Epilepsy in children - Seizures, Causes, What to do, Treatment...

Epilepsy is a disorder manifests itself in seizures (fits).

What is epilepsy

Epilepsy is the occurrence of multiple seizures (fits), but not caused by high fever or recent head/brain injury.  The brain as we all know uses electrical impulses for a lot of its activities. Sometimes, there is a sudden surge in electrical activity in the brain, which causes the seizures.

What are the different kinds of epileptic seizures?

Epileptic seizures are of multiple types. Some may be generalized seizures that occur when the surge of electrical activity affects the whole brain, while some are partial seizures in which only a part of the brain is involved. They manifest themselves in some of the common ways below.

Absence seizures - Petit mal (generalized seizure)

In this type of seizure, it appears that the child stops doing what they are doing. They stop moving or talking. Their face becomes blank. They seem to just stare. Often those around them may not even notice this seizure. These usually last less than 30 seconds. At the end of the seizure the child completely regains consciousness and continues the previous activity.

Tonic clonic seizures - Grand mal (generalized seizure)

In this kind of epileptic seizure, the child's body becomes rigid (the muscles becomes rigid). The child usually falls down. The child's breathing becomes very strained and the child may start turning blue from lack of breath. This state usually lasts about 30 seconds and then the body muscles go through cycles of relaxation and rigidity. This makes the limbs of the body and the body jerk (When the words epilepsy or seizures or fits are occurred, this is the type of seizure that everyone thinks about). The child may urinate during this seizure as they lose control of their muscles. The rigidity and relaxation eventually stop. The child may be very dazed and may need to rest for a while before recovering. Sometimes the child may have to sleep for a few hours after this seizure.

Partial seizures

Partial seizures manifest themselves in various ways depending on which part of the brain is affected. They usually result in some type of unwilling strange behaviour in the child who suffers them.

Causes of epilepsy in children

It is very difficult to pinpoint the cause of epilepsy in children. Some casues include:

• Severe head or brain injury
• Pre-natal problems that affected the brain
• Genetic issues
• Brain related illnesses like meningitis

Family history is also a risk factor.

In about 50% of Indian children with epilepsy, a cause may not be identifiable¹.

What to do during a epileptic seizure

During an absence seizure, there may not be much you need to do. When the child recovers from it, he or she maybe disoriented and may need comforting and care.

If the child is having a tonic clonic seizure (grand mal), do the following:

• Make sure there is nothing near the child, that they can hurt themselves on when their muscles jerk
• Put a pillow or two under their heads and neck
• Turn your child on their side so any fluid in their mouth can come out.
• Do not put anything the child's mouth
• Do not hold the child down or try to restrain them. The seizure will usually end on its own in a few minutes.If it does not end in a few minutes, get emergency medical treatment.
• When the seizure is over, let your child rest and go to sleep.

Diagnosis and Treatment of Epilepsy in children

As soon as the seizure is over (absence or tonic clonic) and the child has rested, take your child to a doctor.  The doctor will want to know about anything that may have happened before or after the seizure and any changes that may have triggered it.

Remember that one seizure does not mean that the child is epileptic.

An EEG (ElectroEncephaloGram) will be done. An MRI and/or CT scan maybe done also.  The doctor may prescribe long term treatment only after followon seizures occur unless the symptoms of the first seizure warrant immediate start of treatment.

Once diagnosed, there are many medicines that a doctor will prescribe based on the symptoms. Medications can help control seizures or vastly reduce them in most cases.

If the epilepsy does not respond to drugs, doctors may also prescribe a ketogenic diet. This is a diet that provides high fat, average protein and low carbohydrates to the child. The diet makes the body use ketones (produced by burning fat) rather than glucose (produced from carbohydrates) to power the brain. This can help reduce or control seizures.

Sometimes, surgery is also an option for treatment. 

References

1. Vrajesh Udani, "Pediatric Epilepsy - An Indian Perspective", Indian J Pediatr 2005; 72 (4); 309-313

2. "Guidelines for Diagnosis and Management of Childhood Epilepsy", Indian Academy of Pediatrics