Signs of the development of epilepsy in children. Signs of various forms of epilepsy in children. Consequences and complications of childhood epilepsy

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Our brain is a very complex mechanism. The brain controls all the functions of our body. When there are changes in the structure of the brain, changes appear throughout the body. One such manifestation is epilepsy.

Epilepsy is chronic illness, characterized by frequent, most often at regular intervals, loss of consciousness, muscle contractions. It is necessary to distinguish between epilepsy, when attacks are repeated constantly, and epileptic seizures, when attacks are single, sometimes even single, in children most often appear against a background of high temperature (febrile convulsions). With epileptic seizures (attacks), no changes in the structure of the brain are observed, and the manifestations of an attack are not associated with external causes (fever).

Mechanism of epilepsy in children

Our brain is a huge collection of individual cells called neurons. Periodically, each of the neurons is excited - an impulse passes through it, which sends information to some organ so that it performs some function. After the impulse passes through the neuron, it “rests” for some time, that is, it is not able to conduct the impulse. After the neuron "rests", it is again ready to transmit an impulse.

With epilepsy, a cluster of neurons (an epileptic focus) is formed in the brain, which are in constant excitation. The neurons surrounding this focus restrain this excitation, but periodically an impulse from the epileptic focus breaks out, and then all neurons are exposed to excitation brain.

At this moment, an epileptic seizure occurs: the child loses consciousness, the muscles begin to contract, involuntary urination and defecation occur. After the excitation covers all the neurons of the brain, their activity slowly fades away, they are "exhausted". Clinically, this is manifested by single muscle contractions of individual muscle groups.

After that, the neurons go into "sleep mode" - they rest and are not able to transmit impulses. At this time, the child comes to his senses, but feels muscle weakness, soreness in some muscles, due to their increased work during contractions, the children are lethargic, drowsy. After an epileptic seizure, children do not remember anything about what happened.

Very often epilepsy attacks are accompanied by previous "auras". "Aura" is the sensation of taste, smell, the appearance of sounds, pictures before the eyes that appear immediately (a fraction of a second) before the attack. After an attack, only the “aura” remains in the memory of children.

Another feature of epilepsy is that epileptic foci are able to "multiply". After an attack, a site of increased arousal may appear in another part of the brain, while it is initially interconnected with the main area of \u200b\u200bexcitation. But over time, this new area begins to be excited in its own rhythm. It is in this way that the condition worsens and the attacks become more frequent.

Causes of epilepsy in children

What can lead to the appearance of such a focus of increased excitation in the brain?

1. Violation of the development of the brain in a child during pregnancy. The use of alcohol by the mother, smoking during pregnancy leads to a violation of the development of the child's brain. Also, colds, severe gestosis, age-related primiparas (the age of the mother is more than 27 years old at the first pregnancy) can provoke the development of areas of increased excitation in the brain.

2. Features of the course of childbirth. In this case, the already formed brain is damaged and an early organic brain lesion develops. This can be observed with prolonged labor, a long anhydrous period, the birth of a child in asphyxia (breathing disorder), entanglement of the umbilical cord around the neck, the application of obstetric forceps, obstetric benefits.

3. Past infectious diseases nervous system. Neuroinfections transferred by a child (encephalitis, meningitis, arachnoiditis) contribute to the formation of areas of increased nervous excitability in the brain. Also, frequent colds with high fever and the presence of seizures can lead to the development of epilepsy. True, in this case, the child's brain already has a predisposition to the development of epilepsy, which may be due to minor brain damage during pregnancy and childbirth, which went unnoticed due to their insignificance.

4. Head injury. Blunt head injuries, brain concussions contribute to the fact that parts of the brain begin to more actively produce nerve impulses and turn into epileptic foci.

5. Heredity. In addition to the fact that a focus of increased excitation appears in the brain, the inhibitory effect on this focus from both nearby neurons and chemical compounds should also decrease. The main inhibitory chemical in our brain is dopamine. Its amount is programmed in our genetic code (DNA). Therefore, if parents have epilepsy, they pass on to their children through DNA a predisposition to low dopamine levels.

6. Tumors. The presence of a brain tumor can provoke the appearance of a site of increased excitability in the brain.

Symptoms of epilepsy in children

There are several clinical forms of epilepsy: "major" and "small" epilepsy.

With "major" epilepsy clinical picture very bright, basic hallmark loss of consciousness is: children fall, muscle contractions begin, increased salivation, involuntary urination and defecation are possible, respiratory arrest is possible, then everything is replaced by single twitches of individual muscle groups, the child begins to breathe, and then the child falls asleep. After waking up, the child does not remember anything about what happened to him. Also, during an attack, it is possible for a child to bite the tongue, which manifests itself spotting from the mouth sometimes with foam.

With "small" epilepsy, the child does not lose consciousness or fall, everything is limited to the involvement of only a separate muscle group in the process. The child can stop during the performance of some action - “freeze”, remain in this position for several minutes, and then continue, from the same place where he left off, without feeling a gap in time at all. Also, the child can stop in the middle of a conversation and continue it after the attack ends. Muscle contractions are also possible: the child turns his head in a certain direction, while his eyes can turn in a completely different direction, it is possible to turn the entire body of the child in one direction.

