childhood epilepsy

What is Epilepsy ?

Epilepsy is the most common neurological condition in India. Electrical activity is happening in the brain all the time. When there is a sudden, intense burst of  electrical activity, this briefly disrupts the way the brain normally works, so the brain’s messages become mixed-up and this leads to an epileptic seizure.

Epilepsy is the tendency to have recurrent epileptic seizures. 

How common is epilepsy?

The overall prevalence of epilepsy in India is 3.0-11.9 per 1,000 population 1, which is comparable to the developed countries. So roughly 1 in every 100 people have epilepsy.

How do doctors diagnose epilepsy?

With respect to children especially infants and preschool children , making a correct diagnosis of epilepsy is crucial. This is one field of medicine where medicine becomes art  as much as science as there is no single definitive test. It is important to take a good history of the event from someone who has witnessed it. To find out exactly what the child was doing before the event , how the event started , what happened in the event and what happened afterwards .These days videoing the event on the smart phone has also proven useful. Then the doctor will have to decide whether the event described is an epileptic seizure or a non-epileptic episode. Detailed neurological examination can give a clue as to the cause.

What are the different kinds of seizures ?

There are many different kinds of epileptic seizures. They are often put into two groups according to where in the brain they start. Focal seizures start in one side of the brain, while generalised seizures affect both sides of the brain from the start. Watching their child having a seizure is a frightening experience for parents. However seizures are not as serious as they look. Children may become unconscious, they may not respond to parents, they may fall and there can be jerking of the limbs.

What are the causes and what tests are done ?

After a child is diagnosed with epilepsy , the usual tests include EEG and MRI Brain scan. EEG measures electrical activity in the brain and MRI is done to look for any structural causes of epilepsy. There are many causes of epilepsy which could include genetic causes, brain malformations, post meningitis or head injury etc. Some blood tests may also be done. Based on the above information ,we can diagnose the exact type of epilepsy. Some children may need additional genetic testing to find out the exact cause.

Can my child do all normal activities ?

Most children with epilepsy can still do the things they enjoy, including playing sport, taking part in school activities and spending time with friends. Some safety measures include, when swimming, have someone in the water with them who knows what to do if they have a seizure. When cycling, make sure they wear a helmet and keep to paths away from water and busy roads. They should be careful with cooking and avoid climbing heights.

What should parents know about?

 All parents need to know the  first aid management of seizures. For a child has a generalised full body seizure , parents also should be trained on how to use nasal midazolam spray for the emergency management of seizures if needed.

Having epilepsy comes with certain risks. One small but important risk to know about is sudden unexpected death in epilepsy( SUDEP) .This is when someone with epilepsy dies unexpectedly, and there is no clear reason why. SUDEP is rare in adults, and even rarer in children.

How is epilepsy treated ?

Epilepsy is usually treated with medicines called anti-seizure  medication. There are many different kinds of epilepsy in children, it is very important for the doctor to find out exactly which type of epilepsy the child has , so that the correct anti-seizure medication can be prescribed. The aim of treatment is to stop or reduce the seizures. About 70% of the children respond to just one medication. The medication will need to be taken regularly. Most children with epilepsy can lead a normal life with the correct medication. 

What can we do if seizures do not respond to medications?

If the child does not respond to one medication, other medications may be tried. Refractory Epilepsy or drug resistant epilepsy is when the seizures do not stop after trying at least 2 appropriate anti-seizure medications at the correct doses.

If the child’s seizures continue despite medications, the options include ketogenic diet or epilepsy surgery. 

Do children with epilepsy have other problems ?

Children with epilepsy may also have learning difficulty, problems with memory and speed in which they process information, difficulties with attention and concentration and hyperactivity.

Should my child take life long medications ?

 70% of the children with epilepsy get better as they grow older. Hence trial off medications has to be offered to any child who has not had seizures for 2 years and does not have a lifelong epilepsy syndrome. We usually repeat the EEG before giving a trail off the medications.

In summary making a correct diagnosis of epilepsy is crucial and also finding out the type of epilepsy is important so that correct medication can be prescribed. 

 DR RASHMI ADIGA

CONSULTANT PAEDIATRIC NEUROLOGIST 

MBBS, D.C.H, M.R.C.P.C.H (U.K), C.C.T(U. K), F.R.C.P.C.H

References 

1.Epilepsy in India I: Epidemiology and public health

Senthil Amudhan Annals Indian Academy Neurology 2015

2. Eastern Paediatric Epilepsy Network , U.K.