There are a number of diseases in children's neurological practice that have been known since antiquity. One of these "mysterious" diseases is epilepsy. What parents should know about this disease in children is this article.
Causes of occurrence
The most characteristic manifestation of this disease is the appearance of seizures. Such manifestations can be very different. The course of the disease is usually accompanied by the recurrence of such attacks over a period of time. If a child has characteristic seizures more than two times, then this fact should be a reason for parents to seek additional advice from a pediatric neurologist.
This condition is characterized not only by neurological, but also psychopathological disorders. Neurologists in many countries consider this disease one of the most significant in pediatric medicine.
The prevalence of the disease among children is rather low. On average, it is up to 0.55 to 0.8% among all babies.
It is important to note that epilepsy first appears at very different ages. Quite often, the first adverse symptoms begin already in babies under 2 years old. In some cases, the course of the disease can be quite unfavorable. There are certain forms of epilepsy that are difficult to correct with drug therapy. They are also quite common in babies.
Epilepsy has been known to doctors for more than one century. Previously, doctors did not have the necessary knowledge about the disease mechanism. In the Middle Ages, people who suffered from manifestations of the disease were considered "possessed by the devil." Also preserved are literary works of those years that describe patients with epilepsy quite well.
With the development of laboratory and instrumental diagnostic facilities, doctors have acquired new information about the mechanism of development of the disease. This prompted specialists to think that it is necessary to investigate the causes that contribute to the appearance of characteristic manifestations of the disease. There is no single cause that contributes to the development of adverse symptoms of the disease. A variety of reasons can lead to the appearance of unfavorable clinical signs of the disease.
The most unexplained form of the disease is idiopathic. Scientists have not established the reason for the appearance of adverse symptoms of this pathological condition. They assume that a hereditary predisposition leads to their appearance in this case. Until now, scientific experiments are being carried out aimed at studying specific "causal" genes that trigger the onset of a disease in a child's body of varying severity.
To the development of pathological foci in the brain, which produce the appearance of characteristic seizures, leads to the impact of multiple factors. They are also called triggered. The impact of such factors may be even during the period of bearing a child.
Expectant mother's abuse of alcohol or smoking are quite significant triggers. In this case, the formation of a pathological site - an epileptogenic focus, occurs already during the period of intrauterine development of the baby. The first adverse symptoms in this case may appear already in newborn babies.
Severe pregnancy can also affect the birth of a child with pathological areas in the brain, provoking the further development of epilepsy. Gestosis and pathology of placental blood flow, especially in the first trimester and the beginning of the second, can lead to the formation of epileptogenic foci in the unborn baby. The number of such sites may vary. It is almost impossible to predict their possible appearance in a baby at this stage.
Various types of infections transferred by the expectant mother while carrying a baby are also quite frequent triggers. Bacteria and viruses, being quite small in size, perfectly penetrate the hematoplacental barrier. Such a spread of infection quickly reaches the body of the unborn baby through the placental blood flow system shared with the mother.
Viral or bacterial infections suffered by mom, especially at the very beginning of pregnancy, provoke the appearance of various pathological areas in the baby's brain. In some cases, even a severe course of bacterial childhood pneumonia can lead to the development of further adverse symptoms of epilepsy in a child.
Organic brain damage during childbirth - one of the most common reasons for the formation of adverse symptoms of the disease in the baby in the future. Damage and hemorrhage in the brain cause the formation of pathological areas of altered tissue. The work of neurons in this case changes significantly.
Obstetricians-gynecologists note that there are several of the most dangerous clinical situations that occur during childbirth, which can contribute to the appearance of the baby in the future unfavorable symptoms of epilepsy:
- entanglement with the umbilical cord;
- prolonged standing of the fetal head in the mother's pelvis during the passage through the birth canal;
- too long anhydrous period;
- protracted labor.
The resulting oxygen starvation (hypoxia) of the brain leads to the formation of epileptogenic foci in the child in the future. In this case, the first unfavorable symptoms of the disease appear already in infants.