Waking epilepsy, sleep epilepsy and waking epilepsy are classified according to the time of onset.

In wakefulness epilepsy, seizures occur in daytime. In wake-up epilepsy, seizures occur in the morning, when the child has just woken up. In sleep epilepsy, seizures occur only while the child is sleeping. This is the most interesting option, since seizures are associated with sleep phases.

We have 2 phases of sleep: REM and non-REM sleep. Epilepsy attacks occur during non-REM sleep, which is most likely due to changes in brain activity. At the same time, children can talk in their sleep, walk, it is possible to stop breathing in a dream, which is restored after the attack ends.

Usually an attack appears for no apparent reason and most often at the same time, but in some cases, attacks can be triggered by external factors. So, for example, often flashing, rapidly changing bright pictures can cause an epileptic seizure. When the Pokemon animated series aired on television, epilepsy among children became more frequent in Japan, as the animation used fast-paced, bright pictures.

The presence of epilepsy gradually changes the mental state of children. Children become withdrawn, egocentric, school performance decreases, as children do not feel part of society, they think that their attacks frighten the people around them. In part, this is true: it is quite unusual for others to see a child convulsing on the floor, drooling. In ancient times, people with epilepsy were thought to be possessed by the devil. Now the time of prejudice is over, many people are well aware of this condition, so it no longer causes such panic fear as before. Children with epilepsy need to be taught to live with their illness but protected from overprotection.

Diagnosis of epilepsy

To make an accurate diagnosis, it is necessary to clarify: how the birth and pregnancy proceeded, what diseases the mother suffered during pregnancy, the bad habits of the mother and father, the presence of hereditary diseases in the parents, the diseases the child had in early childhood, how the child developed physically and mentally.

After being collected full information about the child, they begin to examine the child himself. An electroencephalogram (EEG) should be performed. In this study, electrodes are placed on the head, which take readings of the electrical activity of the brain. This study allows you to determine the presence in the brain of an area with increased excitability. Magnetic resonance imaging (MRI) of the brain can also be performed. This study allows you to see all the structures of the brain on the monitor screen, exclude a brain tumor, and determine the site of an organic brain lesion.

Epilepsy treatment

After establishing an accurate diagnosis, the child is prescribed treatment. Anticonvulsants are prescribed: phenobarbital, difenin, carbamazepine, sodium valproate. In children, the drug phenobarbital is the most successful: it has fewer side effects, is well tolerated, does not cause liver damage and changes in the child's psyche. Long-term treatment with this drug interruption of treatment for one day is unacceptable. Take phenobarbital at a dosage of 3-8 mg / kg / day. Begin to give the drug with small doses, gradually increasing the dosage, bringing them to medium. If the number of attacks decreases, and side effects are not observed, the drug is started to be given in a full dose. In children, this drug is not canceled even with a long absence of seizures. In adults, a gradual withdrawal of the drug is possible, if there has not been a single attack for 3 years, the drug is gradually reduced in dosage over 1-2 years. If at least one attack appears, then they return to the original maximum dosage.

In some cases, it is possible to use surgical treatment: removal of the affected area of the brain or tumor that provokes the development of epilepsy.

First aid during an attack

During an attack, the child must be laid on a flat surface (preferably the floor), protected from things with which he can injure himself, provide free access to oxygen (no need to crowd over the child). Very often you can find in the literature a note that it is necessary to put a spoon in the mouth so that the child does not bite his tongue. But have you ever tried to put a foreign object in your mouth if your jaw is cramping? Trying to put a spoon in your child's mouth at this time can easily knock out his teeth or dislocate his jaw. Therefore, this is not worth doing.

Epilepsy prognosis

The prognosis for children with epilepsy is favorable. Such children must necessarily attend a general education school, since their mental development, with the right treatment, does not suffer at all, and they do not lag behind their peers in their development.

Prevention of epilepsy in children

Prevention should be carried out even during pregnancy - this is the exclusion of factors that adversely affect the development of the fetus. Helps reduce the risk of epilepsy in children breast-feeding. Breast milk contains everything necessary for the proper development of the baby's brain, in addition, close contact during feeding soothes the baby.

Pediatrician Litashov M.V.

Epilepsy in children is a chronic neurological disease that develops due to increased electrical activity of brain cells and is externally manifested by various seizures.

Attacks can be expressed in the following forms:

convulsions ("large" or "small" convulsive seizures);
temporary loss of consciousness;
mental disorders: hallucinations, loss of connection with reality;
automated, many times repeated movements;
symptoms of "hanging" (freezing in one position, fixing the gaze).

Epilepsy attacks in children develop in connection with the activation of excitation processes in the cells of the cerebral cortex, while foci gradually form in different parts of the brain. When epileptic foci occur, waves and discharges of different frequencies begin to form in the cells, which, under certain conditions or under the influence of provoking factors, become strong and sharp and accumulate in certain areas of the cerebral cortex.

The main reasons for the development of epilepsy are damage to the nerve cells of the brain (neurons) against the background of the immaturity of all organs and systems of the baby:

during pregnancy, this may be the impact on the fetus of infections, toxins, medicines, the development of brain hypoxia (lack of oxygen for brain cells), radiation;
birth trauma during childbirth;
exposure to the brain of toxins (malignant jaundice), infectious agents (neuroinfections), trauma after birth.

