Epilepsy accounts for up to 2% of all diseases in childhood. In the US, statistically over 400,000 children live with this condition. A seizure of epilepsy can begin in any child at any time. The reasons why the disease develops, can be a lot: from hereditary factors, brain injuries, to the influence of various infections. One thing is important: a child suffering from epilepsy faces many limitations, can not feel secure and suffers from this. Teenagers are especially sensitive to the new state. About how to help a child with epilepsy, MediGlobus explains you in this article.
READ IN ARTICLE:
What are the features of childhood epilepsy?
How is epilepsy diagnosed in children?
How to treat epilepsy in children
Where to treat epilepsy in children
Is it possible to cure epilepsy in a child
WHAT ARE THE FEATURES and causes OF CHILDHOOD EPILEPSY?
All parents, whose child is suffering from epilepsy, are wondering – why did their child suffer from this disease? Because of the onset, epilepsy is classified as symptomatic – in such cases, the condition is triggered by a structural defect in the brain, for example, a cyst, a tumor, or a hemorrhage; idiopathic – having no specific brain changes, but there is a hereditary predisposition to epilepsy; and cryptogenic – if the etiology can not be spotted. Epilepsy is a chronic disease, but this does not mean that such a diagnosis is a verdict for life. Today, the manifestations of epilepsy can be suppressed, and with adequate therapy and observance of lifestyle, in 75% of cases, epilepsy can be disposed of forever.
If your child has an epileptic attack, you shouldn’t panic.The algorithm of action is that parents should consult specialists (neurologist, epileptologist, psychiatrist), follow their recommendations, and the planned treatment program, also pay special attention to the development of the cognitive and motor spheres of the child. Remember that childhood epilepsy is much more treatable, and has other characteristics:
- Many children who experienced a single attack and that never repeated (therefore do not immediately diagnose the child by yourselves);
- Diagnostics of epilepsy involves the presence of multiple epileptic seizures for an unknown reason;
- Most children with epilepsy outgrow this condition (however this fact does not negate the need for timely treatment);
- This condition is not connected with a weak child’s health, most children are quite healthy by all other parameters;
- Approximately 70-80% of children manage to control their condition with the help of drug therapy.
The causes of epilepsy in childhood can be: burdened heredity, craniocerebral trauma, tumors, strokes, blood clots, transferred neuroinfections, birth trauma, etc. Another cause of epileptic attacks in childhood can be high fever, the so-called fibril convulsions.
Epilepsy in infants and newborns
Epileptic phenomena in newborn babies can occur very abnormally. Sometimes they are quite difficult to distinguish from ordinary motor activity.
But with close observation, you can see that the child stopped swallowing, his eyes focused on one place and did not respond to external stimuli.
Often, the first manifestations of epilepsy occur against a background of increased body temperature.
As the consciousness return, parents can observe weakness of the right or left side of the body, which can last up to several days.
HOW TO DIAGNOSE EPILEPSY IN CHILDREN?
It is extremely difficult to accurately confirm epileptic attack. A neurologist specializing in epileptology is dealing with this. The types and manifestations of this condition are so great that often a specialist needs time to sort it out. Doctor receives assistance with brain research from: encephalography, MRI, Doppler, PET and others. Aim of the diagnostics of newly developed epilepsy is to exclude the so-called “organic” causes, that is, the inflammatory or tumorous process in the brain. This is helped by an MRI.
Further the doctor look out for the type the epilepsy, on what the further treatment and a choice of a preparation depends. Very great help to a doctor can be given if a video is recorded by parents during an attack. Encephalogram is done to assess the electrical activity of the brain and determine the threshold of convulsive readiness – how much the child is prone to convulsions.
Modern diagnostics of epilepsy in children involves the following procedures:
- Continuous EEG-video monitoring – this technique calculate electrical activity of the brain. Long-term video monitoring of the EEG shows the neuropathologist / epileptologist what the attack looks like, how it starts, and how the EEG changes during the attack. Monitoring continues both during wakefulness and sleep. EEG can help a neurologist determine in which region(or areas) of the brain an attack occurs.
- Magnetic resonance imaging (MRI) of the brain is needed for detecting the type of epilepsy. Thanks to the latest high-resolution MRI (3 Tesla) technologies, it is possible to detect anomalies that the 1.5 Tesla unit can not detect.
- Positron Emission Tomography scan (PET) of the brain is a method that shows how much glucose is utilized in different parts of the brain to ensure its functioning. Region of the brain that uses less glucose can be the focus of a pathological process. In other words, it can possibly be a region of the brain that causes attacks in the child. The harmful radiation in PET scans is much less than in CT.
- Neuropsychological testing is a method used by a pediatric neuropsychologist to test a status of the strengths and weaknesses of the child’s cognitive abilities (lasts 4-8 hours).
In some clinics, a Wada test is used to confirm the type of epilepsy in the child and the lesion area (for the purpose of planning neurosurgical intervention without the risk of causing functional impairment in the child), SPECT (for examining the blood flow in the brain during an attack ), magnetic-encephalography (to measure magnetic fields, which helps to detect the localization of the pathology together with MRI data), functional MRI (for the aim of measuring small metabolic changes, the occurrence in the active part of the brain). If the child is indicated an operation, invasive intracranial EEG monitoring is prescribed.
HOW TO TREAT EPILEPSY IN CHILDREN?
Continued seizures can affect the child’s brain functionality. That is why it is important to stop epileptic seizures before they have a negative impact on overall development.
If you delay the treatment, it will be more complicated to monitor the child’s condition. With frequent attacks, there may be changes in cognitive, motor and psychosocial development, including behavioral problems, difficulty with attention, concentration and learning disabilities.