Infectious diseases leading to the development meningitis or encephalitis in babies, they also contribute to the possible development of adverse symptoms of the disease in the future. The most dangerous in this case are microbes that perfectly penetrate the blood-brain barrier of the brain. Getting into the cerebral blood vessels, microbes quickly lead to the development of the strongest inflammatory process, leading to the development of pathological areas in the baby. This form of epilepsy is quite common in schoolchildren.
Not in all cases, doctors can establish the localization of the pathological focus. However, this does not exclude the appearance in the child of more and more seizures characteristic of this disease. This form of the disease is called cryptogenic. In the general structure of the disease, according to statistics, it accounts for almost 60% of all cases of this disease.
Currently, there are more and more scientific research results indicating that an autoimmune mechanism takes place in the development of epilepsy. This confirms the fact that patients suffering from this disease have an increased amount of specific antibodies in the blood, which have an adverse effect on their own brain cells.
Such manifestations also occur not only in the primary form of epilepsy, but also as a result of the transferred infectious diseases.
During epilepsy, a whole complex of various disorders occurs in the child's body. Their appearance is triggered by disruption of the main "computer" of the body - the brain. Interestingly, similar changes are found in the parents and close relatives of the sick baby. Changes in water-electrolyte metabolism, acid-base balance, as well as metabolic processes contribute to changes in the work of many internal organs.
Kinds
The clinical variants of the disease can be very different. This diversity is largely due to the initial localization of the pathological focus, which is localized in the brain. In some cases, there may be several such epileptic foci. In this situation, the course of the disease, as a rule, deteriorates markedly.
Doctors identify several types of epilepsy, which are quite common in pediatric neurological practice:
Rolandic. The first signs are found in babies, as a rule, after 3 years. Most often characterized by the appearance of spontaneous nocturnal seizures. Usually the musculature of the face is involved in the pathological process. According to statistics, most babies experience epileptic seizures during sleep from 3 to 5 times a year.
Idiopathic partial. It is characterized by the development of occipital seizures. Quite often, this clinical form of the disease is accompanied by the appearance of various visual disturbances and hallucinations, as well as various eye symptoms. As a rule, this variant of the disease occurs in babies from two years of age to adolescence. Quite often, the first cases of the disease are recorded in babies under 3 years old.
- Benign idiopathic. Collecting a genealogical history is essential for establishing the correct clinical diagnosis. Signs of epilepsy in this case are detected in the closest relatives and even in the parents of a sick baby. The disease is inherited in an autosomal dominant manner. The first signs of the disease usually appear in the first months of a baby's life.
- Benign myoclonic epilepsy of infancy. Quite a rare clinical form of this disease. This variant of the disease is characterized by the appearance of myoclonic seizures in a sick child. The kid in this case can remain fully conscious. The first symptoms of the disease can be recognized already, as a rule, in a one-year-old child.
Children's absence. It occurs in babies from 1 to 10 years old. It is characterized by the appearance of absences of various duration. Motor and convulsive contractions, as a rule, are completely absent in this clinical form. The average duration of absences for this variant of the disease is from a couple of seconds to ½ minute.
Youth absence. The debut of the disease is adolescence. In terms of clinical symptoms, it resembles a child's absence form. The first adverse symptoms appear in adolescents, but they can develop at the age of 18-22 years. The duration of the seizure period, as a rule, is 2-40 seconds in this clinical form.
Youthful myoclonic. The hereditary factor plays an important role in the development of the disease. It is found mainly in adolescents. It is characterized by the development of multiple convulsive contractions in a child. Consciousness may persist during an attack.
With generalized convulsive seizures. Also, this clinical form of the disease is called epilepsy with periods of awakening. The age at which the first adverse manifestations of the disease appear can be very different. The symptoms of this type of epilepsy are found in both the smallest children and adults. When examining an electroencephalogram, a clear center of damage or a pathological focus is not found.
