The term "epilepsy" refers to a chronic disease of the brain, which is characterized by disordered bursts 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 causes
It is far from always possible to determine exactly why a child suffers from epilepsy. But this does not mean that there is no point in examining babies. Depending on the causes of epilepsy in a child, the types of this disease are also distinguished.
Many call the trigger mechanism injuries, infectious lesions. It is also said to be 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 reasons can provoke the onset of the disease.
1. Heredity. But scientists say it's wrong to say that epilepsy is transmitted. By inheritance, you can only get a predisposition to it.appearance. Each person has a certain level of seizure activity, but whether epilepsy develops depends on a number of other reasons.
2. Brain disorders. Malfunctions in the work of the central nervous system arise due to the influence of harmful substances on the fetus, diseases of the mother during pregnancy. They can also be 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 blows can provoke the onset of epilepsy. But the relationship is not always possible to establish, because the disease does not begin immediately.
Knowing what are the causes of epilepsy in a child, you can decide on the tactics of further examination and treatment.
Disease classification
Specialists identify several subspecies of this disease, depending on what caused the attacks.
If the problem developed due to structural defects in 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. We are talking about idiopathic epilepsy in cases where there are no visible changes in the brain, but the child has a hereditary predisposition to develop thisdiseases.
But there are cases when the symptoms of epilepsy in a child are pronounced, and the cause of this condition cannot be established. This type of disease is called cryptogenic.
Also, experts distinguish localized and generalized forms of the disease. In the first case, the centers 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 allocate a mixed version. Initially, epileptic seizures begin as localized, but the focus of excitation 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 physical activity. The child turns his head, actively moves his arms and legs. The convulsive component is not always present in them.
Seizures can appear at any age. But most often they occur when the brain and nervous system have not fully matured. It is easier for pathological foci of excitation to appear in such cases.
Some seizures may be invisible to others. Even parents may not pay attention to them. They manifest in "hover" states that last only a few seconds. The most common form of the disease in children is absence epilepsy (pycnolepsy). During an attack, the child's consciousness disappears, retropulsive movements are noticeablehead, eyes can roll up. At the end of the attack, automatic pharyngo-oral movements often appear. It can be lip licking, smacking, sucking. Such attacks usually last no more than 30 seconds. But they can be repeated many times even within one day.
Parents should know that these are symptoms of epilepsy in a child. Seizures can be provoked by a sleep disorder, reduced or, conversely, too active brain activity, photostimulation.
Disease forms
Specialists distinguish not only localized and generalized types of epilepsy. Depending on the factors that provoke the onset of the disease, the following forms are distinguished:
- primary: occurs against the background of increased convulsive activity of the brain;
- secondary: appears as a result of an infectious or traumatic lesion;
- reflex: occurs 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 minor, they are typical for infancy;
- myoclonic is an early childhood form;
- impulsive, occur during puberty;
- psychomotor - they can be accompanied by convulsions or pass without them, these can be sensory, auditory, adversive seizures, fits of laughter.
Depending onthe frequency of occurrence and rhythm of seizures, distinguish these types of epilepsy:
- with rare (less than 1 time per month), frequent (up to several times a week) attacks;
- with irregular and growing seizures.
The following forms of epilepsy are distinguished by the time of occurrence:
- night;
- awakenings;
- generalized (seizures appear at any time).
Focuses of excitation can be located in the occipital, cortical, temporal, diencephalic and other areas of the brain.
Main symptoms
Depending on the site of the main lesion, the signs of epilepsy in a child will also differ. After all, the disease is not always manifested by convulsions. Temporary loss of consciousness, movement disorders, disorientation in space, disturbances in perception (taste, sound or visual), aggressiveness, sudden changes in mood should alert. Also, older children may report numbness in certain areas 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 may mistake them for normal absent-mindedness. But there are signs that attract attention. This is respiratory arrest, muscle tension of the body, which is accompanied by the fact that the child's limbs bend and unbend, convulsive contractions, involuntary defecation, and urination are observed. The patient may bite his tongue, some scream during attacks.
Sometimes people have seizurestrembling of the eyelids, tilting the head back, looking at one point can only be observed. They do not respond to external stimuli. But many fail to recognize epileptic seizures unless they are accompanied by convulsions and rocking on the floor.
