Epilepsy in children and adolescents: symptoms and treatment

Pediatric epileptology is a subsection of neurology devoted to epilepsy at a young age. This is a disease in which repeated attacks occur - paroxysms. The diagnosis can be made only if at least two seizures have occurred, and no other causes other than epilepsy could lead to them.

The fact is that in young children, convulsions can occur when the temperature rises during infectious diseases, intoxication, or the administration of certain medications, as a reaction to vaccinations. Seizures may accompany metabolic disorders such as diabetes.

Children often suffer from this disease: statistics say that it occurs in 7 out of 1000 children under the age of 16. In addition, in childhood the disease occurs with certain characteristics. It is for this reason that pediatric epileptology was singled out.

Signs of epilepsy

Pediatric epileptology identifies the following main symptoms of the disease:

• Grand mal seizure. This is the main symptom of epilepsy. It can begin suddenly, but more often it is preceded by an “aura” - specific sensations, for example, the feeling of a breath of wind, sparks before the eyes, some kind of unclear sound. After this, the patient makes a sharp sound caused by a spasm of the glottis, then he begins to have convulsions that take over the whole body, his breathing becomes noisy, and foam comes out of his mouth. The attack ends on its own, after which the patient may fall asleep and not remember what happened to him, or remain conscious, remaining confused for some time. Seizures may occur rarely or several times a day.
• Minor convulsive seizure. During it there are no general convulsions. The patient makes automatic movements: turning the head, chewing movements and other automatisms. With them, a short-term partial disorder of consciousness is observed.
• Absence. This symptom most often occurs in children, and more often in girls than in boys. It manifests itself in the fact that the child disconnects from reality: he stops speaking and moving, freezes, his gaze is fixed at one point, he does not react to external stimuli. There are no convulsions in this case.

In addition to these striking manifestations, epilepsy in children may be accompanied by:

• sleepwalking;
• mood disorders, the appearance of irritability, sudden changes in mental state;
• a change in character, the appearance of hypertrophied pedantry and accuracy.

Epileptic seizures can occur both while awake and during sleep, quite often when falling asleep or waking up.

Mechanism of occurrence of an epileptic seizure

The root cause of epilepsy is excessive activity of brain cells. It usually occurs in a certain area - the epileptic focus, in the cells of which the excitation processes are modified.

Epilepsy: general information

Epilepsy is a chronic neurological disease that occurs when there is excessive electrical activity in the brain. Patients with epilepsy suffer from recurrent seizures. These are short-term involuntary spasms. They may affect one part of the body or the entire body. Sometimes these attacks cause people to lose control of their bowel and bladder functions. Loss of consciousness is also possible.

If a patient has an attack: first aid

What NOT to do with a patient during an epileptic attack:

• Do not use any object to force the jaw open.
• Do not give the patient any medications or liquids.
• Do not try to restrain jerky movements.
• Do not hit the patient on the cheeks or pour water on them.
• Do not perform artificial respiration or cardiac massage.

What to do during an attack?

• When a diagnosis of epilepsy is made, emergency specialized medical care is required only in cases of a series of seizures.
• If the ambulance has not arrived yet, make sure that the patient does not injure his head.
• Turn the person on his side, hold him, make sure his head is turned to his side.
• Do not put anything in the mouth, otherwise you will damage the patient’s teeth, palate, or tongue. Due to the spasm of the chewing muscles, he may bite off your finger.
• Do not be alarmed; during an attack, foam may come from the mouth or even blood if the person bites his tongue.
• After the attack, the patient is usually disoriented for 5-10 minutes. You need to talk to him calmly. Tell us who you are, where he is and what happened to him.
• Diabetics using insulin may experience cramps due to low blood sugar. Then after an attack, give the person a spoonful of honey or candy, but only if you know for sure that he is using insulin.
• Typically, after an epileptic attack, people feel very tired and confused. They need rest and sleep to regain their strength.

Kovalchuk Maria Sergeevna

expert

UZ "GSSMP Minsk"

The exact mechanisms of development of epileptic seizures are still unknown. It is assumed that seizures are a consequence of an imbalance in the processes of excitation and inhibition in the cerebral cortex. Normally, they equalize each other, creating an optimal level of brain activity. However, with epilepsy, excitatory activity increases markedly. Nerve cells begin to synchronously produce electrical discharges, which can spread to other parts of the nervous system. This leads to an attack¹.

According to the World Health Organization (WHO), there are approximately 50 million people worldwide with epilepsy². Up to 80% of all patients live in low- or middle-income countries. WHO estimates that up to 70% of people with epilepsy can live full, seizure-free lives. This requires timely diagnosis and adequate therapy.

5 myths about epilepsy

1. This is a mental illness.
Many people confuse mental illness with neurological illness. Epilepsy is a “classical” neurological disorder. Therefore, this problem is dealt with by neurologists and neuropathologists, and not by psychiatrists. At the same time, a patient with epilepsy may also suffer from mental disorders, but this will only be a concomitant disease.

2. Epileptics suffer from dementia.

Some people with epilepsy actually have dementia. But this statement is also true for people with hypertension, atherosclerosis and any other diseases. This does not mean that dementia is a consequence of a specific pathology.

In the vast majority of cases, epilepsy does not have any effect on the intellectual abilities of patients. Such great minds as Socrates, Thomas Edison, Isaac Newton, Alexander the Great and many others suffered from this disease.

3. A person with epilepsy needs to completely change their lifestyle.

This is wrong. Thanks to modern treatment methods, a person with epilepsy is in most cases able to lead a normal life. Such people study in schools, universities, work and start families. It is noteworthy that mental activity, physical labor and sports reduce the number of attacks, easing the course of the disease.

But there are also restrictions for people with epilepsy. For example, they cannot drive vehicles or machinery, perform military service, or work in potentially hazardous enterprises.