First aid for epilepsy. There are certain rules for the behavior of parents and the provision of emergency care for a seizure in a child:
1. In the presence of aura (harbingers of an attack), it is necessary to put the child on the back on bed or on the floor, unbutton the collar and release from tight clothing.
2. Isolate the child from any damaging objects (sharp corners and edges, water).
3. Do not panic, behave calmly. Observe silence and closely monitor the course of the attack. To fix the duration of the attack by the hour.
4. Rotate the child’s head sideways to avoid aspiration of saliva and tongue twisting.
5. In case of vomiting, keep the child (without the use of force) in the position on the side.
6. In no case should you use any objects (spatula, spoon) to unclench the jaws.
7. Do not give any medicines or liquids by mouth (through the mouth).
8. To be near the child until the seizure is complete.
9. Do not disturb the child after an attack and, in case of the onset of sleep, give him a good sleep.
10. If you suspect a febrile attack, measure body temperature.
SURGICAL TREATMENT OF EPILEPSY IN CHILDREN
Fortunately, approximately 75% of children are well treated by medication. However, it is important to understand that almost 80% of children with epilepsy live in low- or middle-income countries, where state access to antiepileptic drugs or their generics is provided only by half. Those patients who can not receive treatment at home, are forced to go abroad.
Drug therapy of epilepsy involves taking 1 drug, this is the so-called monotherapy. However, if such therapy does not have the proper effect, the drug is combined with others.
Approximately 1/3 of children population with epilepsy are not helped by anti-epileptic medications. In such cases, the option of surgery is considered. Note that the growing child’s brain is much more “plastic” than the adult brain. This neuro plasticity helps other areas of the brain to take on the functions of the resected area(impossible in adults). It provides good reason for conducting surgical procedure in earlier age.
Before making a final decision about the method of therapy, a pre-operative assessment is done. According to its results, a consulting doctor decides whether to do the operation,or gives recommendations on the next steps in treatment (taking another antiepileptic drug, implanting a vagus nerve stimulator or other devices).
If a decision is made to perform an operation for treating epilepsy, the patient must follow certain precautions before surgery to avoid causes of seizures; continue taking daily medications; do not eat and drink 8 hours before surgery; exclude insomnia (for this patient takes low doses of benzodiazepines); Premedication for sedation is prescribed only by a doctor.
TYPES OF SURGICAL INTERVENTIONS
Half of all surgical cases involves removing the brain neoplasm. The second reason of surgical epilepsy is most often associated with the hippocampus sclerosis of the temporal lobe (mesial sclerosis). Temporal lobectomy is the method of choice in the cure for such patients. Operations for the localization of epilepsy foci outside the temporal lobe (extratemporal operations) require long pre- and postoperative EEG monitoring using electrodes mounted directly on the cerebral cortex. Removal of pathologically functioning areas of the cortex of the cerebral hemispheres is the main task of such operations.
If the attacks are appearing in the region which is not accessible or deleted, then doctor can recommend various operations in which surgeons make a series of cuts in the brain in order to prevent the spread of seizures to other parts of the brain (commisurotomy of the corpus callosum, functional hemispherectomy).
In many patients after the operation, epilepsy disappears forever. However, even after an operation success, some patients still need medications to prevent rare seizures, although the doses may be significantly less. In a small number of cases, surgical intervention with epilepsy can cause complications associated with the removal of functioning areas of the cerebral cortex.
The risks of surgical intervention is infection, stroke, bleeding but in leading clinics of the world these complications are in less than 5%. The death rate is less than 1%.
IS IT POSSIBLE TO CURE EPILEPSY COMPLETELY IN A CHILD?
The main question that worries parents is whether it is possible to completely cure epilepsy in a child. Not one doctor can promise you to cure the child of epilepsy forever. You can only talk about getting the child out of attacks for a long time or completely getting rid of pathological symptoms. After 2-5 years, under condition of absence of attacks, a child may stop taking drugs without relapses in the future.
Prognosis for the surgery depends on certain factors, the overall success rate largely depend on the cause of convulsion, epilepsy type and the area of resection. With mesial temporal epilepsy, a positive result is achieved in 90-95% of cases. If the pathology is limited to one hemisphere and the risk of spreading the pathological process is prevented, the success rate is almost 100%. The chance of getting rid of seizures in patients with cortical dysplasia is 50-67%.
WHERE TO TREAT EPILEPSY IN CHILDREN?
Today, the best clinics in the world have succeeded in controlling seizures, improving the quality of child’s life and reducing surgical risks. In modern medical institutions a whole team of doctors, including neurologists, neurosurgeons, neuropsychologists and neuroradiologists, works with the patient.
Many parents wonder where they effectively treat epilepsy in children, because a child requires a special approach. Among the best clinics in the world, whose departments specialize in childhood epilepsy, it is worth mentioning the Motol University Hospital in Czech Republic, the Schneider Children’s Clinic and the Sheba Hospital in Israel, the Teknon Medical Center and the Navarra University Clinic in Spain, the Severance Hospital in South Korea, the Asklepios Clinic in Germany, and Clinics of Memorial and Koc in Turkey.
To find out more details about the treatment of epilepsy in children, leave a message on the site. The medical coordinator of MediGlobus will contact you.
Testimonial about childhood epilepsy
“My nephew was diagnosed with epilepsy after seizures developed in his early age. Whole family was worried as we were given a suspected diagnosis by a local neurologist. After collecting information we decided to go to Turkey and show our nephew there to get a second opinion about his condition. Long story short we are really happy with the decision we made as he was consulted there by a narrow specialist epileptologist who diagnosed the right type of epilepsy and prescribed us medications for preventing seizures. It’s been 1 and a half year already and our nephew hasn’t developed these attacks. Only thing is that some time we have to order these medications from abroad”.
Comments