Therefore, often the first symptoms ("debut") of epilepsy appear in young children up to two or three years.

One of the factors is heredity - a number of forms of epilepsy are transmitted from parents.

Diagnosis of epilepsy

Establishing the diagnosis of epilepsy is based primarily on the appearance of symptoms of the disease at a certain age in a child. With large convulsive attacks, repeated two or more times against the background of the child's complete health, this is much easier to do. Also, the occurrence of “small” seizures testifies to the disease, especially with the development of epilepsy in children under one year old, which are manifested by specific types of seizures:

absences: fading in one position, turning off consciousness with fixation of the gaze;
repetitive obsessive movements, in most cases resembling the usual movements of a child (sucking, blinking, smacking);
single muscle contractions of a specific muscle group.

Often they are not immediately noticed by parents, so the diagnosis of such forms is more difficult and the disease is not always diagnosed on time.

Therefore, if even minor signs appear that indicate the occurrence of neurological pathology in children at any age (from birth to 16 years), it is necessary to contact a pediatric neurologist and conduct the necessary examination to exclude the formation of this severe pathology.

It is also important to know that the earlier the diagnosis is made with the definition of the form and cause (with symptomatic epilepsy), the necessary treatment is prescribed, the greater the likelihood of a positive prognosis, long-term remission (no seizures) or complete cure of the pathology.

Instrumental methods for diagnosing a disease

If symptoms of epilepsy appear in a child, it is necessary to contact a district pediatrician or a pediatric neurologist as soon as possible to examine the baby, determine the neurological status and conduct various tests. If necessary, consultations of other specialists (ophthalmologist, endocrinologist, cardiologist) and instrumental diagnostic methods are carried out.

First of all, if you suspect the development of epilepsy, an electroencephalographic study of the brain (EEG) is performed. This method determines the bioelectrical activity of the brain and its pathological changes associated with the formation of epileptic foci. Using this method, in most cases, a doctor (neurologist or epileptologist) can determine the presence of epilepsy in a small patient and clarify its form.

In complex forms of epilepsy, specific changes in the EEG may be absent in the presence of clinical manifestations, therefore, repeated studies are carried out, a long-term EEG recording with video recording (EEG - video monitoring) is prescribed, which is performed for a long time: several hours or even days.

Also to additional methods studies for epilepsy include magnetic resonance imaging (MRI) or computed tomography of the brain (CT), which can be used to determine one of the causes of epilepsy: the presence of a congenital anomaly, a tumor, changes after an injury, a site of cerebrovascular accident.

Also, to determine the causes of epileptic seizures, identify the form and cause of epilepsy, a specialist may prescribe other examinations:

electroencephalography with stress tests or provocations;
neurosonography (ultrasound of the brain) - for the diagnosis of epilepsy in infants with an open large fontanel;
dopplerography or radiography of cerebral vessels to determine vascular pathology.

Epilepsy treatment

The tactics of treating epilepsy in children depends on the form and cause of the disease, but antiepileptic drugs are almost always prescribed, which reduce the convulsive readiness of the brain. The drug and dose are selected individually, taking into account the form of epilepsy, the type of seizures, the age of the child and the presence of concomitant diseases. Anticonvulsant therapy continues continuously and for a long time (for several years) under the supervision of an epileptologist, and with a long remission, the complete absence of seizures, it is possible to completely cancel the drugs.

In severe malignant epilepsy, a complex ketogenic diet, steroid hormones are added to antiepileptic drugs, and if indicated, a neurosurgical operation is performed.

Prognosis for health and life

The prognosis for epilepsy in children depends on:

on the form and severity of the disease, the frequency of repetition and duration of attacks;
on the age of the “debut” of the disease, the timeliness of diagnosis and the initiation of therapy;
the presence of concomitant ailments that complicate the course of the disease, provoke the development of seizures or reduce the effectiveness of treatment (liver and kidney diseases, severe endocrine pathology, chromosomal diseases, metabolic disorders).

The most unfavorable malignant forms of the disease are epilepsy with frequent generalized "big" convulsive seizures, with the onset of development at an early age, developing against a background of severe brain pathology. In most cases, the child is constantly monitored by a neurologist and epileptologist, receives long-term complex treatment, this type of epilepsy is an indication for disability in case of epilepsy in children, but in each case the decision is made by a medical commission.

The most benign forms of epilepsy with a positive prognosis for the life and health of the baby, subject to constant monitoring by a specialist and long-term treatment (even in the absence of symptoms and seizures), are:

sleep epilepsy in children, which is manifested by night attacks of sleep-talking, sleepwalking, parasomnia (attacks of cramps in the legs at night);
reading epilepsy, when epilepsy attacks in children and adolescents develop during or after reading;
benign rolandic epilepsy;
benign neonatal convulsions.