4. Hyperactive children are more likely to become epileptic.

This myth is well established even among doctors. Excessive excitability, hysteria and sudden mood swings may be mistakenly perceived as the first signs of epilepsy.

Some children sometimes have affective-respiratory attacks. This is a short-term breath holding, which in some cases is accompanied by loss of consciousness. Doctors may prescribe anticonvulsants to such children, believing that this is the first manifestation of epilepsy. However, increased excitability and affective-respiratory attacks have nothing to do with epilepsy. Here you need a consultation with a competent neurologist and differential diagnosis.

5. You can only get epilepsy in childhood.

In most cases this is true. In approximately 70% of patients, their first epileptic seizures occurred in childhood. However, the second peak incidence of epilepsy occurs in old age. This is due to a number of neurological diseases (stroke, brain tumors and others), which often develop in old age.

Treatment

After a thorough examination, diagnosis, and clarification of all associated factors, the pediatrician will not be able to accurately answer the question: “Is epilepsy in a child curable or not?” Since it is impossible to eliminate the focus that causes it in the brain. But the chances of stopping the seizures, given the statistics, are not bad.

The neurologist prescribes complex treatment, including:

• drug anticonvulsant therapy;
• optimization of the daily routine;
• organization of special meals;
• bioresonance therapy;
• exposure of the brain to a magnetic field, vortex fields;
• Exercise therapy (physical therapy).
• Anticonvulsants are the basis for the treatment of epilepsy in children

Drugs and dosage are selected specifically for each patient. Since, due to the characteristics of the body, it is impossible to predict the severity of the effects of certain tablets in advance.

In each specific case, the treatment paradigm is selected taking into account the characteristics of the disease and the characteristics of the patient.

Symptoms of epilepsy

Symptoms and signs of epilepsy vary. First of all, this is due to the fact that an attack can be caused by various factors and stimuli. The same patient may have a seizure one or more times over a certain period of time. In this case, the nature of convulsive attacks may change.

Figure 1. Common symptoms of epilepsy. Image: Natty_Blissful / Depositphotos

Despite this variability of clinical manifestations, doctors identify 4 characteristic features of epileptic seizures:

1. They start suddenly. A person does not know when he will have another attack. This is a serious psychological factor, due to which the patient is in constant tension and expects that a seizure will happen to him. Some patients experience an aura before an epileptic seizure. These are specific sensations, such as emotional feelings or smells, that indicate an impending attack.
2. The attacks do not last long. Lasts from a few seconds to several minutes. Some patients do not notice the attack at all. For example, they may freeze or experience some unusual sensation. Some fall, losing consciousness. Sometimes attacks follow one after another.
3. The attack may go away on its own. As a rule, this is what happens. During a seizure, no medical intervention is needed to stop it. The exception is status epilepticus, when the patient experiences a series of incessant seizures.
4. The attacks have a stereotypical character. If a patient has a certain type of attack, then, as a rule, future attacks will be the same. In some cases, the nature of the attacks changes over a long period. However, over a short period of time, the attacks are almost identical.

Safety precautions for people with epilepsy

Following these simple rules will help you avoid serious complications:

• Don't cook food alone. If you are alone at home, buy ready-made food. Also, refrain from using tools and household appliances if no one is around.
• Instead of a stove, use a microwave oven.
• Take a shower instead of a bath. Bathtub drowning is one of the most common causes of death in people with epilepsy.
• Lay a rubber mat in the bathroom.
• Cover hard corners of tables, chairs and other furniture. This is especially true for objects that are lower than you (that you could potentially fall on during an attack).
• Move the bed away from walls and furniture.
• Use seizure alarms. These are various gadgets for epileptics (bracelets, watches or devices that are attached to the head), which notify the victim’s loved ones or a doctor about an attack.

Epileptic seizures are different:

• long-term;
• random – occur without a provoking stimulus;
• cyclical – appear periodically;
• provoked - arise in response to the action of some factor;
• with or without convulsions.

According to clinical manifestations, seizures are generalized and partial. Generalized ones include:

• Tonic-clonic. This is the most common type of generalized seizure. The man suddenly loses consciousness and falls. His body arches due to tonic muscle tension. Tonic-clonic seizures are characterized by short-term holding of breath and muscle twitching (clonic convulsions). Some patients experience involuntary urination and bowel movements. Typically, tonic-clonic seizures last no more than 5 minutes.
• Clonic. They are rare. Manifested by repeated muscle twitching.
• Tonic. This is a sudden attack-like muscle tension. The patient's eyes roll back and it becomes difficult for him to breathe. If an attack occurs in a standing position, the person falls, which may be accompanied by injuries.
• Atonic. During such attacks the patient does not have convulsions. He loses consciousness, and his muscles lose tone. Atonic attacks are characterized by rapid recovery.
• Absence seizures. These seizures most often occur in children. The child freezes for a few seconds. Sometimes some movements may occur during a seizure.
• Atypical absence seizures. Seizures begin and fade gradually. They are characterized by head nodding, body bending and falling. Sometimes the muscles twitch slightly.
• Myoclonic. These are attacks with short, non-rhythmic muscle twitching.

Figure 2. First aid for an epileptic attack.
Image: leremy / Depositphotos Partial seizures can also occur in different ways. It all depends on in which area of ​​the brain epileptic activity is observed. For this reason, such attacks are also called focal or local. They are often accompanied by impaired coordination of movement, loss of orientation, frequent mood swings, impaired cognitive functions and sensory organs.

Some patients experience seizures that do not meet the criteria described above. These are unclassified epileptic seizures. For example, a person suddenly begins to move his eyes rhythmically or make intense chewing movements with his jaws.

Seizures are not always a symptom of epilepsy. In some children they occur in response to hyperthermia (increased body temperature), in pregnant women diagnosed with eclampsia - in connection with increased blood pressure. Convulsions can appear after binge drinking during alcohol withdrawal syndrome and with various types of shock.

