neurologist) may order several tests, the most important of which is an electroencephalogram (EEG), a painless test that record the brain’s electrical activity. It is often necessary to perform several EEG’s in different circumstances (while the child is sleeping and while the child is looking at flashing lights, for example) to identify the type of seizure disorder present.
Treatment of Epilepsy
In the majority of cases, children’s seizures can be satisfactorily controlled or reduced in frequency with drug therapy. The success of the therapy depends chiefly on the severity of the seizure disorder, as well as on the child’s compliance in taking his medication, and on careful monitoring of blood levels by the physician.
One or more of about six different agents, called antiepileptic drugs, are generally prescribed for the treatment of epilepsy in children. Each of the drugs is useful in specific types of seizure disorders, and each has different dosage requirements and side effects that the physician takes into consideration before deciding which one to prescribe. In many cases, finding the proper medication and correct dosage level takes some time. Recent developments in specific types of brain surgery for intractable seizures offer new hope for very severe cases of epilepsy.
Looking After a Child with Epilepsy
A child who has a seizure disorder should be treated the same way you would treat any other child. Certain precautions should be taken while the threat of seizures exists.
- Make sure the child is well supervised in the bathtub, and at the beach or swimming pools.
- Teach the child to recognize the signs of an impending seizure and seek help.
- Have the child wear a MedicAlert bracelet that identifies his condition.
- Most important, be sure the child continues to take medication at the prescribed doses, even after seizures are under control. The doctor may recommend tapering off the medication after the child has been free of seizures for two or three years, but close medical supervision is needed for this process.