West syndrome. Appears only in children. It is characterized by the appearance of multiple convulsive contractions in a sick baby. Hypsarrhythmia is a specific change in the EEG that occurs precisely in this clinical variant of the disease. Spasmodic attacks usually last for several tens of seconds, but can successively replace each other.
Lennox-Gastaut syndrome. The peak incidence occurs at the age of 3-6 years. This clinical form of the disease is accompanied by the development of not only neurological, but also psychopathological disorders. A sick baby lags behind his peers in terms of physical and mental development over time. Such specific deviations from the age norm are found in 90-92% of babies with this form of the disease.
With myoclonic-astatic attacks. This clinical form is also called Duse syndrome. According to statistics, the first adverse symptoms of the disease appear in preschool children. This form manifests itself in various cramps that occur in the arms and legs. In some cases, the child develops a characteristic sign of this clinical variant of the disease - "nodding" by the neck.
Eses syndrome. Specific symptoms of the disease occur during slow wave sleep. It is accompanied by the appearance of characteristic signs on the electroencephalogram (EEG). The peak incidence is from 5 to 15 years. In the scientific literature, there is information about the appearance of adverse symptoms in babies in the first months of life.
Focal. It is characterized by the presence of a pathological focus in some local anatomical area of the brain. Quite often, it is localized in the temporal or frontal lobe. Often, doctors note that this option is secondary and arises from other diseases. The prognosis of this clinical form of the disease is conditionally favorable.
What seizures are there?
One of the most characteristic manifestations of the disease is the appearance of special attacks. They are accompanied by the development of seizures in the child. Their duration can be very different and depends on many different factors. The severity of the course of this disease largely depends on how often such seizures occur, as well as how long they last in a particular baby. Characteristic seizures can be partial and generalized.
Partial
This clinical appearance largely depends on the initial localization of the pathological focus. With this variant of the disease, the baby does not lose consciousness during an attack. He can describe his feelings quite well. The most common disorders are motor disorders. They are characterized by the appearance of multiple contractions of individual groups of muscle fibers. Quite often, this symptom is manifested by the appearance of cramps in the legs, arms, and on the face.
Verbal partial seizures are much less common in babies. They are characterized by the appearance in the child of some sound melodies or even separate voices. Sometimes the baby "hears" the conversation of several people.
Many children note that during these verbal seizures, they hear individual sounds or parts of words. Such manifestations of the disease can often be confused with various hallucinations that occur in certain mental illnesses.
Some babies experience sensorimotor changes. Such violations can occur in the arms, legs, and in some cases even affect half of the body or face.
Vegetative seizures are also reported in babies. They are characterized by severe sweating, pronounced pallor or redness of the skin, significant dilation of the pupils of the eyes, and other specific signs. It is important to note that such symptoms are quite rare and significantly complicate the differential diagnosis.
Complex partial seizures are already accompanied by the development of a more dangerous clinical sign. During such attacks, the child may lose consciousness. A characteristic feature of this type of seizure is the preliminary appearance of an "aura". More than 90% of babies describe this special condition. It is characterized by the appearance of discomfort in the stomach or severe weakness, the development of nausea and an increase in dizziness and headache.
All these symptoms appear in a child usually before losing consciousness and are very unfavorable.
The symptoms of the aura can be very varied.
Some children also report that before losing consciousness, they feel:
severe general weakness, which increases in a few minutes;
numbness in the tip of the tongue, lips, as well as increasing pressure in the larynx;
soreness or discomfort in the chest area;
growing shortage of air, difficulty of forced (increased) inhalation or exhalation in full breast;
severe drowsiness and an intolerable desire to sleep;
the appearance "in the head" of various voices that speak a language incomprehensible to the baby.
The combination of pathological symptoms that occurs during an attack can be very different. Such seizures are already called secondary generalized. According to their mechanism of development of pathological symptoms, they can be tonic, clonic or tonic-clonic. The onset of the appearance of characteristic specific signs is a simple or complex epileptic seizure. The duration of the aura in this case is from a few seconds to a couple of minutes.