Keto diet for epilepsy

Even before the advent of antiepileptic drugs, the mainstay of treatment for epilepsy was the ketogenic diet.
It began to be used in the 20s of the last century, when it was noticed that when carbohydrates were limited, patients with epilepsy were less likely to experience seizures. The ketogenic diet is a diet with a predominance of fatty foods. On such a diet, you can eat eggs, fatty meats, fish, avocados, butter and vegetable oil. Protein and leafy vegetables are also allowed. But you need to give up sugar, flour products, potatoes and other carbohydrate foods.

When you sharply reduce your carbohydrate intake, ketosis starts within 2-3 days. The body switches to another fuel - fats, the oxidation of which produces ketones. The latter are then used as fuel, including by brain cells.

There are several types of ketones, including beta-hydroxybutyrate and acetoacetate. They are known to have anticonvulsant effects. The positive effect of the keto diet is associated with this property of ketones. However, the exact mechanism of the therapeutic effect of the keto diet for epilepsy is not yet completely clear.

Idiopathic epilepsies of adolescence

Currently, IGE is defined as a form of generalized epilepsy in which all seizures are generalized from the very beginning; the neurological status usually lacks focal symptoms and signs of decreased intelligence; electroencephalography (EEG) patterns are primarily generalized, bilateral, synchronous and symmetrical with the main activity of the background recording intact; Neuroradiological examination reveals no structural changes in the brain.

The concept of IGE (or primary generalized epilepsy (PGE - primary generalized epilepsy, which better describes it) implies that these syndromes have a genetic basis, a favorable prognosis, a characteristic EEG appearance - a spike-wave with a frequency of 3 Hz, without connection with structural diseases of the brain and are associated with certain types of seizures, such as myoclonus, absence seizures, or generalized tonic-clonic seizures. These attacks usually occur in the morning upon waking and are often triggered by sleep deprivation.

The problem of adolescent epilepsy is undoubtedly of great interest, since puberty, neuroendocrine changes and psycho-emotional development are associated with the course of epilepsy.

IGE criteria for adolescents:

• adolescence;
• good potential for treatment;
• IGE – different episyndromes, the main criterion is that all attacks and EEG patterns are generalized from the very beginning;
• seizures: absence seizures, myoclonus, primary generalized convulsive seizures (PGSP);
• EEG patterns: primary generalized, bilateral synchronous, symmetrical.

Features (not absolute):

• debut in childhood or adolescence;
• PGSP triad: absence seizures, myoclonus, generalized convulsive seizures (GSP);
• genetic predisposition: high frequency among relatives of the proband (5–45%);
• no changes in neurological status and intelligence;
• absence of structural changes in the EEG, preservation of the basic rhythm;
• absence of pathology according to computed tomography and magnetic resonance imaging;
• there is no generalized or polypeak activity on the interictal EEG;
• EEG seizure: generalized bilateral synchronous peak-wave activity;
• favorable prognosis: remission – 60–85%;
• good therapeutic response to valproate (VPA);
• tendency to transform forms: juvenile absence epilepsy (JAE) – juvenile myoclonic epilepsy (JME);
• According to some data, there may be signs of residual organic encephalopathy.

The ILAE classification system identifies 10 different types of IGE (Commission on Classification and Terminology of the International League Against Epilepsy, 1989):

– benign convulsions of newborns;

• benign familial neonatal seizures;
• benign myoclonic epilepsy of infancy;
• childhood absence epilepsy (CAE);
• SAE;
• JME;
• epilepsy with awakening GSP;
• epilepsy with isolated GSP;
• primary photosensitivity epilepsy (PSE);
• unclassified, “transitional forms”.

Let's consider various syndromes of IGE in adolescents.

SAE. Accounts for 12% among all IGE. Debut usually occurs at 9–21 years of age (75% at 9–13 years of age). Debut with GSP occurs in 41% of cases, with absence seizures – in 47%. When debuting with GSP, absences usually join quickly; when debuting with absences, GSP joins after 1–8 years. There is a connection between GSP and waking up and falling asleep. 12% of patients have a history of febrile seizures. Often JAE is transformed from DAE.

Symptoms: simple absence seizures predominate. Myoclonic absences (eyelid, perioral, perinasal) and absences with short pharyngeal-oral automatisms may occur. Usually there are single attacks every 2–3 days. GSP can be provoked by sleep deprivation, absence seizures by hyperventilation.

The EEG in JAE is less typical than in DAE. Seizure EEG consists of short discharges, fast, bilaterally synchronous, generalized peak-wave, and less often polyspike-wave activity (3–5 Hz). Provoked by photostimulation. The main background activity is preserved.

The occipital delta rhythm pattern is more typical for DAE (33:9%).

Epiactivity responds less well to treatment and may persist for a long time. Recurs when provoked (sleep deprivation, reduction in the dose of antiepileptic drugs (AEDs)). The criterion for an unfavorable prognosis is single fast short discharges of peak-wave activity during photostimulation. Currently, therapeutic remission in JAE is about 60% (absences + GSP - 50%, pure absences - 70%, improvement - 35%. Resistant forms are about 5%).

Treatment. The drug of choice for JAE is VPA. In case of side effects of VPA, it is possible to start therapy with topiramate (TPM) and levetiracetam (LVT).

For resistant absence seizures, combinations are prescribed: VPA + ethosuximide (ETS), VPA + clonazepam, VPA + lamotrigine (LTG). Resistant forms with GSP require combinations of VPA + TPM, VPA + LVT.

