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How To Deal With Epilepsy In Children?

Epilepsy is a neurological condition that affects the transmission of these signals. A person can develop epilepsy at any age. However, the incidence rate is known to be higher in children under 20 years.

Epilepsy is one of the most common neurological conditions affecting people around the world. Characterized by frequent seizures, epilepsy can leave the child paralyzed or even unconscious at any time, making it a serious threat that cannot be ignored.

What Is Epilepsy?

The brain follows a synchronous pattern to send electrical signals to control the different functions and senses of the body. Epilepsy is a neurological condition that affects the transmission of these signals. A person can develop epilepsy at any age. However, the incidence rate is known to be higher in children under 20 years.
When the person has epilepsy, the brain signals are disrupted, and an epileptic seizure begins in brain. An epileptic child can experience different types of the seizures affecting the entire body or just particular part. That said, not all seizures are epileptic, which is why it is important to understand what happens to child during seizure and what you can do about it.

Epileptic Seizures

Epilepsy affects the individual physically in the form of seizures also referred to as ‘fits’. These occur when the communication of neurons from and to the brain is disturbed. These seizures can be focal or generalized seizures.

Generalized seizures affect neurons or cells on both sides of the brain, and can manifest in convulsions ranging from barely noticeable to severe fits. They may result in loss or impairment of consciousness sometimes. Generalized seizures can be:
Atonic seizures that limp the muscles, causing the patient’s body to crumple down to the floor, often resulting in injuries.

Absence or Petit Mal are fits that occur suddenly, when the patient becomes motionless and stares straight ahead. After the seizure, the person continues to be active as if this time of absence never happened. These are uncommon and last for at least 15 seconds.

Myoclonic fits lead to the increased muscle tone, causing the muscle spasms or the jerks in a particular body part.

Clonic seizures cause the child’s body to spasm and jerk. During this seizure, the legs, the hands and the elbows first fle,x and then relax, slowly at first and then at greater speed.

Tonic seizures stiffen the muscles first and then result in loss of consciousness. The muscles of the head, chest, and the hands contract causing back to arch and the eyes to roll back into head. The person has difficulty of breathing.
Tonic-clonic seizures, earlier referred to as Grand Mal seizures, are perhaps the most difficult. They have several phases, starting with the loss of consciousness followed by tonic phase, and then clonic phase.

Focal seizures are partial seizures that affect only a particular part of the brain. These seizures can be the simple focal seizures, which occur in less than the 15% of people with epilepsy, and the dyscognitive focal seizures, which occur in more than the 35% of people having epilepsy. Both the simple and the dyscognitive focal seizures affect only one part of brain. However, the dyscognitive focal seizures cause the confusion, loss of memory and the awareness, while the simple focal seizures do not affect child’s cognitive abilities. Further categorization of the focal seizures is based on where they begin and what they affect.

When child is awake and aware during seizure, it is called focal onset aware seizure. When the child is confused or not entirely awake during episode, it is called the focal onset impaired awareness. If the beginning of seizure is not known or if no one observes seizure, it is called the unknown onset seizure.

Symptoms Of Epilepsy In Children

The symptoms of the epilepsy depend on where seizure had begun and which part of body it has affected, and can be the physical or mental. So, what happens during seizure depends on the type of seizure the child has.

Epileptic seizures are usually characterized by the following:

  • Motor symptoms
  • Severe jerking or convulsions of the body
  • Weakness or numbness of the muscles
  • Rigid or tensed muscles
  • Muscle twitching
  • Epileptic spasms
  • Repetitive movements such as the clapping hands or the rubbing hands, chewing, running, or the lip smacking indicate the focal seizures
  • Inability to swallow, drooling
  • Difficulty talking
  • Losing control of the urine or the stool suddenly, especially during seizure
  • Biting of tongue
  • Non-motor or absence symptoms
  • Changes in the sensations, the emotions, or the cognition, usually before seizure – these could include the déjà vu (a feeling of having been at a place or experiencing something earlier too, although it didn’t) and jamais vu (a feeling that something is familiar although it isn’t)
  • Brief twitches
  • Staring spells (Absence fits), which can be mistaken for daydreaming
  • Changes in the internal functions such as the gastrointestinal activity, the heat or cold waves, the rapid heartbeat, and the goosebumps
  • Sweating
  • Dilation of pupils

What can a parent do to help a child having a fit?

