Child Epilepsy from World Championship
Epilepsy affects all ages groups. But for children, a variety of issues exist that can affect one's childhood.
Some epilepsy ends after childhood. Some forms of epilepsy are associated only with conditions of childhood that cease once a child grows up.[1] Approximately 70% of children who have epilepsy during their childhood eventually outgrow it.[2]There are also some seizures, such as febrile seizures, that are one-time occurrences during childhood, and they do not result in permanent epilepsy.[3]
Pediatric epilepsy may cause changes in the development of the brain. For this reason, epilepsy in children is vastly distinct from epilepsy in adults and they must be considered differently in most regards.
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Effects
Education
Epilepsy can affect a child's education, thereby leading to trouble learning and lower grades. While many children are capable of functioning in a normal classroom environment, many end up in special education.[4]
The child may be forced to miss a lot of school due to seizures. The seizures can impair a child's ability to memorize learning materials.
Tonic-clonic seizures can have a serious impact on education due to the memory loss they cause, and the time needed to recover following the seizure causing there to be missed time in school.[5]
Absence seizures can have a high negative impact on a child's education. As they are less obvious than tonic-clonic seizures, they can occur many times within a single day, thereby resulting in the child's ability to learn being impaired, and leading to low grades.[6] Often, these educational deficits lead to the investigation of neurological conditions and result in the diagnosis of this seizure subtype. Children may appear to be 'zoning out' or day-dreaming during classes when in actuality they are experiencing uncontrolled absent seizures. Once treatment begins, these children often exhibit improved attention and their grades improve.
When seizures are controlled by a medication, many anticonvulsants have side effects that include drowsiness, thereby also impacting a child's education.
The high school graduation rate[where?] has been reported at 64%, compared with an overall national average of 82%.[7]
Social
The social stigma can stand in the way, as the child is more prone to bullying.[8]
Many children with epilepsy are overprotected by their parents, who do put restrictions on them in the name of safety, requiring more adult supervision than other children, and not allowing them to participate in certain activities normal to the age group, such as sports. It is a subject of debate if a child with controlled seizures needs additional protection or restrictions, or if the benefits outweigh the losses a child would face.[9][10]
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Causes
The causes of epilepsy in childhood vary. In about ⅔ of cases, it is unknown.[16]
Unknown 67.6%
Congenital 20%
Trauma 4.7%
Infection 4%
Stroke 1.5%
Tumor 1.5%
Degenerative .7%
Treatment
Most children who develop epilepsy are treated conventionally with anticonvulsants. In about 70% of cases of childhood epilepsy, medication can completely control seizures.[2] Unfortunately, medications come with an extensive list of side effects that range from mild discomfort to major cognitive impairment. Usually, the adverse cognitive effects are ablated following dose reduction or cessation of the drug.[17]
Medicating a child is not always easy. Many pills are made only to be swallowed, which can be difficult for a child. For some medications, chewable versions do exist.[18]
The ketogenic diet is used to treat children who have not responded successfully to other treatments. This diet is low incarbohydrates, adequate in protein and high in fat. It has proven successful in two thirds of epilepsy cases.[19][20]
In some cases, severe epilepsy is treated with the hemispherectomy, a drastic surgical procedure in which part or all of one of the hemispheres of the brain is removed.[21]
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Summary
Epilepsy is common in children and can be confused with other conditions. An accurate diagnosis is essential.
Seizures usually respond well to medication and most children will enjoy a normal and active childhood.
The impact of epilepsy will vary for each child. Try to keep epilepsy in perspective for your child and your family.
Remember to keep a balance between protecting your child and fostering independence.
Recognising epilepsy in children
Seizures are not always recognised in children when they first occur. Seizures can be subtle and short, such as an ‘absence seizure’ in which the child has brief episodes of decreased awareness and responsiveness.
Some childhood events that may be confused with seizures are:
Fainting spells
Breath-holding spells
Normal sleep jerks
Daydreaming
Night terrors in young children
Migraine
Heart and gastrointestinal problems
Psychological problems.
Febrile convulsions
Febrile convulsions are brought on by fever, usually during times of illness. One in 25 children has a febrile convulsion at some time, usually between the ages of six months and six years.
One third of children who experience febrile convulsions will have repeated febrile convulsions. Febrile convulsions are not considered a type of epilepsy and 97 per cent of all children with simple febrile convulsions do not develop epilepsy later.
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List of Disease in alphabetic order
Epilepsy syndromes
Once seizures are confirmed, the next step in the diagnosis is to clarify the type of seizures and the possible cause. Electroencephalography (EEG) can help determine the type of epilepsy and an MRI may be required if a brain lesion is suspected.
If the epilepsy fits a particular pattern or syndrome, this can help the doctor to select the best treatment. It can also help to predict whether the seizures are likely to be easily controlled and limited to childhood, or whether the condition may be more persistent.
Some epilepsy syndromes include:
Childhood and juvenile absence epilepsies – also called ‘petit mal’ epilepsy. Onset age is usually four to 10 years. It involves brief staring spells and is often outgrown.
Benign rolandic epilepsy – onset age is usually five to ten years. Seizures may be minor and cause drooling and speech arrest (when the child cannot speak for a while). They usually happen in sleep or first thing in the morning as the child wakes. Convulsions may also occur. It is always outgrown.
Juvenile myoclonic epilepsy – onset age is usually in the teenage years. It may include generalised seizures on waking, brief myoclonic jerks and absence seizures. Usually well controlled, but ongoing medication may be needed.
Infantile spasms – also called West syndrome. Onset occurs during the first year. Clusters of jerks cause the baby to fall forward. It is a serious form of seizure. It may be followed by other forms of epilepsy and be associated with developmental delay.
Lennox-Gastaut syndrome – onset age is one to eight years. It includes mixed seizure types such as drop attacks and convulsions. It is difficult to treat and developmental delay is common.
Temporal lobe epilepsy – this form can start at any age. It involves complex partial and simple partial seizures, with staring and confused behaviour. Can include generalised seizures. Treatment may include surgery.
Frontal lobe epilepsy – can also start at any age. Seizures often occur during sleep and may include vigorous motor activity.
Understanding the diagnosis of epilepsy
When epilepsy is thought to be due to a genetic disposition to seizures, it is called idiopathic or genetic epilepsy. Where epilepsy is the result of an illness, brain lesion or brain injury, it is called symptomatic or structural–metabolic epilepsy. Sometimes, it is not possible to pinpoint the cause of the condition.
Understanding the pattern of epilepsy in a child can be a slow process and a frustrating time for parents. It may not be possible to know all the answers about a child’s condition at the time of diagnosis. The picture may only become clear as the child grows.
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