JME (Jantz syndrome) is a very common form that must be differentiated from frontal lobe epilepsy. Among all forms it is 4–12%. The onset is usually in adolescence - 50%. The gene is located on the short arm of chromosome 6. Inheritance in the proband’s family – there can be any form of IGE. Debut at 2–22 years (80% at 12–18 years). The symptoms are dominated by persistent myoclonic seizures (MS). Debuts with MP in 30% of cases. There may also be massive symmetrical synchronous and asymmetrical asynchronous hemiclonias at the onset of the disease. Single and multiple hemiclonias are possible, varying in amplitude, frequency and intensity. They most often occur in the arms and shoulder girdle (50%).

Myoclonic-astatic seizures can occur in 19% of cases. MPs of the face, neck, and head also occur in 19% of patients. The frequency of attacks is distributed as follows: daily – 40%, 3–5 rubles/week. – 43%, rarely – 40%. Occurs in 80% of cases in the 1st hour after waking up. They are provoked by sleep deprivation - 70%, forced awakening - 30%, photostimulation - 25%. According to the structure of seizures, the following options are possible: MP + GSP - 30%, MP + absences + GSP - 40–50%, isolated MP are quite rare. GSP in JME occurs in 65–95% of patients.

The debut of SHGs often occurs several years after MP. Debut with GSP + MP occurs in 30% of cases. Variants of GSP are possible: a series of increasing frequency of MP, turning into GSP - clonic-tonic paroxysms - 30%, GSP of awakening - 70%, falling asleep - 10%. Within JME, absence seizures may occur in 50% of cases. The debut usually occurs at puberty before the age of 13. After 17 years, as a rule, they do not debut. Complex absence seizures with a myoclonic component dominate.

The EEG pattern is characterized by generalized discharges with a frequency of 4–6 Hz of polypeak-wave activity, in 80–95% - in the interictal period. Before the slow wave, discharges of high-amplitude 15–300 μV surface-negative polyspikes occur. EEG patterns can be clinical or subclinical. More than 4 spikes are highly likely to correlate with MP. The main background recording activity is saved. Bifrontal periodic rhythmic slowing may often occur.

With adequate therapy, rapid electroclinical suppression of ictal and interictal patterns is observed. Rare myoclonus and normal EEG are indications for increasing the dose of AEDs. With this form of epilepsy, discontinuation of therapy is possible only with complete electroclinical remission; video-EEG monitoring is necessary. At the same time, the probability of relapse is very high, even with many years of remission.

Jeavons syndrome (eyelid myoclonus with absence seizures) can occur in various forms of epilepsy, including JME. The attacks are short. Occurs with photosensitivity (PS), later GSP joins. There is high resistance to therapy. It is necessary to strictly observe the sleep and wakefulness regime and avoid physical activity in everyday life. In this form, even with clinical remission, it is necessary to continue to “treat the EEG.” Therapy is started with VPA (30–50 mg/kg/day in 2 divided doses). The drug is highly effective for all types of attacks. May be insufficient for GSP in which TPM (200–400 mg/day) is prescribed. In case of resistance, combinations of drugs are possible: VPA + ETS 20–30 mg/kg 3 times/day, for resistant absence seizures – VPA + benzodiazepine 10–30 mg/kg/day (high PS). Therapy with LVT 1000–3000 mg/day is also possible. The duration of drug remission should be at least 4–5 years. There is a high risk of relapse. Cancellation of treatment is possible only after video-EEG monitoring.

Epilepsy with isolated awakening GSP. Genetically determined. It occurs without an aura and focus on the EEG. The onset usually occurs at 7–11 years of age. The structure of the seizures is primary generalized convulsive. They can last from 30 s to 10 min. The frequency is variable - from 1 rub./week. up to 1 rub./year, status course is possible. There is a coincidence of attacks with awakening. Triggered by sleep deprivation. In 30% of women, attacks with this form occur during the perimenstrual period (often referred to as catamenial epilepsy).

It is possible to add absences or myoclonus with transformation into JAE or JME. There is usually a normal EEG in the interictal period. Seizure EEG patterns are short discharges of generalized polypeak-wave activity, bifrontal predominance of EEG patterns. Core activity is unchanged and there is no prolonged regional slowdown.

Treatment: basic AEDs are used: TPM, VPA, carbamazepine (CBZ). Initiation of therapy is recommended with TPM 100–400 mg/day. Second choice: VPA (30–50 mg/kg/day). Third choice: CBZ (20 mg/kg/day). Frequent EEG monitoring is necessary.

For resistant forms, combinations of VPA with TPM, CBZ, LTG are prescribed.

Drug remission is observed in 90% of cases. Lack of effect is often due to inaccurate diagnosis.

Forms of epilepsy with FS. Epilepsy with FS is the most common type of reflex forms of epilepsy; seizures are provoked by visual stimulation. FSE is an age-dependent syndrome.

The debut is usually noted at 10–25 years, the peak at 12–14 years. The prevalence is 5–15%. 65% of all FSE can be attributed to IGE, i.e., genetically determined.

“Net” FSE is 14%. At the onset, attacks are provoked only by intermittent photostimulation and do not occur spontaneously. Isolated GSPs predominate (84%), absences are observed in 6% of cases, complex partial seizures (CPS) - in 2%, myoclonus - in 1.5%.

FSE in combination with spontaneous seizures is the most common IGE: JME, JAE, SPP, occipital epilepsy.

Other forms of epilepsy with FS

Unferricht-Lundborg syndrome - FS with progressive myoclonus epilepsy, myoclonus of the eyelids with absences (Jealons syndrome), self-induced FSE, pattern photosensitive epilepsy (visual disturbances: drawings with black and white stripes and dots, wallpaper, curtains, escalator steps, notebook in cell), epilepsy with seizures (absences, myoclonus), which occurs with loss of visual fixation (closing the eyes, transition from light to darkness), television epilepsy (seizures with GSP).

Factors of provocation can be TV, computer, foliage, headlights, light music, coming out of the darkness into the light.