Parents need to remember that the diagnosis of epilepsy is not a sentence - with timely diagnosis, constant monitoring and properly selected long-term therapy, most forms of this disease can be successfully treated, and the development of a child with epilepsy is age-appropriate. Various mental disorders or mental retardation are observed only in severe forms of epilepsy with frequent seizures or in symptomatic epilepsy caused by a severe organic pathology of the baby's nervous system (congenital anomalies in the development of the brain, injuries affecting large areas of the brain, after complex neuroinfections suffered in early childhood). age).

Of course, epilepsy imposes a number of restrictions on parents and the child.

Epilepsy is one of the most common diseases of the nervous system. Epileptic seizures can begin at any age, but children are most often affected: the greatest risk of developing the disease exists from one to nine years. Many people think that epilepsy is just seizures. However, this disease does not always manifest itself in this form. And some convulsive seizures, on the contrary, do not indicate epilepsy. How to recognize epilepsy in the early stages and choose the best treatment? What should be done during an attack in a child? And, finally, how to behave with a sick baby so that he does not feel “not like everyone else”? Dmitry Kuzmin, neurologist, network epileptologist, tells medical clinics"Family".

neural "storm"

Currently under epilepsy understand repetitive seizures (both convulsive and non-motor) caused by chronic nervous disease. Epileptic seizures occur as a result of disturbances in the processes of excitation and inhibition in the cerebral cortex. the nerve cells of our "gray matter" convert the excitation that comes to them from the senses into an electrical impulse and transmit it further along the chain of neurons. The process of excitation alternates with inhibition, that is, a period when the neuron is not able to transmit an impulse. In epilepsy, a focus of neurons is formed in the brain, which are in constant excitation. If neighboring nerve cells cannot cope with this voltage, the electrical impulse spreads to other parts of the brain, and an epileptic seizure occurs. In nature, something similar happens during a thunderstorm, when the sky bursts into powerful electrical discharges - lightning.

There are many causes for epilepsy. Heredity plays a significant role: in families in which one of the relatives suffers from the same disease, the risk of developing the disease in children is higher. But at the same time, epilepsy is not necessarily inherited, that is, from parents to a child. Brain damage can also provoke epilepsy: congenital anomalies, intrauterine infections, chromosomal diseases, birth injuries of the central nervous system, infections of the nervous system (poliomyelitis, meningitis, encephalitis, etc.), traumatic brain injuries and tumors. Even the use of future mother alcohol and nicotine during pregnancy.

Epilepsy or not?

Most often, epilepsy manifests itself in the form of convulsive seizures. However, it should be remembered that not all seizures indicate epilepsy. Every child can experience convulsions at least once, for example, after vaccination or at a high temperature. The latter are called febrile seizures- they occur between the ages of three months and five years due to a strong rise in temperature, usually with respiratory infections. (It is important to remember that illnesses such as encephalitis or meningitis can start with a high fever and seizures, and for such symptoms, a visit to a doctor is essential.) Febrile seizures are usually short (a few minutes) and do not damage the brain, but disappear spontaneously with decreasing temperature.

Often parents describe seizures that are very similar to epilepsy, but upon closer examination, it turns out that it is not the cause of the seizures. When the cause is found and eliminated, such convulsions disappear, and the child no longer needs treatment.
Remember: you can diagnose epilepsy only when the baby had several (two or more) seizures, and they arose without any obvious external causes.

Types of epilepsy in children

An epileptic seizure is a rather frightening sight for an unprepared person. The most common symptoms are: convulsive contractions of the muscles of the body or their strong tension (flexion of the arms, strong straightening of the legs), erratic movement of one of the parts of the body (twitching of the limbs, curvature of the lips, rolling the eyes, throwing back or strong turning of the head to one side), loss consciousness, temporary cessation of breathing, involuntary urination and defecation. When motor manifestations stop, the child may come to his senses, but feel weakness and lethargy, some soreness in the muscles, or may fall asleep immediately. After the attack, the children do not remember anything about him.

Often, epileptic seizures are preceded by characteristic signs: nervousness, dizziness or headache, and sometimes the so-called "aura" - these can be special sensations (numbness of a part of the body, tingling), smell (usually unpleasant) or taste, sounds, pictures before the eyes, which arise in the mind of the child in seconds, and sometimes more long time before the attack, and are stored in memory after it.

Some manifestations of epilepsy in children differ from those commonly known and are not always easy to recognize. These forms include absence epilepsy, atonic seizures and baby spasm.

At absences(from French absence - absence) the child does not fall during seizures, but simply freezes and stops responding to external stimuli. He can literally stop in mid-sentence, stop the action he has begun, while the gaze is concentrated on one point, and it is impossible to attract the child's attention. After the termination of the seizure of the absence, the child continues the movement started and does not remember anything about the "failure". Such attacks can occur up to 10-15 times a day. This form of epilepsy most often occurs in girls aged 6-7 years.

Atonic seizures very similar to fainting: they are characterized by a sharp loss of consciousness and relaxation of the muscles of the body. However, this is also a form of epilepsy, and if the child has fainted several times, it is imperative to take him to the doctor.

At the age of two or three years, it may appear baby spasm, that is, a sudden and involuntary pressing of the hands to the chest, inclinations of the head or the entire body and intense straightening of the legs. Mild attacks are manifested as periodic nodding of the head. Often, children's spasms occur in the morning, immediately after waking up. By the age of five, this form of epilepsy may disappear or transform into some other form. With symptoms similar to childhood spasm, it is important to show the child to the doctor as soon as possible, since it can be a sign of severe damage to the nervous system.