You should also know that the immunity of epileptics is rather weak. They often suffer from various psycho-emotional disorders. They may develop anxiety and depression. They are petty and quarrelsome in nature, they often have bouts of aggression. People with epilepsy are characterized by excessive pickiness, vindictiveness, rancor. Experts call this an epileptic character.
Diagnosis of disease
Noticing periods of fading or convulsive movements in a child, you should immediately go to the doctor. Only a full examination and selection of the right treatment can return a person to normal life.
Special laboratory and instrumental examinations are needed to diagnose epilepsy with 100% certainty. The disability group is established once before the age of majority. After the onset of the eighteenth birthday, it will be necessary to undergo a recommission.
One of the main methods of examination is electroencephalography. True, in almost half of the patients in the period between attacks there may not be any changes on it. During functional tests (hyperventilation, sleep deprivation, photostimulation), 90% of patients develop characteristic symptoms of epilepsy.
In addition to EEG, neuroimaging is also used. itthe 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. Determine the level of immunoglobulins, transaminases, albumin, electrolytes, calcium, alkaline phosphatase, magnesium, glucose, iron, prolactin, thyroid hormones and others.
Additional studies include ECG monitoring, dopplerography of brachiocephalic vessels, CSF analysis.
Choosing treatment tactics
It is possible to normalize the child's condition 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 take pills for several years so that mental epilepsy subsides and the attacks stop completely.
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, stable remission can be achieved in 75% of young patients.
In addition to drug therapy, doctors advise setting a clear daily routine for the child and transferring him to a special diet. This lifestyle should become a habit. After all, the mode minimizes the likelihood of foci of excitation in the brain. Doctors also note that the ketogenic diet gives good results. Its essence lies in the fact thateat 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 in such a way that they bring maximum benefit with a minimum of undesirable consequences. Treatment begins only after the diagnosis is established. To prescribe this or that drug, the doctor must determine the nature of the seizures, take into account the characteristics of the course of the disease. The role is played by the age at which the attacks began, their frequency, the patient's 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, mainly anticonvulsants are prescribed), the doctor should pay more attention to the nature of the attacks, the form of the disease is less important.
For therapeutic purposes, patients are prescribed the usual age dose. True, the doctor must describe the regimen. After all, they begin to drink antiepileptic drugs with a lower dose. If the effect of their intake 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 precisely that it is undesirable to change the drugs. If the body does not respond, you just need to increase the amount of a single dose taken. Although approximately 1-3% of patients achieve remission with reducedaverage dosage.
Selection of medicines
There are times when the prescribed drug does not help. This is evidenced by the lack of improvement throughout the month, provided that the maximum age dosage is reached. In such a situation, it is necessary to change the drug. But it is not so easy to do so. There is a special scheme for treating epilepsy with various medications.
To replace funds, the second prescribed drug is started to be introduced gradually, and the previous one is canceled at the same time. But it's done smoothly. Sometimes the change of the drug 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 anticonvulsant drugs. Often prescribed "Diazepam", "Phenobarbital", "Carbamazepine". Preference is desirably given to agents in which the active substances are released slowly. After all, their use reduces the risk of side effects. These drugs include derivatives of valproic acid and carbamazepine. These include tablets "Valparin XP", "Konvulsofin", "Enkorat", "Konvuleks", "Depakin Enteric 300", "Finlepsin", "Apo-carbamazepine".
Possible Complications
Properly selected therapy can completely eliminate the symptoms of epilepsy in a child in a few years. In some cases, sequential monotherapy does not stop seizures. itpossible with drug resistance. Most often, it is observed in those patients who have early onset of seizures, there are more than 4 seizures per month, there is a decrease in intelligence and brain dysgenesis. In such cases, a slightly different scheme should be treated for epilepsy of the brain. Your doctor may prescribe two medications at the same time.
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 a deterioration in the condition. Seizures may recur. Even after the end of the specified period, the cancellation of funds should be made gradually over 3-6 months. It is important to regularly monitor the condition using an EEG. In some cases, therapy is lifelong.
It must be understood that the earlier the disease began, the more serious the consequences of epilepsy can be. This is due to the fact that at an early age, the human brain is still immature and, as a result, more vulnerable. Parents should take the prescribed treatment seriously, because if you do not adhere to the selected therapy regimen, skip taking the pills or cancel them yourself, the child may resume seizures up to the appearance of status epilepticus. This condition is characterized by the fact that the child's seizures go one after another without interruption, the consciousness between them does not clear up.