EEG: upon awakening, EEG patterns are blocked during slow-wave sleep, generalized epiactivity when closing the eyes.

Treatment. CBZ drugs are prohibited due to aggravation; the drugs of choice are VPA 30–50 mg/kg/day. For resistant forms, combinations of AEDs are prescribed: VPA + TPM (5–8 mg/kg/day), ETS (20–30 mg/kg/day), LTG (3–5 mg/kg/day). The combination of VPA + clonazepam gives a pronounced antiphotosensitivity effect. Preventive measures include covering one eye, blue sunglasses, a TV screen with a frequency of 100–200 Hz, maintaining a distance of 2 m from the TV, a large screen illuminated by a separate lamp.

Treatment of epilepsy

Drug, non-drug and surgical methods are used to treat epilepsy. In most cases, the result is achieved with the help of antiepileptic drug therapy. The basis of such treatment is anticonvulsant drugs. These are anticonvulsant drugs of various pharmacological groups, in particular, drugs based on carbamazepine and benzonal.

Recently, drugs containing valproic acid (valproate) have been used to treat epilepsy. Such drugs, in addition to their anticonvulsant effect, also protect nerve cells from damage and improve their metabolism. This is especially important for patients with epilepsy with concomitant mental disorders.

Electrical stimulation of the vagus nerve

If drug treatment does not bring the desired results, doctors use other options. One of these is VNS therapy or electrical stimulation of the vagus nerve.

The essence of this treatment comes down to the subcutaneous implantation of a neurostimulator, which constantly sends impulses to the vagus nerve. The latter is an important link between the body and the brain. Such stimulation of the vagus nerve in most cases leads to a decrease in pathological electrical activity in epileptic foci. The patient's frequency of seizures decreases.

Surgical treatment of epilepsy

If it is determined that the cause of epilepsy is a tumor, cyst or vascular pathology of the brain, the problem is often solved surgically. After the operation, the patient's condition stabilizes. Sometimes the epileptogenic focus is also removed (if this is permissible).

Causes of epilepsy

According to experts, this disease has a fairly wide range of causes that can affect not only its occurrence, but also its further development. There are also individual cases when it is simply impossible to determine with exact certainty a certain cause-and-effect relationship between attacks.

Doctors consider the two main risk groups to be:

• predisposition to this diagnosis along a consanguineous line (i.e. genetic cause). This feature is already laid down in utero and encoded in genes, passed on from generation to generation;
• a predisposition that was acquired as a result of a number of specific damaging factors or pathological diseases of the cerebral cortex.

It has also been proven that the cause of epilepsy in both children and adult men and women can be:

• Traumatic brain injuries;
• Acute or chronic meningitis, encephalitis;
• Serious cerebral circulatory impairment (especially if direct hemorrhage has occurred);
• Volumetric processes in the brain (i.e. formation and rapid development of a tumor);
• Due to frequent and excessive use of drugs or alcohol;
• The presence of cysts, adhesions, aneurysms, etc. in the left, right, or both hemispheres of the brain at once

Almost all of the above risk factors, for the most part, one way or another lead to the emergence of a certain category of neurons with a low excitation threshold. It is this category of neuron cells that provides fertile ground for the emergence of an epileptic focus. Next, a nerve impulse is generated in it, which infects nearby cells, managing to reach new healthy neural networks. By the way, this is where convulsions or, in other words, epileptic seizures appear.

Prognosis and prevention

Each patient's disease progresses differently. The prognosis for epilepsy depends on a number of factors, including:

• type of epilepsy;
• age at onset of disease;
• frequency of epileptic seizures;
• severity of concomitant mental disorders;
• the body's reaction to the therapy used;
• other factors.

Specific prevention for epilepsy has not been developed. The risk of developing the disease can be minimized by eliminating the factors of acquired epilepsy. This includes timely treatment and prevention of infections, avoiding brain injuries and a healthy lifestyle. Sports, proper nutrition, and the absence of bad habits (including avoiding alcohol) reduce the risk of developing neurological disorders in old age (this is also true for epilepsy).

Epilepsy and pregnancy

Epileptic seizures during pregnancy are fraught with serious consequences for both mother and fetus.
The risk of miscarriage, birth injuries, or intrauterine developmental disorders increases significantly. However, this does not mean that pregnancy is contraindicated for women with epilepsy. It is better to prepare for it under the supervision of an experienced doctor. Conception should be planned against the background of stable remission, when there are no symptoms of epilepsy for 1-2 years.

During the first trimester of pregnancy, your doctor will advise you to take folic acid. This is necessary to reduce the risk of abnormal fetal development.

Pregnant women with a history of epilepsy should regularly undergo tests prescribed by their doctor and monitor their condition.

If it is difficult for a woman with epilepsy to achieve stable remission, then conception is undesirable.

Various generalized types of epileptic seizures include:

Generalized tonic-clonic seizures. Most often they appear when the discharge spreads throughout the cerebral cortex and can be manifested by the patient’s shrill cry + unnatural tongue bite, tension and twitching of the whole body, increased heart rate, increased blood pressure.

Absence seizures. They may first appear at a young age or early adolescence. Usually, at the time of an epileptic attack, the child’s gaze suddenly freezes and is fixed on one point, while his eyelids may twitch. Then, swallowing movements, throwing the head back may be more often observed, or, conversely, the patient drops his head; rarely there may be manifestations of a vegetative nature. The duration of these attacks is no more than 30-45 seconds.

Myoclonic seizures. They arise quite suddenly for the person himself, but have a very long duration. This attack externally manifests itself in involuntary muscle contraction, which often affects not only the head, arms and legs, but also the entire body.

Tonic seizures. They manifest themselves in the form of sharp, varying duration of tension in various muscle groups, mainly on both sides, and can be accompanied by a fall, including a sharp fall forward with injury.