First aid for a seizure

If a child has an aura, that is, he says that he hears or sees something special, feels an unusual taste or smell, you should immediately lay him on the floor away from sharp corners or on the bed, unbutton the collar and take off tight clothes.

During an attack, you should not panic: it is important to follow its course in order to tell the symptoms to the doctor in as much detail as possible, and measure the duration by the hour.

The child's head should be turned to the side to avoid the retraction of the tongue and for the free flow of saliva.

Do not open the child's jaws with a finger, spoon, medical spatula or any other object!

Also, do not pour any liquids or medicines into his mouth.

If the child vomits, gently hold him in a position on his side.

Do not leave the child unattended until the attack stops.

If the child falls asleep immediately after the seizure ends, do not wake him until he wakes up on his own.

How to treat?

Epilepsy should be treated without fail, because each new attack, capturing more and more brain neurons, "paves the path" for the next one. Frequent attacks of epilepsy can slow down mental and psychomotor development, while timely treatment in most cases ensures a speedy recovery. However, the doctor must be completely sure of the diagnosis, and this requires a thorough examination of the child and finding out the factors that could lead to the disease. First of all, you need to know how the pregnancy and childbirth proceeded, what diseases the mother suffered when she carried the baby, whether the parents have bad habits and hereditary diseases, and also what the child himself had been ill with. After collecting preliminary information, a specialized examination is needed. For this, electroencephalography methods are used (it allows you to detect areas of increased excitability in the brain), and magnetic resonance imaging (shows the presence of tumors and areas of organic damage to the brain). During MRI the child must lie still, so this procedure is recommended for children over five years of age.

Only after establishing an accurate diagnosis can adequate treatment be prescribed. Exists a large number of anticonvulsants, which are used depending on the type of epilepsy. in most cases, doctors resort to monotherapy, that is, prescribe one anticonvulsant. Currently, experts are of the opinion that this approach is more effective than the use of several drugs at once.

Parents should strictly adhere to the basic principles of epilepsy treatment: regularity (you can not stop taking medication for even one day) and duration (at least three years). And, of course, epilepsy is not the case when you can treat a child on your own. Changes in therapy must also be agreed with the doctor.

The effectiveness of the treatment of epilepsy is currently quite high: about three-quarters of patients can be completely free from seizures only thanks to anticonvulsant monotherapy. However, in some cases, when taking anticonvulsants is not enough, surgical intervention is advisable, that is, the removal of the affected area of \u200b\u200bthe brain or tumor that provoked epilepsy.

Special prevention of epilepsy has not been developed by doctors. But still, there are preventive measures that can reduce the risk of this disease. It is worth taking care of this even during pregnancy: it is important to exclude to the maximum those factors that adversely affect the development of the fetus. Breastfeeding also reduces the risk of epilepsy: human milk contains substances necessary for optimal brain development of the baby, and contact with the mother during feeding calms the baby.

Epilepsy is not a sentence!

Children with epilepsy, if the treatment is right for them, as a rule, do not differ from their peers in either mental or mental development, therefore, protect them from visiting kindergarten and school is not worth it. It is very important for a child that he does not feel like a “disabled person”, “not like everyone else”. Of course, educators and teachers need to be told about the characteristics of the child and informed about the rules of first aid for an attack. It is also a good idea to talk to the school or daycare staff about the possibility of taking an anti-seizure medication during the day, if necessary.

Physical activity for a child with epilepsy is also not contraindicated and even desirable (of course, if seizures are stopped by medications). There are only restrictions on the choice of a sport: it is worth abandoning those in which there is a danger of falling from a height (like bars), skiing and skating, and horse riding, ski jumping, and scuba diving should not be practiced. Swimming in the pool, open water and even in the bath should be treated with special attention: the contrast of water and air temperatures, as well as staying in cold water may trigger an attack.

parental fears

Many parents fear the diagnosis of epilepsy. And they can be understood modern society many outdated stereotypes are still alive, which appeared because people could not find the cause of a frightening disease. As we have already seen, epilepsy is not necessarily inherited and is not incurable. This disease is also not a mental disorder (and the special aggressiveness, propensity to violence or mental retardation of patients with epilepsy is also a myth).

Parents also fear that, in their opinion, anticonvulsants are “very strong, with a lot of side effects and it is dangerous to take them.” In fact, failure to treat epilepsy causes much more harm to the child than taking strong drugs. It should be noted that modern anticonvulsants are much easier for patients to tolerate, they are not addictive and do not affect mental functions.

It is a fairly common misconception that if a child is prone to tantrums, then he will certainly develop epilepsy. Sometimes such an opinion can be heard even from a pediatrician. However, general excitability and even loss of consciousness when crying do not indicate a child's predisposition to epilepsy.

Currently, epilepsy is well studied, to combat it developed effective methods, and now this disease has ceased to be an obstacle to a full life for both children and adults.