Place the kid gently on the floor, and remove the objects that are around him. Put child in the recovery position, i.e., on the side, with bottom arm up, top arm flexed and the top leg flexed.
Slowly turn the child to his side to prevent choking on the vomit or saliva, especially if there is drooling.

Turning the child on the side or keeping the head lower will allow the secretions to run out and not pool in the back of the throat. Do not put any objects or fingers in the mouth in the middle of a seizure; that might cause damage as the jaw often clenches.
Loosen the clothing around the neck, such as the collar or necktie. Check if the breathing is fine.
Keep track of how long the seizure lasts.
Call doctor once the child is in safe position.
Once seizure ends, child will probably feel tired or sleepy.
Stay with kid throughout seizure and until child wakes up after resting. Make sure that kid gets some rest after episode.

Do not:

  • Panic
  • Try to stop the child’s shaking or convulsions. Holding the child will not stop the seizures but will only make them uncomfortable.
  • Put anything in the child’s mouth.
  • Give child any food to eat or the drink, medicinal pills, or the tonics during seizure. Wait till child is awake and alert to give the medication.
  • Put anything in child’s mouth or try open the mouth with your hands when child has tonic seizure. Your child will not swallow his tongue. Forcing teeth apart can cause the injuries and even block his airways.
  • Call the doctor immediately if:

The seizure lasts for more than five minutes.Has difficulty breathing

The color of skin, lips, or the face turns bluish.

The kid has hit his or her head due to a fall or any other way before seizure
The child has seizure when in water

Take child to doctor if he seems very ill or has unusual or concerning symptoms.

Causes Of Epilepsy

The causes of epilepsy vary by age. In some of the people, epilepsy is genetic, but in many others, reason remains very unknown.
Some children develop the genetic epilepsy, which is caused by one or more genes in body. How the genes affect brain and how they cause seizures is not clear yet.
Developmental disorders such as neurofibromatosis, Down’s syndrome, Angelman’s syndrome, and tuberous sclerosis can also increase the chances of epilepsy.
Around 3 to 10% of kids with autism disorder may have seizures from time to time.
In 3 to 10% people, epileptic seizures are caused due to changes in the brain structure. Sometimes, children are born with these structural changes, which can lead to seizures,
Seizures can also occur due to head injuries, which are common in young adults and children.
Fever, the infections, and the brain tumors can also cause the epilepsy. Seizures are common when infection, even though removed by the medication, damages the brain to some extent.
Progressive brain diseases can cause seizures in kids.

Diagnosing Epilepsy In Children

Every child who has the seizures or the fits need not necessarily have the epilepsy. Hence, knowing about the different seizures and differentiating between the epileptic and the non-epileptic seizures is not easy. Accurate diagnosis of the epilepsy is imperative to determine right course of treatment. To do that, doctors may recommend:
Blood tests to check for any infection in the brain, genetic conditions, or other medical conditions that could trigger a seizure.
Neurological tests to check child’s behavior, the motor abilities, the cognitive function, and such to determine type of epilepsy in the child.
Electroencephalogram (EEG), which is the most commonly prescribed test to diagnose epilepsy. Electrodes are attached to the scalp to study the brain’s electrical activity. The behavior of the brain waves is examined for abnormalities and presence of epilepsy.
Computerized tomography or CT scan to get cross-sectional images of the brain to determine if abnormalities such as bleeding, cysts, or tumors if any, are causing the seizures.
Magnetic resonance imaging or MRI to get a detailed view of the brain for abnormalities or lesions in the brain.
Functional MRI to detect changes in the blood flow when certain parts of the brain are active or functional. This helps in identifying the specific areas of the brain that are affected and prevents surgeons from damaging critical areas of the brain during surgery.
Other tests such as positron emission tomography (PET) and single-photon emission computerized tomography (SPECT) may be needed to detect abnormalities in the active regions of the brain and pinpoint where the seizures are originating.

