Childhood epilepsy refers to a neurological disorder characterized by recurrent seizures that begin during childhood. Seizures occur due to abnormal electrical activity in the brain, resulting in various symptoms like convulsions, staring spells, or loss of consciousness. Causes of childhood epilepsy can include genetic factors, brain injury, infections, or developmental disorders. Diagnosis typically involves a thorough medical evaluation, including neurological exams, imaging studies, and electroencephalograms (EEGs).
Parents can become overwhelmed when their child has epilepsy. 2 major reasons for this are:
1) Difficulty in understanding seizures
2) Concern about the child's future.
Let us address these issues.
Cause of childhood epilepsy
Normally, one part of our brain communicates with another using tiny electrical currents. Sometimes, there is a sudden storm during which these electrical currents become disorganized. This event is a Seizure.
Types of childhood epilepsy
A seizure many produce varied symptoms. This depends on the part of the brain affected. Based on the symptoms, seizures have many different names:
1) Absence seizure: The child stares off into blank space and becomes unresponsive. Sometimes the eyes may flicker during this episode.
2) Myoclonus: There are sudden jerks, usually of the upper part of the body. If the child is holding a toothbrush or a toy, it may fall from the child's hand.
3) Focal seizure: The electrical storm happens in a small part of the brain. In this case, the child has sensations or movements only in one body part. For example, only the right hand may twist or shake.
4) Generalized convulsion: The electrical storm takes over the entire brain. The whole body starts shakes violently. This kind of seizure is also known as a generalized tonic-clonic (GTC) seizure.
5) Atonic Seizures: There is sudden loss of body power. This can cause a sudden fall called a "Drop Attack".
Besides these common types, seizures have many other names. For example, if a seizure produces uncontrolled laughing, it is a "Gelastic seizure". If a seizure produces crying, it is a "Dacrystic seizure" and so on.
To categorize the seizures, doctors may need MRI, EEG, and sometimes video-EEG monitoring. An MRI is a picture of the brain. An EEG measures electrical activity in the brain. If the EEG is done for 1 day or more with video-recording, it is called "Video-EEG monitoring".
Treatment for childhood epilepsy
There are more than 30 medications to treat seizures. Without knowing the seizure type, one cannot choose the right medication. For example, a medication called Oxcarbazepine is very good for Focal seizures. But the same medication can make Absence seizures much worse!
80% of children become completely seizure-free with properly chosen medications. But, about 20% of children don't stop having seizures, even with many medications. We call this "Medically Resistant Epilepsy".
There are many life-changing options for such children as well. Just like medications, not all these treatments are effective for all children.
The doctor has to choose the right treatment very carefully. Please do not take any of these treatments on your own.
1) Steroids: High dose steroids may reduce EEG abnormalities, improve thinking and stop seizures.
2) Removal Epilepsy surgery: If the electrical storm comes from a small brain part, we remove that small part.
Doctors call this "removal surgery" or "resective surgery". These surgeries have many other names. These include "temporal lobectomy" and "focal resection".
3) Vagus Nerve Stimulation (VNS): This is a small device, about the size of a matchbox. It is kept below the skin of the chest. It calms down abnormal brain activity.
Also, when it detects seizures, it sends extra signals to the brain to stop the seizure.
4) Cannabis extract: Highly purified extract from the cannabis plant helps stop seizures. Doctors use it only in selected conditions. These include Lennox Gastaut Syndrome (LGS) and Dravet syndrome (DS).
5) Ketogenic Diet: This is a special diet. It is very low in carbohydrates. In children with very severe seizures, it may help to stop seizures.
In most cases, children stop having seizures with these advanced treatments.
Understanding childhood epilepsy
Seizures are a small part of the child's life. The child's emotional needs, education and future plans are much more important. We, the doctors and parents, need to provide them with this special care.
If the child wishes, we should support all their life goals. This includes (if they wish!) getting employed, married and having children.
One common misconception is that Epilepsy is always hereditary. This is wrong. More than 95% of babies born to parents with epilepsy do NOT have epilepsy.
I have had the privilege of seeing many of my patients getting married. Most are working. Many of them have children. None of these children have epilepsy.
History teaches us a lot. Theodore Roosevelt (president of the United States), Julius Caesar (Roman Emperor) and Alexander the Great had seizures.
These people are not famous because they had seizures. They are famous because, like your child and any other person, they were capable of doing great things.
Few points to note
- You can stop seizures in children.
- Precise diagnosis is essential.
- Advanced treatments including surgery are available at many places in India.
- Stopping seizures enables a wonderful, full life.
(Author: Dr. Siddharth Kharkar, Consultant Neurologist & Movement Disorder Specialist, Nanavati Max Super Speciality Hospital)