Dmitry Kuzmin, neurologist, epileptologist of the network of medical clinics "Semeynaya"
magazine for parents "Raising a Child", June-July 2014

Epilepsy is a serious brain disorder that is most commonly manifested by seizures. At the same time, the child does not necessarily fall and convulse, seizures of other forms are quite common - loss of consciousness, convulsions of one part of the body (arm or leg), non-convulsive paroxysms. However, it is worth remembering that seizures are not always a sign of epilepsy.

Possible Causes of Seizures in Children

Seizures are not always epilepsy. In many cases, they can be caused by other processes in the brain. Here is an incomplete list possible causes seizures in children:

true epilepsy,
infectious process of the brain,
brain tumors,
severe disorders of the development of the nervous system,
consequences of injury
convulsions at high temperature (febrile),
toxic, medicinal and other causes.

Thus, it is necessary to distinguish between true epilepsy and convulsive syndrome, which is a companion of many other diseases.

True epilepsy is a congenital disease that is inherited. If a father or mother suffers from it, then the child is also likely to develop it. Epilepsy can be first detected both in early childhood and in adolescence up to 20 years or more. It is impossible to detect epilepsy without the manifestation of the first seizure.

Convulsive syndrome can develop after serious head injuries, infectious diseases, etc.

Epilepsy symptoms

Epilepsy can be manifested by seizures or other symptoms, the main thing in which is paroxysmal. It does not matter what kind of symptom, convulsions or something else, what is important is that it appears with an attack (paroxysm).

The classic symptom of epilepsy is seizures. It is not always the leading and not always the only manifestation of this disease. Seizures may begin suddenly or gradually, with or without full consciousness. They can spread to the whole body or only to part of it - an arm or a leg. After convulsions, there may be involuntary urination and excretion of feces.

In addition, there may be non-convulsive symptoms: sudden softening of the body, loss of tone, freezing of the gaze, involuntary movements of the arms or legs, head, teeth, etc. For example, a child can sit at a table, eat, and suddenly his gaze freezes at one point, a spoon falls, the child does not respond to the calls of the parents. After a few seconds it passes, but he does not remember what happened to him.

First aid for an epileptic seizure in a child

It is important for parents to remember that during an attack, the main danger for a child is a head injury, which he can get when he falls. Seizures themselves are practically not dangerous. Therefore, it is very important to recognize an attack of epilepsy with loss of consciousness in time and provide assistance without doing unnecessary actions that can harm.

At the first sign of a convulsive attack, you need to put the child on the floor or on the bed so that he does not hit his head on sharp objects or the edges of furniture.

If possible, lay the child on his side so that he does not choke on saliva or vomit.

Support your head to prevent injury to the child.

If the mouth is open, put a handkerchief or bandage between the teeth, but without blocking the airways and without restricting breathing.

It is forbidden to open your mouth by force, push a spoon between your teeth, hold your tongue!

As a rule, after 2-3 minutes the attack ends. Thereafter:

Check your baby's breathing. If he is not breathing, begin mouth-to-mouth resuscitation. During convulsions, this cannot be done;
stay close to the child until he is fully conscious. This may take a long time, depending on the form of epilepsy;
do not give food and drink until the child's consciousness is fully restored;
if the child has heat, put him a candle with paracetamol (cefecon, etc.).

You need to call an ambulance if the seizures happened for the first time, lasted longer than 5 minutes, or the seizure was repeated for a short time. You should also call a doctor if the child hits his head or causes other injuries to himself.

It is good if the second parent makes a video recording during an attack - later it will help the doctor make an accurate diagnosis.
All children with new onset epilepsy need hospitalization and a thorough examination. The same applies to children who are already taking epilepsy medication, but the seizure still occurs.

Accurate diagnosis

An accurate diagnosis of epilepsy can be extremely difficult. This is done by a neurologist specializing in epileptology. There are so many types and manifestations of epilepsy that it often takes a doctor time to figure it out. Brain studies help the doctor in this: encephalography, MRI, dopplerometry and others. The main task in diagnosing epilepsy for the first time is to exclude the so-called "organic" causes, that is, the inflammatory or tumor process of the brain. MRI helps with this.

Next, the doctor finds out what type of epilepsy is, what further treatment and the choice of drug depend on. A video recording made by parents during an attack can be very helpful to the doctor. An encephalogram is done to assess the electrical activity of the brain and determine the seizure threshold - how prone the child is to seizures.

Principles of treatment of childhood epilepsy

The treatment of childhood epilepsy is no different from the treatment of this disease in adults. Epileptology is a separate very large area of neurology, and it will not work to cover all the nuances in one article. Consider the most important aspects regarding the treatment of epilepsy.
It is extremely important to accurately determine the cause of seizures - they are not always the result of congenital epilepsy. If in this case the cause of the disease is not eliminated, it will progress and cause very serious consequences.

One or two seizures does not mean that a child will need antiepileptic treatment.

Treatment is not always lifelong - sometimes it can be stopped after the child's condition improves.

The main goal in the treatment of epilepsy is to prevent new seizures.

In most cases, one drug is enough for a child.

In more than 80% of children, medications help prevent seizures completely.

It is important to strictly adhere to the medication schedule prescribed by the doctor. In case of missing a dose, the risk of a recurrence of the disease increases many times over.

