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National Epilepsy Day 2021: Epilepsy In Children: Causes, Symptoms And Does Treatment Help Ease The Condition?

In India, National Epilepsy Day is observed annually on 17 November to raise public awareness about the disease. The Epilepsy Foundation of India began this nationwide campaign to reduce the prevalence of this disease in the country.

According to the World Health Organization (WHO), approximately 50 million people around the world suffer from epilepsy, 80 per cent of whom live in developing countries. Despite the fact that epilepsy is treatable, three-fourths of those affected do not receive the treatment they require. In India, there are approximately 10 million people suffering from seizures related to epilepsy.

Epilepsy In Children

Epilepsy is a disorder in which a person experiences recurring seizures. The seizures are caused by changes in electrical and chemical activity in the brain. Any injury to the brain can cause seizures, including head injuries, infections, poisoning or problems with brain development prior to birth. It is often impossible to identify the cause of seizures and epilepsy.

Epilepsy Causes, Symptoms, Triggers, Risk factors & Treatment

Childhood epilepsy is one of the most common brain disorders reported in India [1]. It is relatively common for children to suffer from epilepsy. Most children with epilepsy outgrow the condition before their teens, and if not, treatment usually ensures a full and healthy life. People with epilepsy often experience their first seizure as children or adolescents [2].

The impact of epilepsy varies with each child depending on their age, the kind of seizure they experience, how well they respond to treatment, and any other medical conditions they may have. Medication can control seizures in some cases, while other children may continue to experience seizures for the remainder of their lives [3].

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Types Of Epilepsy In Children

A number of different types of seizures occur in children. While some are very brief, lasting only a few seconds, others can last up to a few minutes. The type of seizure that a child experience depends upon where the seizure occurs in the brain and how much of the brain is affected. There are two main types of epileptic seizures: focal (partial) seizures and generalized seizures [4].

1. Focal (partial) Seizure

During focal seizures, abnormal electrical brain activity occurs in one or more areas on one side of the brain. Your child may experience an aura prior to a focal seizure. The 2 types of focal seizures are as follows [5]:

  • Simple focal seizures: Symptoms vary depending on the brain area affected. The abnormal electrical brain function could affect your child's vision (occipital lobe). The muscles may also be affected. The child may also sweat, feel nauseated, or become pale. It is unlikely that your child will lose consciousness.
  • Complex focal seizures: These usually occur in the region of the brain that controls memory and emotion. Most children will lose consciousness. Your child may appear to be awake but have unusual behaviours ranging from gagging, lip-smacking, running, screaming, crying, or laughing. Following a seizure, your child may appear tired or sleepy. This is known as the postictal period.
  • Expert Speaks About Ketogenic Diet For Epilepsy

    2. Generalized Seizure

    A generalized seizure occurs on both sides of the brain. Your child will lose consciousness and be tired after the seizure (postictal state). Types of generalized seizures include the following [6]:

    • Generalized tonic-clonic seizure (GTC): This is also called grand mal seizure and has 5 distinct phases. The arms, legs, and body of your child will flex (contract), extend (straighten), and shake. This is followed by contraction and relaxation of the muscles (clonic phase) and the postictal phase. Your child may be sleepy in the postictal phase. There may be problems with vision, speech, fatigue, or body aches.
    • Absence seizure: This is also called petit mal seizure. An altered state of consciousness is caused by this seizure. Children will likely maintain posture. Most seizures last no longer than 30 seconds. Your child may not remember what happened during the seizure. He or she may go on with activities as though nothing happened. They may occur several times daily. Seizures of this type are sometimes mistaken for learning disabilities. Absence seizures usually begin between ages 4 and 12 [7].
    • Atonic seizure: This is also called a drop attack. In an atonic seizure, your child loses muscle tone and may drop their head suddenly. Seizures leave your child limp and unresponsive.
    • Myoclonic seizure: Muscles jerk or move quickly during this type of seizure. They usually occur in clusters, that is, they may occur several times a day, or for several days in a row.
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Symptoms Of Epilepsy In Children

The symptoms your child experiences will vary depending on the type of seizure. Seizures are generally characterized by the following symptoms and warning signs [8]:

  • Staring
  • Jerking movements of the arms and legs
  • Tense body posture
  • Breathing difficulties
  • Loss of bowel or bladder control
  • Loss of consciousness that occurs suddenly without apparent cause
  • Inability to respond to noise or words for a short period of time (appearing confused or disoriented)
  • Head nodding rhythmically in the event of a loss of awareness or consciousness accompanied by rapid blinking of the eyes and staring
  • Note: Specific symptoms are mentioned under Types Of Epilepsy In Children.

