Childhood epilepsy: types, symptoms, causes and treatment

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

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

• Related article: "Epilepsy: definition, causes, diagnosis and treatment"

What is childhood epilepsy?

Childhood epilepsy is a disease of the nervous system characterized by an abnormal discharge of electrical impulses in certain areas of the brain and cerebral cortex. Children with this chronic disorder have recurrent seizures or seizures, called seizures.

This disease usually manifests itself in various ways, depending on the affected brain structure and the region where the epileptic seizure originates. These crises can be simple, without the child losing consciousness, or complex, in which a loss of consciousness does occur. Seizures can be short and last only a few seconds, or they can be long and last several minutes.

The effects of childhood epilepsy on the child and its environment also vary depending on factors such as age, the types of seizures, the child's response to treatment, or other health problems concomitants.

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

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Types of seizures (and their symptoms)

The epileptic seizures that occur in a disease such as childhood epilepsy can be classified into two large groups: those with focal or partial seizures and those causing seizures generalized. Within each category, up to 30 types of seizures have been described.

Focal or partial

Around 60% of childhood epilepsies present with focal or partial seizures. These originate from only one side of the brain and are described based on the brain area in which they originate (p. ex. frontal lobe or medial temporal lobe). Its duration ranges from 1 to 2 minutes.

During this type of crisis, the child does not lose consciousness and may have strange sensations, such as intense memories, which can be expressed in different ways. Motor symptoms include various automatisms, blinks, tics, 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 in the level of consciousness, which generates in the patient a sensation of being like 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 seizure.

The characteristic symptoms of focal seizures can confuse clinicians and be misinterpreted as signs of other illnesses, such as narcolepsy, fainting, or even some illnesses mental. For this reason, a good differential diagnosis and the application of different tests are required.

Generalized

In generalized seizures, abnormal electrical shocks occur on both sides of the brain. These types of seizures can cause loss of consciousness, leading to falls and generalized muscle spasms. There are different types:

• Absence crisis: the child seems to have a lost gaze fixed on a specific point. Mild muscle spasms may be present. It causes attention and concentration problems in the child.
• Clonic seizures: they cause repetitive jerky movements on both sides of the body.
• Tonic seizures: they produce muscle stiffness, especially in the back, arms and legs.
• Myoclonic seizures: they cause sudden jerking movements in the upper part of the body, mainly in the arms and legs (and sometimes in the whole body). Its duration is very short, just a few seconds.
• Tonic-clonic seizures: they cause a mixture of the symptoms that generate tonic and clonic seizures, such as muscle stiffness and sudden movements in the arms and legs. They are the most serious crises.
• Atonic seizures: they generate a great hypotonia (decrease in 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 can be genetic and hereditary, due to trauma, brain development abnormalities, infections and diseases, metabolic disorders, tumors and other problems. Actually, 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 the genes can occur spontaneously and without a family history. For example, mutations affecting ion channels, such as those of the SCN1A gene, have been described. responsible for the epileptic seizures that occur in severe myoclonic epilepsy of childhood or syndrome by Dravet.

Brain damage can also be a determining factor in the development of childhood epilepsy. East can originate in different stages of growth: during pregnancy, early childhood, or adolescence. Malformations in the blood vessels and cerebrovascular diseases can also be factors responsible for producing an epileptic disorder.

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

Treatment

To treat childhood epilepsy, doses of antiepileptic drugs are used that are usually administered depending on the type of epilepsy, the age and weight of the affected child, divided into two or three doses daily. The neurologist is in charge of monitoring the pharmacological treatment, taking into account possible side effects and interactions with other medications. A correct diagnosis is also essential.

Most single-drug treatments (known as monotherapy) are effective in reduce and eliminate the incidence of seizures, without unwanted effects significant. However, periodic controls are 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 blood plasma.

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

Surgical intervention is proposed taking into account the area of ​​the brain where the seizures originate (epileptic focus). A removal of this area can be done; sectioning various brain areas so that the seizures do not spread; A callosotomy can be carried out, which involves sectioning the network of neuronal connections between hemispheres; or perform a hemispherectomy, in which half of the cerebral cortex or hemisphere is removed, a drastic technique and 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). Official guide of the Spanish Society of Neurology of clinical practice in epilepsy. Neurology, 31 (2), 121-129.
• Travé, T. D., Petri, M. AND. Y., & Victoriano, F. G. (2007). Descriptive study of childhood epilepsy. Journal of Neurology, 44 (12), 720-724.