Treatment Of Epilepsy In Children

The course of the treatment for the epileptic child will depend on type of the epilepsy, and the age of the child, response to the medication, and the other factors such as the child’s overall health. While it is possible that the epilepsy symptoms, including the seizures, may eventually fade away in some cases, it depends on the type and severity of epilepsy.
Otherwise, the goal of the epilepsy treatment is to reduce the frequency of the seizures and control them with the medications. The doctor may also consider other treatment options ranging from the simple dietary changes to the brain surgeries to stop the seizures.

Medications

Anti-epileptic drugs are the most commonly used medications to minimize the frequency of seizures and to prevent them if possible. There are several brands of anti-epileptic medicinal products, but not all may be the same.

Your epileptologist will consider your child’s age, the type of seizures and their severity, the frequency, the lifestyle, side-effects of the drug, and other factors before prescribing anti-epileptic drug for child.
Usually, only one anti-seizure medication is enough to control the seizures. The medicines are for at least two years, sometimes three or four years after the seizures stop. They are then tapered and eventually discontinued. There may, however, be a chance that the seizures may return, but most of them can be controlled using the medication. That said, 65% of children who have not had a seizure in two years with the help of medication tend to remain seizure-free after the drug is discontinued.
Please note that anti-epileptic medications also have certain side-effects such as weight gain, inability to concentrate, inability to reason, and behavioral problems such as hyperactivity and irritability. Talk to your doctor about the medication’s side-effects before starting the treatment.

Dietary change

The doctor may recommend change in the diet depending on child’s age and if epilepsy is medication-resistant. A high fat, low carbohydrate ketogenic diet triggers a state of ‘ketosis’, wherein the body breaks down the fat instead of the carbs. Ketosis can prevent seizures, although it works only for some types of epilepsy in children.
Studies show that 50% of epileptic patients on a ketogenic diet have more than 50% improvement in controlling seizures and a 10% more chance of living a seizure-free life. The child may also be free of the seizures after transitioning to normal diet, with help of a trained healthcare specialist.
Note that it is not easy for children to adhere to dietary restrictions with little or no carbohydrates in the food. Keeping the child away from carbohydrate rich foods such as bread, rice, sugars, and sweets, may not be easy.

Surgery

Surgery is recommended when seizures are persistent and not responding to the medications or the dietary changes, or when doctors identify brain lesion that is causing the seizures. If the preliminary examination and tests deem that the child is fit for surgery, experts suggest that it should be done as early as possible.

VNS Therapy

Vagus nerve stimulation or VNS therapy uses a pacemaker like device to send electrical impulses to the brain via the vagus nerve, to prevent seizures. The device is implanted under skin near the chest, and is ideal for the epilepsy patients who are not responding to the medications and are not fit for the surgery. While the efficiency of this has been tested extensively on the adults, the effect of the VNS device on the pediatric epilepsy patients is still being studied.

Prevent Epileptic Seizures

Epileptic seizures cannot be stopped using medications. But if you know what kind of seizures the child has and what triggers them, you can prevent situations which lead to the seizures. While the triggers may vary based on the type of epilepsy that the child has, here are a few commonly reported triggers that must be avoided.

  • Sleep deprivation is a common trigger for seizures. Ensuring that the child gets enough sleep every night can help reduce the chances of a seizure.
  • Prevent head injuries with protective gear such as helmets while biking or skateboarding.
  • Teach children to walk and step carefully to avoid the falls, which can cause the head injuries.
  • Keep the child away from over-stimulants such as bright lights or loud noises to prevent a seizure.
  • Make sure that the child does not skip the anti-seizure medication, and ensure that he takes it at the same time every day.
  • Teach child stress-management techniques and create  stress-free environment, as the stress and the strain can also trigger the seizures in some cases.
  • Follow a healthy diet with more protein and fewer carbohydrates. However, talk to the doctor before making any drastic changes to the kid’s diet.

Conclusion:

Epilepsy is not easy to live with. That said, the epileptic child need not lose out on little pleasures of life. Use of the medications and following seizure-preventive measures, can improve your child’s and your quality of life. Talk to and seek guidance of medical practitioner, preferably epileptologist, to learn more about how you can help epileptic child. (source)

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Doctor by profession and blogger by passion

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