To understand epilepsy, you first have to understand how the
brain functions. The brain controls and regulates all voluntary and involuntary
responses in the body. It consists of nerve cells that normally communicate
with each other through electrical activity.
Epilepsy is defined as two or more seizures that occur without a
specific cause. Seizures are altered behavior that occurs when part(s) of the
brain receives a burst of abnormal electrical signals that temporarily
interrupts normal electrical brain function.
Different kinds of epilepsy are classified according to:
·
Signs and symptoms
·
The child's age when they begin to occur
·
The child’s EEG pattern
·
Neurologic findings on examination
·
Special kinds of imaging (x-ray-type) tests, including magnetic
resonance imaging (MRI) and computerized tomography (CT) scans
Seizure
Classifications
Focal Seizures
These seizures take place when abnormal electrical brain
function occurs in one or more areas of one side of the brain. If the child
does not lose consciousness throughout the seizure, the seizure was previously
classified as simple. If the child loses consciousness or does not respond
appropriately, the seizure was previously classified as complex.
Focal seizures may include one-sided jerking movements of the
arms or legs, stiffening, eye deviation to one side or twisting of the body.
Sometimes these symptoms follow these other signs:
·
Seeing visions
·
Hearing noises
·
Tasting and smelling things
·
Dizziness
·
A rapid heart rate
·
Dilated pupils
·
Sweating
·
Flushing
·
Stomach fullness
·
Psychic symptoms such as a sense of deja-vu, distortions,
illusions and hallucinations
Generalized Seizures
These seizures involve both sides of the brain. As a result, the
seizures are less variable than focal seizures.
Typically, they involve brief staring spells; sudden, quick
muscle jerks; generalized and rhythmic jerking of the extremities; generalized
stiffening episodes; or generalized stiffness followed by rhythmic jerking of
the extremities or a sudden loss of muscle tone, resulting in a head drop or
sudden fall to the ground.
Causes
Fever (febrile seizures) are caused by fever in children age
three months to five years of age, with no other underlying neurologic problems
present. Febrile seizures are common and occur in 2-5% of all children. Simple
febrile seizures are brief (usually less than five minutes), generalized
convulsions that only occur once in the course of an illness.
Metabolic or chemical imbalances in the body may also cause
seizures. Conditions that prompt seizures include hypoglycemia (low blood
sugar), hypo/hypernatremia (too little or too much sodium in the blood) and
hypocalcemia (too little calcium). Meningitis or encephalitis (brain
infections) may also induce seizures. Other acute problems that can cause
seizures include toxins, trauma and strokes. In children with epilepsy, a
common reason for sudden increase in seizures is that the youngsters are not
taking their medications as directed.
Trauma at birth or brain abnormalities such as tumors can also
be the source of seizures. A lack of adequate oxygen near the time of birth,
trauma, infection and stroke can induce a seizure. Sometimes the seizures
appear suddenly, although the brain abnormality may have been present for a
long time.
Seizures can also develop as a result of a neurodegenerative
disease. While neurodegenerative diseases are rare, they can be devastating.
The best tool the doctor has to evaluate the spells is the
child's history. This includes knowing what happened immediately before the
seizure, the first indication that something was wrong, a complete description
of the event, the level of responsiveness of the child, how long the seizure
lasted, how it resolved and what the child did after the event. All or some of
the following tests may be used:
·
Blood tests
·
Electroencephalogram (EEG) – A procedure that records the brain's continuous, electrical
activity by means of electrodes attached to the scalp.
·
MRI – A diagnostic
procedure that uses a combination of large magnets, radiofrequencies and a
computer to produce detailed images of organs and structures within the body.
·
CT scan – A diagnostic imaging procedure that uses a combination of
x-rays and computer technology to produce cross-sectional images (often called
slices) of the body, both horizontally and vertically. A CT scan shows detailed
images of any part of the body, including the bones, muscles, fat and organs.
CT scans are more detailed than general x-rays.
·
Lumbar puncture (spinal tap) – A special needle is placed into the lower back into the spinal
canal. This is the area around (but not into) the spinal cord. The pressure in
the spinal canal and brain can then be measured. A small amount of cerebral
spinal fluid (CSF) can be removed and sent for testing to determine if there is
an infection or other problem. CSF is the fluid that bathes your child's brain
and spinal cord.
Medication
Many types of medications may be used to treat seizures and
epilepsy. Epilepsy medications are selected based on:
·
The seizure type
·
Child’s age
·
Side effects
·
Consistent use of the medication
Discuss your child's medication side effects with their
physician. While your child is taking medications, different tests may be done
to monitor the effectiveness of the medication. These tests may include the
following:
·
Blood work: Frequent blood
draws testing may be required to check the level of the medication in the body.
Based on this level, the physician may increase or decrease the dose of the
medication to achieve the desired level. This level is called the
"therapeutic level," and is where the medication works most
efficiently. Blood work may also be done to monitor the effects of medications
on body organs.
·
Urine tests: These tests are
performed to see how the child's body is responding to the medication.
·
EEG
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You should weigh the risks and benefits of therapy versus the
risks of a subsequent seizure before your child begins taking a medicine.
Treatment is generally not started after the first seizure in children.
While reports vary, the recurrence risk after the first seizure,
if it occurred for no apparent reason, is approximately 40%. The majority of
recurrent seizures occur soon after the first event — 50% occur within six
months.
The use of only one drug is preferable if possible, as
approximately 70% of children become seizure-free on therapy with one
medication. Another 15% of children become seizure-free on a combination of
several. The final 15% have epilepsy that does not respond to medication.
Other Treatments
·
Ketogenic diet – A strict, high-fat diet useful for generalized
seizures that don't respond to medication.
·
Vagal nerve stimulator – A surgically implanted wire around the
vagal nerve hooked to a pacemaker device in the chest that is programmed to
give intermittent stimulation to the vagal nerve. This device is FDA-approved
as adjunctive therapy for partial seizures in children over age 12. However,
some researchers believe it’s useful for younger children, as well as in
children with intractable generalized seizures.
·
Epilepsy surgery – For some patients, particularly those with
focal seizures that don't respond to medication or with identifiable lesions on
head imaging studies, epilepsy surgery may be the best treatment.
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