Parents should constantly monitor the child's medication intake and teach him to self-control.

Living with epilepsy

Children with epilepsy can lead full lives. To do this, they must constantly and precisely according to the schedule take the appointments assigned to them. medications. It is very important that a child with epilepsy does not have complexes about his health and communicates fully with his peers. This is where a child psychologist can help. Children with epilepsy especially need to develop the ability of self-control, commitment, diligence and support them in every possible way in life.

Children's pathologies of the nervous system, unfortunately, are quite common in medical practice. Some pass as the little patient grows up, some require close supervision of specialists throughout life. Epilepsy is a very dangerous disease, the most widespread among children. In adults, the disease proceeds differently. Seizures, aura, spasmodic muscle contractions are all signs of epilepsy in children. How the disease proceeds and is there a possibility of complete healing from a terrible pathology.

Childhood epilepsy can manifest itself in the first year of a child's life. This is a chronic disease. Epileptic seizures may be absent for many years, which leads the patient to believe that he has recovered. But when exposed to the body certain factors an epileptic seizure in adult children may recur.

Seizures occur with loss of consciousness, convulsive syndrome, the presence of an aura. For example, the disease can proceed without convulsions. The child may smell a certain aroma or feel the characteristic taste of a particular product in the mouth. Such symptoms indicate the presence of epileptic foci in the brain.

The causes of epilepsy in young children are still being studied by scientists, because the human brain is a mystery that is difficult to solve even for science.

Many mothers, having heard a terrible diagnosis, panic. You should not react so sharply to neurological pathology, attacks can be controlled and prevented. The task of parents is to ensure the prevention of injuries to the child and to control the timely intake of medications.

Let's return to the brain and to the mechanism of development of epilepsy in young children. The brain is millions of neurons that process the received information and signal the body about the necessary action. In the presence of convulsive disease, neurons are concentrated in one place (epileptic foci) and work tirelessly. Nearby neurons try to control the excitation, but when a bunch of neurons gives an impulse, all processes in the brain are activated, which is the cause of the seizure. All muscles contract, the child loses consciousness. When the neurons become less active, the attack goes away. The muscles completely relax and the patient comes to his senses. The events preceding the attack, a small patient usually does not remember.

Who is at risk. Causes of the development of convulsive syndrome

The causes of epilepsy in children include many factors. Some are associated with intrauterine pathology and birth trauma, others are a consequence of serious disturbances in the work of the central nervous system and the brain.

The development of epileptic foci contribute to:

intrauterine pathological changes in the brain. If the mother did not refuse for the period of bearing the baby from bad habits, the fetal brain suffers from hypoxia, processes in the neurons of the brain are disrupted. Also, the causes of epilepsy are infectious diseases transferred during pregnancy, the age indicators of the mother and preeclampsia;
features of labor activity. Factors such as the duration of the anhydrous period, protracted labor, fetal asphyxia, the nature of obstetric care are of importance;
neurological diseases of an infectious nature previously transferred by the baby: meningitis, encephalitis. Leads to the development in the brain of clusters of neurons that contribute to the development of the pathological process;
diseases accompanied by fever to high numbers and convulsive syndrome. Activate foci of epilepsy in the brain, which is the impetus for the development of a dangerous disease;
previous injuries of the skull and head. Falls, bumps and concussions activate the sensitivity of neural impulses;
tumor processes. Neoplasms provoke an increase in the excitability of the brain and the formation of foci of the disease;
hereditary factor. With status epilepticus, the concentration of dopamine, a substance that inhibits excitation, is disturbed in the brain. If parents suffer from a neurological disease, automatically, with the genetic code, they pass on to the child deliberately incorrect DNA with a low concentration of a chemical.

How can you recognize the disease, especially if there are no convulsive seizures, let's take a closer look.

How does a neurological disease manifest itself?

The symptoms of epilepsy in children are significantly different from the clinical manifestations in adults. Seizures are not the main indicator of the disease. There are a number of signs indicating the presence of pathological processes in the central nervous system and the brain.

Consider the main symptoms and features of the course of the disease, indicating the presence of epileptic foci:

Classification of childhood epilepsy

The appearance of the disease is preceded by many reasons. But the main one is a malfunction in the brain. Depending on the affected areas and the concentration of foci, epilepsy can be:

temporal. For this type of disease is characterized by a blackout of consciousness, without a convulsive syndrome. The child suddenly interrupts motor and mental activity;
parietal and occipital. May present with any clinical symptoms, rarely develops in children;
frontal. Manifested by convulsions, loss of consciousness, night sleepwalking, impaired speech.

For childhood characterized by frontal and temporal lobe epilepsy. At limited defeat individual parts of the brain, we are talking about a focal form of the disease, which, in turn, is divided into:

Symptomatic. It develops due to past pathologies, such as:

tumor processes of the brain;
vascular failure;
tuberculosis;
meningitis;
rheumatic lesions of the tissues of the nervous system;
stroke;
oxygen starvation of the brain;
poisoning with poisons;
traumatic brain injury;
diabetes;
kidney and liver failure.

This form is typical for teenagers.