Atonic (attacks of falls). Perhaps, they are still considered the rarest types of this disease and, accounting for only 1.5% of the total number of epileptic seizures, are diagnosed in the most complex forms of epilepsy.

Causes of epilepsy

The causes of epilepsy still remain unclear. Researchers consider the hereditary component of the disease as fundamental. According to statistics, 40% of people with epilepsy have blood relatives with a history of the same disease. But at the same time, epilepsy cannot be classified as a hereditary disease. Even if both parents suffer from this disease, this does not mean that their child will also suffer from it. You can inherit from your parents the specific structure of the brain and nerve cells, as well as the degree of their sensitivity to external stimuli. These features make a person more or less prone to epilepsy.

It has been established that epilepsy in both parents increases the likelihood of the child becoming ill by 10-12%. If one of the parents is sick, the risk is halved. The likelihood of inheriting the disease also depends on the degree of its severity in the parents. The more severe the disease, the higher the risk of passing it on by inheritance.

If a child has inherited from his parents a special brain structure that is prone to abnormal electrical activity, then the disease may not manifest itself for a long time (or may not make itself felt at all). However, there are factors that contribute to the occurrence of epilepsy, even without a hereditary component. These include:

• Brain injuries. In approximately 10% of cases, brain contusions provoke the appearance of epileptic seizures in children and adults. Most often, such injuries occur in road accidents, falls or sports (for example, boxing). If the injury causes the victim to lose consciousness, then the likelihood of an epileptic complication is higher.
• Infections. The danger comes from toxins produced by microbes. They disrupt trophic processes in brain tissue, promoting changes in the electrical activity of neurons.
• Circulatory disorders. Most often these are age-related changes associated with loss of vascular elasticity. Thus, the supply of nutrients and oxygen to the brain is disrupted. This leads to metabolic changes, and sometimes to an imbalance between the inhibitory and excitatory systems.
• Metabolic disorders. As a rule, these are pathological changes that occur against the background of hormonal imbalance.
• Anomalies of brain development. Sometimes congenital abnormalities in the structure of the brain or blood vessels (for example, arteriovenous malformation) become a trigger for the occurrence of epileptic attacks.
• Brain tumors. Epilepsy in adults and children often occurs against the background of an intracerebral tumor. The larger the size of the tumor, the higher the risk of epileptic seizures. As a rule, after the tumor is removed, the symptoms of epilepsy disappear.
• Action of toxins. Alcohol, drugs, heavy metals and some medications have a toxic effect on nerve cells. Against the background of intoxication, entire groups of neurons may not function properly.

It is important to understand that the factors described above almost never cause epilepsy on their own. The common factor in this case is organic damage to the brain, in which a focus of epileptic activity is formed.

An epileptic focus is a group of neurons with unstable cell membranes. They are prone to spontaneous electrical excitation, which leads to a seizure.

Electroencephalogram of an epileptic seizure. Photo: Neuroscience Journal / Open-i

Variants of the disease

Epilepsy in adolescents can occur in different ways. This is due to the fact that epileptic foci can be located in different parts of the cerebral cortex. Moreover, the form of the disease does not depend in any way on its causes, and over time it can become milder or more severe.

The main forms of epilepsy:

• myoclonic (Jantz syndrome). Develops against the background of puberty. At an early stage, twitching of the muscles of the arms and shoulder girdle is noted;
• absence The mildest form of epilepsy, in which seizures occur without loss of consciousness or memory. But without treatment it can develop into a generalized form. Attacks occur from once a day to once every couple of weeks;
• with generalized attacks. The most severe form of the disease. Accompanied by attacks with a frequency of 1 time per week to 1 time per year. Sometimes absence seizures or myoclonic seizures may occur;
• catamenial. A subtype of epilepsy that occurs against the background of hormonal changes associated with the formation of the menstrual cycle. After its normalization, epilepsy usually goes away.

Types of epilepsy

Let's look at the main types of epilepsy based on the classification described above so that you understand what you are dealing with.

Generalized epilepsy

This is a type of epilepsy in which almost the entire brain is engulfed in increased electrical activity. The causes of generalized epilepsy are unclear, which is why it is called idiopathic. It is believed that this pathology has a genetic component. In this sense, genetic and idiopathic generalized epilepsy are synonymous.

Focal epilepsy

In focal epilepsy, pathological electrical discharges occur only in a certain area of ​​the brain. If there is only one epileptic focus, then such epilepsy is called unifocal; if there are several foci - multifocal. In rare cases, pathological activity affects the cerebral hemisphere. This is hemispheric focal epilepsy.

Combined epilepsy

Some patients experience seizures characteristic of both generalized and focal types of epilepsy.

Unknown epilepsy

Unknown or unspecified refers to epilepsy for which it is impossible to determine the type of seizure (focal, generalized or combined).

Epileptic syndromes

The next level of classification of epilepsy is the definition of the syndrome by which the disease can be expressed. Currently, dozens of different epileptic syndromes have been described in children, adolescents and adults. Many of them bear the names of their discoverers, for example, Ohtahara, West, Dravet, Lennox-Gastaut syndromes and others.

Figure 3. Ketogenic diet recommended for epilepsy. Image: macrovector/freepik.com

Etiological criterion

Based on etiology, the following types of epilepsy are distinguished:

• Genetic. It occurs due to genetic, chromosomal abnormalities or other features of the human genome. However, genetic etiology does not mean that the disease is inherited.
• Structural. These are epilepsies caused by structural abnormalities of the brain. Such features may be congenital or acquired (for example, after injury, infection or poisoning).
• Metabolic. In this case, epilepsy develops due to disturbances in creatinine, cerebral folic acid, mitochondrial disorders, deficiency of certain enzymes and other metabolic disorders.
• Immune. Against the background of some immune (and autoimmune) disorders, parts of the central nervous system become inflamed. This increases the risk of developing epilepsy.
• Infectious. One of the most common etiologies of epilepsy, especially in developing countries. A variety of pathogenic pathogens infect the nervous system, causing both acute and epileptic seizures. Such infections include bacterial meningitis, viral encephalitis, cytomegalovirus, cerebral toxoplasmosis, HIV and others.
• Unknown. Unspecified etiology is said to exist when the underlying cause cannot be determined.

