Childhood epilepsy: types, symptoms, causes and treatment

What is childhood epilepsy and what are its typical symptoms? Let us review its characteristics.

Childhood epilepsy is a neurological disorder that causes a malfunction of neuronal activity in the brain. of the brain. This disease stands out for the epileptic seizures it causes in the child, resulting in strong convulsions that affect the muscles in one or more areas of the body and that sometimes cause loss of consciousness and blows due to falls.

Below we explain what childhood epilepsy is, what types of epileptic seizures exist and what their symptoms are, as well as the causes and available treatment.

What is childhood epilepsy?

The infantile epilepsy is a disease of the nervous system that is characterized by an abnormal discharge of electrical impulses in certain areas of the brain and cerebral cortex.. Children suffering from this chronic disorder have recurrent seizures or convulsions, called epileptic seizures.

This disease usually manifests itself in various forms, depending on the brain structure affected and the region where the seizure originates. These seizures can be simple, where the child does not lose consciousness, or complex, where there is a loss of consciousness. The seizures may be short and last only a few seconds, or they may be prolonged and last several minutes.

The effects of childhood epilepsy on the child and the child's environment also vary depending on factors such as age, seizure types, the child's response to treatment or whether there are other concomitant health problems.

The incidence of childhood epilepsy is estimated to be between 40 and 100 cases per 100,000 children, and affects more than 10 million children worldwide.and affects more than 10 million children worldwide. Forty percent of all new cases are detected in children under 15 years of age.

Types of seizures (and their symptoms)

Epileptic seizures occurring in a disease such as childhood epilepsy can be classified into two main groups: those with focal or partial seizures and those with generalized seizures. Within each category, up to 30 types of seizures have been described.

Focal or partial

About 60% of childhood epilepsies involve focal or partial seizures.. These originate on only one side of the brain and are described according to the brain area in which they originate (e.g. frontal lobe or medial temporal lobe). Its duration ranges from 1 to 2 minutes.

During this type of seizure, the child does not lose consciousness and may have strange sensations, such as intense memories, which may be expressed in different ways. Motor symptoms include various automatisms, blinking, twitching, mouth movements, etc. The child may also experience intense emotions (joy, anger, sadness, etc.) and sensory-perceptual disturbances.

In focal seizures there may be some alteration of the level of consciousnessThis generates in the patient a sensation of being in a cloud or in a dream. In some cases, children feel an "aura" or prodrome, a sensation that allows them to anticipate the occurrence of an imminent epileptic seizure.

The characteristic symptoms of focal seizures may confuse clinicians and be misinterpreted as signs of other diseases, such as narcolepsy, fainting or even some mental illnesses. This is why a good differential diagnosis and the application of different tests are required.

Generalized

In generalized epileptic seizures, abnormal electrical discharges occur on both sides of the brain.. This type of seizure can cause loss of consciousness, resulting in falls and generalized muscle spasms. There are different types:

• Absence seizures: the child appears to be staring blankly and fixedly at a particular point. Mild muscle spasms may be present. It causes attention and concentration problems in the child.
• Clonic seizures: cause sudden repetitive movements on both sides of the body.
• Tonic seizures produce muscle stiffness, especially in the back, arms and legs.
• Myoclonic seizures: cause sudden jerking movements in the upper body, mainly in the arms and legs (and sometimes in the whole body). Their duration is very brief, lasting only a few seconds.
• Tonic-clonic seizures cause a mixture of the symptoms of tonic and clonic seizures, such as muscle stiffness and jerking movements of the arms and legs. They are the most severe seizures.
• Atonic seizures: generate a great hypotonia (decreased muscle tone), causing the child to fall suddenly or hit his head when falling under his own weight.

Causes

The most common causes of childhood epilepsy may be genetic and hereditary. genetic and hereditary, trauma, brain development abnormalities, infections and diseases, metabolic disorders, tumors, and other problems. and other problems. In fact, any phenomenon that disrupts a normal pattern of brain activity can cause epilepsy.

Genetic factors, such as mutations, play an important role in some types of epilepsy that have a strong hereditary component. In some cases, alterations in genes can occur spontaneously and without a family history. For example, mutations affecting ion channels have been described, such as those in the SCN1A gene, which is responsible for the epileptic seizures that occur in severe myoclonic epilepsy of infancy or Dravet syndrome.

Brain damage may also be a determining factor in the onset of childhood epilepsy. This can originate at different stages of growth: during pregnancy, early childhood or adolescence.. Blood vessel malformations and cerebrovascular diseases may also be factors responsible for producing an epileptic disorder.

Other diseases such as cerebral palsy or metabolic disorders such as phenylketonuria may be related to childhood epilepsy. It is believed that 20% of epileptic seizures have their origin in neurodevelopmental disorders and the most common seizures tend to occur in children with autism spectrum disorders and severe intellectual impairment.

Treatment

To treat childhood epilepsy, doses of antiepileptic drugs are administered according to the type of epilepsy, age and weight of the affected child, divided into two or three daily doses. The neurologist is in charge of monitoring the pharmacological treatment, taking into account possible side effects.The neurologist is responsible for monitoring the drug treatment, taking into account possible side effects and interactions with other drugs. Correct diagnosis is also essential.

Most single-drug treatments (known as monotherapy) are effective in reducing and eliminating the incidence of seizures without significant unwanted effects. However, periodic monitoring is usually carried out with tests such as electroencephalography, to collect data on the functioning of brain activity, and blood tests, to assess tolerance and drug levels in the blood plasma.

Sometimes a small number of epilepsies can be difficult to control and several drugs need to be introduced at the same time, with the consequent increased risk of interactions and side effects. In cases where drug treatment does not work and the child is resistant to its effects, surgery may be considered as an alternative.

Surgical intervention is proposed taking into account the area of the brain where the seizures originate (epileptic focus). (epileptic focus). This area may be excised; several brain areas may be sectioned to prevent seizures from spreading; a callosotomy may be performed, which involves sectioning the network of neuronal connections between hemispheres; or a hemispherectomy, in which half of the cerebral cortex or hemisphere is removed, a drastic technique used only as a last resort.

Bibliographic references:

• Cerdá, J. M., Argani, M. T., Llerda, J. M., González, F. L., Puig, X. S., & Rieger, J. S. (2016). Spanish Society of Neurology official guideline for clinical practice in epilepsy. Neurología, 31(2), 121 - 129.
• Travé, T. D., Petri, M. E. Y., & Victoriano, F. G. (2007). Descriptive study of childhood epilepsy. Journal of neurology, 44(12), 720 - 724.