After this condition, the child usually falls to the floor. His body stretches, his head tilts to the side. The jaws are tightly clenched. Breathing is usually weakened or stopped. After a few seconds, the sick baby has cramps in the limbs or the entire body. The duration of such a tonic seizure is usually 10 to 30 seconds.
The next stage is the development of a clonic seizure. It is characterized by the appearance of severe cramps in the arms and legs. Foam comes out of the mouth. It is usually profuse with bloody streaks that appear in it due to the fact that during an attack, the child bites the tip or back of the tongue.
The final stage is relaxation. During this period, the baby lies motionless, his pupils are dilated, he does not respond to external stimuli.
These specific features have been known since ancient times. This course of development of the disease and contributed to the emergence of a number of its names. This disease was also called "epilepsy" or "dance". During the period of the "holy" Inquisition, it was believed that at the moment of a seizure, a demon possessed a child. There were even multiple rites that were performed to drive out various demons.
Currently, the understanding of the mechanism of the disease has changed significantly. During the development of such dangerous tonic-clonic seizures, it is very important that the parents are with the baby.
For dads and mothers of babies who have epilepsy, it is very important to know what to do during the onset of the characteristic seizure. The assistance provided will help prevent adverse consequences in the baby.
Generalized
The manifestations of this disease are accompanied by the development of absences, characterized by short-term loss of consciousness. Moreover, the duration of clonic seizures can be very different in time. In some cases, they may even be completely absent.
The onset of an episode of absence epilepsy cannot be predicted. A few minutes before the complete shutdown of consciousness, the small patient becomes motionless, looks at one point or completely freezes.
Memories in the memory of a seizure can be present or erased. Many children also react to external stimuli during a deterioration in consciousness. The most common symptom of a generalized seizure is loss of consciousness. It should be noted that in most cases it completely recovers quickly enough. The aura is usually not characteristic. Absences in time can be from a couple of seconds to ½ minute.
They can be simple or complex. The former are characterized by all of the above symptoms. Complex ones are accompanied by the development of a wide variety of symptoms. The most common manifestation at this time is a pronounced contraction of certain muscle groups. Reviews of dads and mothers of sick babies indicate that during such a difficult absence, a child can accidentally scatter or throw objects and toys.
At the same time, many children fall on their knees, and then on their buttocks. The next stage in the development of an attack is complete loss of consciousness. Some babies develop involuntary limb contractions. They are usually finely sweeping in amplitude. The child's pupils dilate. In a few seconds, the tension of the skeletal muscles increases.
Some babies develop tremors of the limbs. It, as a rule, is at first finely sweeping, but then turns into separate convulsive contractions of the limbs. Usually, these adverse symptoms persist in babies for 15-25 seconds. In some children, these manifestations can last even for several minutes.
During such an attack, it is very important that parents or medical workers are with the child, as this will help prevent dangerous consequences and complications.
Symptoms
The severity of the adverse manifestations of the disease largely depends on where the pathological epileptogenic sites are located. Age of disease onset or onset is not important. In some cases, newborn babies have the disease much easier than adolescents. The presence of concomitant pathologies in a child, as a rule, worsens the overall prognosis.
For babies with epilepsy, the most specific manifestations of the disease are various types of epileptic seizures. Quite often they develop Jackson's seizures. These changes are characterized by the appearance of multiple contractions of muscle groups. They may not be the longest in the time of their appearance. These specific signs are characterized by the emergence of twilight consciousness.
Some parts of the body may become numb in your baby. These are usually limbs, tongue, or cheeks. As a rule, during an attack, contact with the child is completely disrupted. The kid becomes indifferent to the situation, and also practically does not respond to external stimuli.
Minor seizures are also quite common in babies. They are characterized by the occurrence of frequent oculomotor movements and facial hypotonia. In some clinical forms, absences occur, which are accompanied by complete numbness of the muscle groups of the face. During these seizures, the child usually rolls his eyes violently.