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Causes Of Epilepsy In Children

Potential causes or contributing factors may include the following [9]:

  • Developmental disorders, such as autism
  • Tumours or cysts in the brain
  • Infectious diseases, including meningitis
  • Genetics, as some forms of epilepsy, are inherited
  • High fevers in childhood leading to seizures, known as febrile seizures
  • Maternal infections during pregnancy
  • Poor nutrition during pregnancy
  • Oxygen deficiency before or during birth
  • Trauma to the head
  • Certain factors can trigger a seizure in those with epilepsy. Common triggers include the following [10]:

    • Excitement
    • Lack of sleep
    • Skipping meals
    • Stress
    • Flashing or flickering lights
    • Missing a dose of antiseizure medication
    • In rare cases, music or loud noises
    • A seizure may be caused by a combination of these.

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Complications Of Epilepsy In Children

Epilepsy may increase the risk of a child developing a mood disorder or learning disorder. Headaches, ulcers, and other physical complications may also occur. A parent should be aware of possible co-morbidities and discuss any concerns with their child's physician [11].

Diagnosis Of Epilepsy In Children

Some types of epilepsy can be challenging to diagnose in children, especially in infants and young children. Epilepsy is usually diagnosed by a physician when there is more than one seizure occurring, as well as when no apparent cause for the seizure is apparent, such as a fever or trauma [12].

To make a diagnosis, the doctor will take into account:

  • the type of seizures
  • the age of onset
  • the findings of an electroencephalogram (EEG) that measures brain activity
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Treatment For Epilepsy In Children

Treatment options for epilepsy in children include the following [13]:

  • Medications: Many people (and children) with epilepsy require antiepileptic drugs to control their symptoms. These medications may prevent seizures from occurring, but they are not a cure, and they cannot stop a seizure once it has begun.
  • Keto diet: If medications are not enough to control seizures, some children may be able to try a ketogenic diet, or a keto diet, to help them. When putting a child on a ketogenic diet, it is imperative to consult a doctor and dietician [14].
  • Neurostimulation: If drugs fail to resolve epilepsy, a physician may recommend neurostimulation. During this therapy, a device delivers small electric currents to the nervous system.
  • Surgery: In some cases, children can have surgery to remove a portion of the brain. These surgeries may prevent or reduce seizures.
  • Refractory Epilepsy And Role Of Keto Diet In Treating Epilepsy

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How To Identify Seizures In Children?

When children are very young or unable to communicate what is happening, it can be difficult to recognize a seizure.

In order to identify a seizure, a number of factors must be considered, including the child's age and the type of epilepsy or seizure that the child is experiencing. As an example, absence seizures are very easy to miss, while GTC seizures are much more difficult to miss [15].

It is important for parents and caregivers to be aware when their older children appear absent at inappropriate times, such as in the middle of playing, eating, or conversing. Rapid blinking, staring, or confusion may also indicate a seizure. A sudden loss of muscle tone, resulting in a fall, is another indication.

Identifying epilepsy symptoms in infants:

In babies, the signs can be very subtle. The following symptoms may be observed [16]:

  • A change in breathing patterns
  • A facial expression that is unusual, such as a movement of the eyelids or the mouth
  • Muscle movements, such as jerks, cycling of the legs, or episodes of stiffness
  • Loss of alertness or difficulty focusing the eyes
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On A Final Note...

The majority of children with epilepsy outgrow their seizures by the time they are teenagers. Nonetheless, it is important for parents to encourage their children to maintain a healthy lifestyle and to ensure that regular medical care is provided to them.