Psychological discomfort in epilepsy

Another complication of epilepsy can be considered psychological discomfort. The person realizes that he could have a seizure at any second. Sometimes such attacks are accompanied by foaming at the mouth, urination and defecation. At such moments, it is extremely important that the people around you treat this with understanding.

Types of childhood epilepsy

The following types of seizures are distinguished in children:

• Absence or non-convulsive generalized. A common type, manifests itself from birth to puberty. Difficult to detect, absence lasts 5-20 seconds. The child “switches off” from the world around him. Such attacks may be accompanied by a slight tilting of the head and trembling of the eyelids. With equal probability, after puberty they may disappear or, on the contrary, intensify.
• Absence - rolling of the eyes and trembling of the eyelids
• Infantile spasms appear at 2-3 years of age. Early in the morning after waking up, the body is not completely controlled for several seconds. The baby nods his head, straightens his legs and arms, brings them to his chest, and his torso leans forward.
• Atonic is an externally short-term fainting spell, during which the body completely relaxes and consciousness becomes darkened for a few seconds.
• Full-blown seizures with severe convulsions, loss of orientation in space.
• Night attacks that occur during sleep can be recognized by sleepwalking. As a rule, they go away by the period of growing up on their own without the necessary treatment. Symptoms of childhood epilepsy are often mild, and parents and relatives do not notice the presence of the disease for a long period. The similarity of manifestations with other diseases complicates the diagnosis and prescription of correct treatment. The average age of identification of patients is 5-18 years.

It is possible to determine with certainty whether it is possible to cure epilepsy completely in a teenager or young children or not, and how to do this, only in some of its variants. Those whose causes of development have been established in detail. More often we have to hope for positive dynamics, with the weakening of convulsions and a decrease in seizures.

Diagnosis of epilepsy

Existing diagnostic methods make it possible to establish an accurate diagnosis, as well as distinguish epilepsy from other disorders with similar symptoms. First of all, these are the following instrumental studies:

• Electroencephalography (EEG) is the main diagnostic method for epilepsy. Patients with epilepsy are known to have abnormalities in their brain wave patterns. These changes can be recorded even in the absence of seizures. As a rule, EEG video monitoring is initially performed at night. This allows us to determine the cause of epileptic seizures. Then regular EEGs are done once every six months4.
• High-resolution computed tomography and magnetic resonance imaging (CT and MRI) of the brain allow one to evaluate the structural features of the brain, the presence of cysts, tumors, vascular and other disorders.

To assess the effectiveness of treatment, the patient needs to donate blood every 3 months. The test will also help assess the risk of certain side effects of antiepileptic drugs.

Epilepsy in children and adolescents: symptoms and treatment

Photo pixabay.com In the minds of most people, the term “epilepsy” is associated with the term “convulsive, or convulsive, seizure.” Although this association is not correct, it still reflects part of the truth: one of the common manifestations of epilepsy is indeed seizures. However, not all seizures are caused by epilepsy. Andrey Nosyrev, a neurologist of the highest qualification category at the Krasnoyarsk Regional Clinical Center for Maternal and Child Health , spoke about what epilepsy is and what are the causes of its occurrence in children

Epilepsy is a brain disorder characterized by a persistent predisposition to epileptic seizures and the neurobiological, cognitive, psychological and social consequences of this condition. This definition of epilepsy involves the development of at least one epileptic seizure.

Epilepsy is one of the most common diseases of the nervous system, which, due to its characteristic features, represents a serious medical and social problem. Most people with epilepsy can live virtually seizure-free lives as long as they are properly assessed and treated.

The prevalence of epilepsy in the Krasnoyarsk Territory over the past 10 years is 6.7–7.9 per 1,000 among children and 1–1.6 per 1,000 among adolescents; Boys suffer from epilepsy more often (54%) than girls (46%). The onset of epilepsy occurs mainly in the age groups from 0 to 1 year (26%) and 4–6 years (24%), much less often the manifestation occurs in adolescence (4%).

The structure of epileptic syndromes is dominated by symptomatic focal (41% of cases) and cryptogenic focal epilepsies (28%); the third and fourth places are occupied, respectively, by idiopathic focal epilepsies (18%) and idiopathic generalized epilepsies (10%); a smaller group is epileptic encephalopathies (3%).

A factor in epileptogenesis in childhood is immaturity of the brain, characterized by the predominance of excitation processes necessary for the formation of functional interneuron connections. In addition, premorbid organic brain lesions (genetic or acquired), causing increased convulsive readiness, contribute to epileptization of neurons.

In the etiology and pathogenesis of epilepsy in children, hereditary or acquired predisposition plays a significant role.

The development of hereditary forms of epilepsy in children in most cases is associated with genetically determined instability of neuronal membranes and disturbances in the neurotransmitter balance. If one parent has epilepsy, the risk of developing epilepsy in the child is about 10%.

Epilepsy in children can be associated with hereditary metabolic defects (phenylketonuria, leucinosis, hyperglycinemia, mitochondrial encephalomyopathies), chromosomal syndromes (Down's disease), hereditary neurocutaneous syndromes (neurofibromatosis, tuberous sclerosis), etc.

Among prenatal factors, the leading role is played by toxicosis of pregnancy, fetal hypoxia, intrauterine infections, fetal alcohol syndrome (FAS), intracranial birth injuries, and severe jaundice of newborns. Early organic brain damage may be associated with congenital brain abnormalities, neuroinfections suffered by the child (meningitis, encephalitis, arachnoiditis), head injury; complications of common infectious diseases (influenza, pneumonia, sepsis, etc.).

