epilepsy in children

 Epilepsy in children



  : what it is, how it manifests itself, how it is treated
EDITOR By: Ibrahimewaters


A diagnosis of epilepsy in childhood does not necessarily mean a life sentence of limitations: many children spontaneously heal at the onset of puberty and others manage to control the disease with medication. It is true, however, that many prejudices about this disease remain alive, which can hinder the serenity of children.
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Epilepsy is a disease that is still scary, also because it is still surrounded by prejudices and discrimination. To the point that patients and their families often prefer to keep it hidden. Yet in most cases this disease - affecting about one in 200 children - can be kept safely under control and allows a virtually normal life. And in many cases it passes by itself when the child reaches puberty.



What is epilepsy
It is a brain disease characterized by the repetitive periodic of the so-called epileptic seizures, convulsive crisis or absence, in which the child for a few seconds seems to be absent or absent-minded. "These crises are the expression of anomalies in the electrical activity of neurons, the brain cells", explains Federico Vigevano, head of the Neurology Unit at the Bambin Gesù Pediatric Hospital in Rome. "Neurons communicate with each other through electrical discharges, but it can happen that a group of more or less extensive neurons discharges in an abnormal, excessive: here, that is an epileptic focus, which gives rise to crises."


Warning: in order to talk about epilepsy, epileptic seizures must be frequent and repeated. An isolated crisis or some sporadic crises do not mean epilepsy. It is the case of febrile convulsions, which may seem similar to the convulsions of epilepsy but have nothing to do with this disease.



How it manifests itself
The manifestations of the disease vary depending on how large the outbreak is and its location in the brain architecture. For example, if the area of ​​the brain that controls the movements of the right hand is involved, the crisis will be characterized by abnormal and involuntary movements of this hand. If the neurons involved in the control of eye movements are to discharge "evil", there may be a crisis with lateral deviation of the eyes.



On the other hand, if the electric discharges are generalized, that is, they affect the whole brain, there will be classic crises, in which the patient loses consciousness, falls to the ground, stiffens, with the limbs moving in jerks. These are the so-called tonic-clonic crises, which generally last 2-3 minutes at most.

Then there is a slight form of illness, what was once called "little evil", which manifests itself in the so-called absences: very short suspensions of consciousness, as if for a few seconds - usually a dozen - the stricken person was distracted and get out of the context in which it is located. It is a benign form, which tends to heal with pubertal development, and which does not affect the patient's quality of life. "Ditto for the forms that involve light night-time crises, and which are resolved with age" adds Vigevano.



The most severe forms, with intense and frequent crises, often resistant to drugs, are instead disabling, because they reduce the possibility of a completely normal life. Moreover, these forms can be associated with a delay in the cognitive and motor development of the child, because they decrease the capacity for concentration and attention. "An effect exacerbated by the drugs themselves, which are mainly sedatives" the neurologist specifies.



How the diagnosis is made

To make the diagnosis, in addition to clinical manifestations, specialists rely on the electroencephalogram, an examination that records the electrical activity of the brain. Tactics, magnetic resonance imaging and genetic studies can be used to better define the causes of the disease.



What does epilepsy depend on?
"About one in three cases is due to genetic predispositions," explains Vigevano. "So in the same family you can find more people with the same problem". In two cases out of three the responsibility is of more or less extensive brain lesions, which may depend on various circumstances: congenital brain malformations, child suffering during birth, head trauma, tumors or cardiovascular diseases. "It must be said that it is not always possible to identify the lesion responsible for the disease", explains Vigevano.



When epilepsy heals
A diagnosis of epilepsy is not necessarily "forever". As we have seen, there are forms that heal spontaneously. "It happens in 20-25% of cases, especially those of genetic origin and we generally know from the moment of diagnosis how things will go in these cases", says the expert. Many other forms, however, do not completely heal, but can be kept safely under control with drugs.



"What is important to stress is that very often with epilepsy you can live a normal life," says Vigevano. "Or at least you could do it, if there were no prejudices and discriminations to complicate things, for example: many small patients can play sports, but they find it difficult to find a doctor who issues a certificate of suitability. schools, families but also health workers - on this theme ".

How to intervene during a crisis
Much depends on the type of crisis. If it is a simple episode of absence there is no need to do anything special, except to make sure that there are no external conditions of danger. Often the child does not lose even knowledge: it is important then not to frighten him with his own agitation, reassure him and reassure even any people present.

Even in the event of a seizure, the first thing to do is to stay calm, especially to avoid inappropriate interventions. For the rest:
- if the child has fallen for the convulsion, put a pillow under his head to prevent him from slamming on the floor;
- move away furniture or objects against which it could hit and hurt;
 - turn it on its side, to allow the saliva that can accumulate in the mouth to drain.

Then there is a small list of things to do absolutely:
- if the mouth is closed, do not try to open it - by the way, the idea that it can swallow the tongue is a legend! - also because it is difficult to succeed and there is a risk of getting a bite in the fingers (or breaking a baby's tooth);
- do not try to revive the child with assisted breathing or heart massage. The crisis, as it came, ends up alone within a few minutes.

"In this regard - emphasizes Federico Vigevano - it is good to remember that crises become dangerous for the brain only if they last more than half an hour". As a precaution, it is advisable to keep the drugs that can stop the crisis within reach. These are benzodiazepines, which can be administered rectally or oral: in this case, the drug is not swallowed but absorbed through the inside of the cheek.



Possible therapies
"First of all it must be said that the child does not always have to take medication", explains Vigevano. "Whenever possible, we try to avoid it, because they are demanding drugs, which must be taken for years.If the child suffers from a form that tends to heal and has only some absence or some brief crisis during sleep, treatments are generally avoided".



For other cases there are various drugs available - there are about twenty, more or less recent - that are chosen patient by patient, and can be used alone or in combination with each other. Pharmacology therapy is successful in 65-70% of cases, but unfortunately there are drug-resistant forms, in which we must try other ways, which are mainly three:
surgery, with elimination or isolation of the brain focus responsible for the crises. This route can only be used when the outbreak can be identified and removed or isolated without further damage to the child.
    neurostimulation. It is about providing the brain with electrical stimuli that can silence the anomalous discharges responsible for the crises. The most common form is stimulation of the vagus nerve, which gives widespread stimulation to the whole brain. Today, however, we are trying to work on more targeted therapies.
    ketogenic or ketogenic diet. It is a very high fat diet (90% of the diet, compared to 30% of the classic diets), which causes the excess production of substances - the ketone bodies - with a positive effect on the disease. It is a very demanding diet, even for those who must prepare it, and not very palatable. The characteristic foods are butter, mascarpone, olive oil, dairy products, cured meats and sausages, fish and eggs.

Other sources for this article: information material from the Great Ormond Street Hospital in London; information material onketogenic diet of the Department of Public Health and Experimental Medicine of the University of Pavia; information material from the English Health Service; information material of the Bambin Gesù Pediatric Hospital From Rome.