Cryptogenic. This form of the disease is established by doctors in cases where it is not possible to explain true reason epilepsy.
Idiopathic. characteristic feature– change in the function of neurons. In this case, we are talking about a pathological increase in the activity and excitability of nerve endings. The reasons for the development of the disease include:

hereditary factor;
anomalies in the physiology of brain development;
mental and neurological diseases;
harmful effects of drugs.

A common variation of this form is rolandic epilepsy in children. The diagnosis is made between the ages of 3 and 13. The focus is located in the groove passing in the cerebral cortex.

The main symptoms of Rolandic epilepsy:

Loss of sensation in cheeks, tongue and lips.
Convulsive contractions of limbs and face.
Violation and inhibition of speech.
Undisturbed consciousness.
Salivation.
Night seizures.

Upon reaching the age of 16, the disease disappears.

An equally common form of the disease, characteristic of childhood, is absence epilepsy. The peak falls on 5 - 7 years. According to statistics, girls suffer from this type of disease more often than boys. The disease proceeds with seizures, but without convulsions. Upon reaching adulthood or after puberty, the clinical symptoms disappear and the disease passes to another stage of the course.

Seizure types

There are both classical forms of the disease and a small form of pathology. They are characterized fast current and loss of consciousness. Internal organs especially sensitive to an attack.

Depending on the course, seizures are divided into the following types:

cataleptic, arising from severe fatigue and excessive loads of the child. In the midst of an attack, the child may fall. Muscle tone decreases, and the child becomes limp. Consciousness and memory of the child are preserved;
narcoleptic. Develops suddenly and transiently. The child begins to want to sleep very much. After sleep, the state stabilizes, all disturbed processes are quickly restored. Children do not feel tired or unwell;
hysterical. This form is characterized by the development of an attack in a crowded place or during psychological stress. Such children do not collapse to the floor in convulsions, they slowly sink to the ground, trying not to injure themselves with nearby objects. The child is hysterical, cries loudly or screams, knocks his legs.

The latter form is more associated with psychological abnormalities than neurological ones.

How is it diagnosed

The doctor is in charge of the diagnosis. You will not be able to independently make a verdict on the form and course of the disease. They begin an examination with a neuropathologist, if a small patient is suspected of having a convulsive syndrome, they are referred to an epileptologist.

To establish a diagnosis, the following diagnostic methods are used:

Magnetic resonance imaging.
CT scan.
Skull x-ray.
Lumbar punctures.
Blood analysis biochemical and immunological.
Examination of the fundus.
Examination for the presence of convulsive syndrome, febrile convulsions and spasmophilia.

Is there a cure for neurological disease? Doctors say that it is impossible to completely heal the patient from the disease, but there is the possibility of preventing seizures.

Treatment and prognosis

Treatment of epilepsy in children begins with a comprehensive examination and consultations with specialists. After the diagnosis is confirmed, therapy is prescribed to normalize the functioning of the central nervous system and reduce the risk of seizures.

The mainstay of treatment is anticonvulsants. medicines:

diphenin;
phenobarbital;
sodium valproate;
carbamazepine.

Phenobarbital is traditionally prescribed for young children, it does not affect the liver and mental state of the child. Risk of occurrence side effects from taking the drug, is minimal.

Parents should be patient, as epilepsy treatment takes years. The child takes the drugs every day, in some cases - several times a day.

To begin with, the doctor prescribes the minimum daily dose, gradually the single dose increases. In the absence of third-party reactions of the body, anticonvulsants are taken at the dose indicated by the doctor.

Do not abruptly stop taking medications. Even if the attacks subsided and it seems to the mother that the child is completely healthy. The danger lies in the development of a withdrawal syndrome, which will certainly provoke another seizure.

If the patient does not have seizures for 3 years, the dose is gradually reduced. After 1 - 2 years, the dosage of the drug is reduced to zero. With the next occurrence of an attack, the drug is taken again, at the previously taken maximum dose.

If it is possible to remove the lesion or tumor that provokes attacks, doctors decide on surgical intervention.

Helping a child during an attack

The main mistake of parents who see a child struggling in seizures is an attempt to open their jaws and insert a spoon or spatula into their mouths. Under no circumstances should this be done. Imagine how hard your teeth are clenched, trying to open them, you will simply break them. The tongue will not be able to fall, as it is tense. Just turn the child on the floor, and put something soft under the head.

Remove all dangerous pieces of furniture around the child so that the child does not get injured when falling and convulsing.
Do not try to keep the patient by force. Hold it calmly during an epileptic seizure.

If after 5 minutes the attack has not stopped, call an ambulance. Watch your breathing, its absence indicates the need to call an ambulance.

In young children under the age of 1 year, the prognosis is favorable. Anticonvulsants help to cope with neurological disease. Older patients require constant monitoring by parents and physicians.

In the absence of seizures for more than three years, the doctor removes the diagnosis of epilepsy and cancels the drugs. Seizures do not recur in the future, according to medical statistics, in 65% of former epileptics.

Having considered such a disease as epilepsy in children and the main causes of the disease, we can say that the disease is not fatal and more than 35% of the world's population live with it. It is important to take prescribed medicines on time and protect yourself from stress.

Pediatric epileptologist in the medical center "Birth".