A rather dangerous clinical situation is epileptic seizure. This condition is accompanied by a series of several seizures, which successively replace each other. The child may be unconscious for a short time. In this condition, muscle tone is significantly reduced, which is accompanied by hyporeflexia. During an attack, the child experiences cardiac disorders - the heart rate increases, and the pulse becomes very weak.
An epileptic seizure is usually accompanied by a change in several clinical conditions. First, the baby falls spontaneously. From a strong spasm of the glottis, the child can cry out loudly. After a few seconds, the baby throws his head back. From the side, intense movements of the chest become clearly visible.
The appearance of a child during an epileptic seizure usually terrifies parents. It is important to always remember that you cannot panic! Parents should help the child and provide him with the proper first aid. During an attack, the baby's skin usually becomes pale. The lips and visible mucous membranes are blue.
In some cases, babies have no tonic or clonic changes at all. In this situation, the child has only visual or verbal hallucinations. Babies can see different color flashes or images that appear literally in the air. Verbal hallucinations are accompanied by the appearance of various words or sound phrases in the brain.
There are also quite rare, but very interesting forms of the disease. These include reading epilepsy. In this case, adverse symptoms appear after reading the first words of a text.
Usually, this form of epilepsy is recorded only at school age, and then in adults. The most common manifestation of this clinical variant is severe twitching of the lower jaw.
Quite often, this process is one-sided. In some cases, the child also develops combined visual disturbances. The child may have dyslexia - a speech disorder. Usually this symptom occurs in babies with a long course of the disease. The severe course of this clinical variant of the disease can lead to severe mental disorders.
The first signs in infants
Hereditary benign idiopathic epilepsy often leads to the development of adverse symptoms in newborn babies. The first signs of the disease are detected in the first week of a child's life. This form is accompanied by the appearance of multifocal clonic seizures. They are characterized by monotonous or ocular symptoms.
Quite often, multiple convulsive contractions are accompanied by vegetative manifestations. These include: strong saliva production, increased sweating, increased heart rate and surges in blood pressure, redness of the skin of the face and upper half of the body. Typical changes in this case are recorded only during an attack. In the period between such seizures, it is not possible to identify any abnormalities on the EEG.
Benign neonatal seizures do not have a hereditary predisposition. The first adverse symptoms in this case occur in the baby on the 3-5th day of life. In this case, it is impossible to identify signs of the disease in the next of kin. This form is manifested by the appearance of multiple monoclonal seizures in a child. They can occur within 20-22 hours.
This form of the disease is accompanied by the appearance of convulsive contractions that occur in various parts of the body. At first, the process may involve limbs or individual parts of the body, then other anatomical zones are sequentially included.
The migration of such disorders is a characteristic feature of this clinical form of the disease in babies. Some children have a whole series of seizures.
Benign myoclonic epilepsy of infancy occurs in babies in the first year of life. The process usually begins with the upper half of the body. Parents can notice these symptoms on their own. Lying in the crib during an attack, your toddler may often lift his shoulders and jerk his arms. You can also notice this form of the disease during the first steps. When standing on its legs, the child can swing violently, and the muscles of the lower extremities twitch very strongly.
Many parents think that if the child often falls, then this may indicate that the child has epilepsy. However, this is not quite true. Usually the duration of attacks is short and does not exceed a few seconds. They can occur at almost any time of the day. Usually, the first symptoms of the disease occur in a child in the first six months of life.
Fencer's pose is one of the symptoms that doctors check when examining a child. During this state, the baby's head is turned to the shoulder. The arm and leg on the same side are strongly extended. The other handle is turned in the opposite direction. The leg on the opposite side is bent at the knee.
Typically, this condition occurs in children who have suffered severe birth damage.
Diagnostics
The initial clinical examination is indicative only. For the correct diagnosis, additional laboratory and instrumental examinations are required.
To date, the "gold standard" for the diagnosis of this disease is considered electroencephalography (EEG). It should be noted that every second baby does not have any changes in the electroencephalogram during the period of absence of an attack.
