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 Children's Health

july 2010
Childhood Epilepsy

Prof. Veena Kalra

 
Fits, faints and epilepsy are more common in childhood than any other age. Superficially they all look similar but are very different.

Seizures/fits imply brief disturbance of brain function resulting in abnormal movements, behaviour or altered consciousness. It affects about four to eight percent of all children.

Faints resemble seizures. Actually, there is loss of posture due to a vasovagal event (where blood pools in the lower body due to a slowed down heart rate and dilated blood vessels, making less blood go to the brain). Breath holding spells, tics (numerous successive occurrences of the same action), night terrors and hysterical events should not be confused for seizures.

Epilepsy refers to recurrent seizures without any provoking factor. A correct diagnosis of epilepsy and its cause is crucial to decide medication. Over generations, epileptics have been socially ostracised. However, most epileptics are well controlled and can have a holistic lifestyle.

Febrile Seizures
Seizures characterised by fever (febrile seizures) are the commonest seizure events in children. Fever of any degree and cause can precipitate them. Though these seizures recur, they are not classified as epilepsy. They only represent the response of a developing brain to fever. Beyond five to six years there could be a natural remission, except in a small minority where epilepsy sets in. They do not require anti-epileptic medications, but only care during febrile periods.

Causes of Epilepsy
Epilepsy is only a symptom, not a disease. It can result from congenital (by birth), structural, genetic, metabolic, inflammatory, or traumatic causes. Lack of oxygen, blood supply and glucose can sow the seeds of epilepsy as often happens in newborn babies. Infancy is a vulnerable period.

Anti Epileptic Drugs
Treatment is given to the underlying cause, if identified, like certain brain abscesses, TB, tumour, etc. Drugs used to prevent and control seizures are called Anti Epileptic Drugs (AEDs). In use for over many decades, they control almost 60-70 percent seizures. AEDs need to be carefully selected for the specific seizure epilepsy type. Doctors might resort to multiple drugs if a single one can’t do the job – but 20 percent epilepsies, especially in childhood, are resistant even to many drugs.
Women of child-bearing age need special caution. While seizures by themselves harm the fetus, AEDs carry the risk of interfereing with normal embryonic development causing lower IQs, epilepsy, etc. The duration of some therapies could be from 18 months, to life long.

4 Alternatives
  1. Corticosteroids help in certain childhood conditions, and need to be given briefly.
  2. Ketogenic diet, which is a high fat-low carbohydrate one, generates a chemical structure called ketone bodies to build up. This, in a complex manner, reduces seizures and may improve outcome in upto 60 percent cases. Diets need strict supervision to succeed though; so don’t plunge into one on your own.
  3. Surgery has a formidable place in epilepsy management for carefully selected patients. Technological advancements enable parts of the brain, where a patient's epileptic seizures originate (called epilectic foci) to be localised in a very precise way. Newer microsurgery equipment, surgical skills and techniques, permit removal, or disconnection of electrically discharging foci with reasonable safety.
  4. Vagal nerve stimulation is an implanted stimulator that sends electric impulses to the left vagus nerve in the neck via a lead wire implanted under the skin, helping abort a seizure quickly.
Lifestyle Modifications
  1. Adequate sleep
  2. Avoid being hungry
  3. Avoid extreme emotional stress
  4. Avoid excess TV viewing
  5. Avoid endangering sports
  6. Don’t get your child to cycle or swim, till the seizures are well controlled

Investigating Epilepsy
Thorough clinical evaluation and investigations are needed to confirm the diagnosis of epilespy.
  • An ElectroEncephaloGram (EEG), which records the electrical substrate of the seizure from the brain, is the primary investigation.
  • To determine the structural cause, neuroimaging like computerised axial tomography CT Scan and magnetic resonance imaging (MRI) are useful.
  • Identification of functional abnormalities of the brain can be done by SPECT/PET scans or functional MRI. These are generally required for possible surgical candidates. Metabolic and genetic tests are also becoming increasingly available and useful in specific situations.
Prof. Veena Kalra is Senior Pediatric Consultant at Indraprastha Apollo Hospitals, New Delhi


    
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