Identification of specific signs directly during a seizure attack allows you to accurately make the correct diagnosis. In difficult clinical situations, when diagnosis is very difficult, several EEGs or daily monitoring of this indicator are required.
Neuroimaging is also used to establish the diagnosis. It allows you to accurately identify various organic pathologies of the brain.
Such a study not only allows you to clarify the correct diagnosis, but also to determine the prognosis and further tactics of therapy. Studies that are included in neuroimaging include computed tomography and magnetic resonance imaging. MRI allows you to clarify local areas of pathological tissue, which trigger the appearance of unfavorable characteristic symptoms in a baby.
Babies with epilepsy undergo multiple laboratory tests. These include general clinical blood and urine tests, biochemical blood tests, determination of specific autoantibodies and glucose and lactate levels, and serological tests.
In some cases, the examination plan also includes an ultrasound examination of the abdominal organs, Doppler ultrasonography of the vessels of the neck and brain, electrocardiography and other studies.
Treatment
Some parents believe that epilepsy can be cured. However, this is not always the case. Some forms of this disease will remain with the child for the rest of his life. The main principle of therapy is to select the necessary scheme of symptomatic drugs that would have the proper therapeutic effect, but would not cause a complex of side symptoms in the sick child.
Treatment should be carried out only after a complete clinical diagnosis has been established. In some cases, the disease is treated with a single drug.
The complexity of treatment has several advantages:
helps to reduce the risk of developing seizures in about 75-85% of cases;
allows you to reduce the dosage of drugs while maintaining the maximum of the therapeutic effect;
reduction of the possible complex of side effects as a result of the use of different drug groups.
Initial therapy of the disease is the appointment of an age-related dosage of the drug. Usually it is prescribed in full according to age.
The dosage selection is carried out individually. This calculation is carried out by a pediatric neurologist who treats and monitors a child with epilepsy.
Currently, doctors give preference to drugs that have a gradual and temporary release. These drugs are better at preventing new seizures than their predecessors. The main agents are the metabolites of valproic acid. These include "Depacinchrono", "Konvuleksretard". Also, carbamazepine-based drugs are used to eliminate adverse symptoms.
During the appointment of therapy, it is necessary that seizures do not appear in the child for a month or more. If this goal is not achieved, then doctors prescribe other drugs of the second and third level, and the previous drug is canceled. Cancellation is carried out rather slowly - within a couple of weeks. Such a systematic refusal helps to reduce the possible risk of side effects.
Compliance with a therapeutic ketogenic diet also plays an important role in the treatment of epilepsy.To prevent new cases of the disease, the children's menu should contain the optimal amount of protein and fatty foods.
Such intensive nutrition is necessary for the child to compensate for the disturbed metabolism. The daily calorie intake must be observed.
In some situations, barbiturates are prescribed. Currently, there are dosage forms that need to be used only once a day. This method of treatment is mainly used for preventive purposes. These drugs have a variety of side effects. These include severe lethargy and general weakness, severe impairment of memory and attention, pathological difficulty with memorization, dyspeptic disorders, hepato- and nephrotoxicity, damage to pancreatic tissue, various disorders of porphyrin metabolism, as well as the appearance of edema.
Rehabilitation
Psychosomatics plays an important role in provoking new seizures of convulsive contractions. Especially often psycho-emotional stress leads to the appearance of seizures in adolescent girls. Prevention of excessive exercise is necessary for the development of new attacks of the disease.
Compliance with the optimal daily regimen is required for all babies who suffer from epilepsy.
The long course of the disease leads to the fact that the child develops multiple muscle disorders. To eliminate these adverse symptoms, a course of medical baby massage is required. The sequence of massage movements improves muscle tone and relieves pathological muscle tension. Children with epilepsy are advised to undergo several courses of medical massage throughout the year.
In this video you will learn about the diagnosis of epilepsy from the Family Doctor clinic.