– It should be noted that childhood epileptology is extremely diverse; there are forms that are not observed in adults. In addition, in children the manifestations of epilepsy are influenced by many specific factors. It is in children that a whole range of forms of epilepsy have been identified with onset at a certain age (age-dependent forms of epilepsy) - from the neonatal period to adolescence,” explains Andrey Nosyrev.

There are also forms of epilepsy with a hereditary predisposition, for example, juvenile myoclonic epilepsy.
With these forms, the risk of having a sick child if one of the parents has epilepsy is low and is only no more than 8%. Progressive hereditary forms of epilepsy are extremely rare, mainly in consanguineous families or in certain ethnic groups. In these families, the risk of having a sick child can be very high and reach 50%. – How to recognize epilepsy?

– Recognizing the symptoms of epilepsy in children is not so easy, given that some forms of epilepsy are sometimes not accompanied by obvious seizures.
If only part of the brain or part of the cerebral cortex is affected, then the seizures do not cover the entire body, but, for example, only an arm or leg. For those who are encountering how epilepsy manifests itself for the first time, this can come as a real shock. The seizure, especially in children or adolescents, looks frightening, for example, unnatural and rhythmic convulsions, periodic blackouts, interruptions in breathing, muscle tension, erratic actions and movements, including facial expressions, rolling of the eyes behind the eyelid.

Symptoms make themselves felt in kindergarten, school or in the first weeks of life in newborns. However, they can go unnoticed for a long time, since teachers sometimes do not closely monitor children, and at home the signs may not appear at all.

- How to treat it?

– Parents must play an active role in the treatment of epilepsy, since treatment can last years, and sometimes a lifetime.
The main goal of treatment is to prevent the occurrence of attacks, or at least to reduce their frequency and intensity as much as possible. The choice of antiepileptic drug is determined by the type of seizure, electroencephalography data and individual tolerance to the drug. The task of an epileptologist is to understand the interweaving of facts about the disease, draw the right conclusions, make the correct diagnosis, select effective therapy, give written recommendations, and tell patients and parents at the appointment about the disease and methods of its treatment in the allotted short time frame. The specialist should take into account the difficulty in understanding information about epilepsy, the different intellectual levels of those present, and the psychological characteristics of the patients.

Epilepsy is often symptomatic with a hereditary predisposition.
It's difficult to fight her. These children are prescribed medications that are taken continuously. During an attack, the best thing you can do is provide air flow to the patient. There is no need to hold it, to fix it tightly. Just try to protect the patient from the possible danger of causing real harm to himself. It is better to place something soft under the head so that the patient does not get hurt. It is better to turn your head so that he does not choke on saliva; if possible, you need to put a rag between your teeth so that a person with an epileptic attack does not bite his tongue.

Many parents try to create overly comfortable living conditions for a child with epilepsy and limit his contacts with others and peers.

Such overprotection, as well as the disease itself, causes children to feel inferior and complex. It is considered more correct to instill optimism in the child and provide him with a harmonious upbringing, as is done in relation to healthy children. As a result of this approach to education, children will develop socially adapted and will not feel doomed.

A reasonable solution is to view the child as an ordinary, normal little person who only needs extra care in the area of ​​health.

In conclusion, it should be noted that childhood epilepsies are very diverse. It is necessary to pay attention to both paroxysmal symptoms and various types of disorders in the higher mental sphere. If there is any suspicion of epilepsy, it is necessary to refer the child for consultation and examination to a specialized specialist.

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Complications of epilepsy

Epilepsy is fraught with the development of a number of serious complications, including:

• Status epilepticus is a series of generalized seizures requiring medical intervention.
• Injuries. If a patient falls, they can suffer serious injuries, sometimes fatal (for example, if they hit their head on a hard object).
• Increased intracranial pressure. Patients with epilepsy may complain of severe headaches and dizziness. Due to high intracranial pressure, patients may experience nausea and vomiting.
• Brain swelling. When fluid accumulates in the brain tissue, the patient experiences a noticeable increase in neurological symptoms. The condition may worsen to the point of coma.
• Strokes. These may be ischemic or hemorrhagic strokes. This complication arises due to the fact that in epilepsy the central regulation of vascular tone is disrupted. Against this background, in some cases, blood pressure rises sharply or the walls of blood vessels are damaged, which leads to ischemic stroke or hemorrhage.
• Thrombosis of intracranial veins. Dysregulation of vascular tone can also lead to venous stagnation, which can lead to thrombosis. In rare cases, the disease is complicated by pulmonary embolism, which can be fatal.
• Aspiration pneumonia. This is one of the most severe complications of epilepsy. During an attack, the patient may vomit. Sometimes a person swallows vomit, which can enter the lungs. This causes a severe inflammatory process in the lungs, which leads to empyema - an accumulation of pus in the pleura.

What can nocturnal epilepsy be confused with?

Sleep disorders similar to sleep epilepsy:

• Parasomnias (somnambulism, night terrors, waking up with confusion).
• Rhythmic motor acts during sleep (benign sleep myoclonus, involuntary movements of the limbs, bruxism = teeth grinding).
• Enuresis (bedwetting).
• Disturbance of the breathing rhythm during sleep (sleep apnea, including physiological apnea in children, obstructive apnea in adults).
• Movements during rapid eye movement sleep.
• Automatisms in sleep (swinging, yactation).
• Nocturnal “paralysis” (or nocturnal “intoxication”).

Sources

1. Kissin M.Ya. Clinical epileptology. – M.: GEOTAR-Media, 2009. – 256 p. : ill.
2. WHO official website - https://www.who.int/ru/news-room/fact-sheets/detail/epilepsy
3. Avakyan G. N. Blinov D. V. Lebedeva A. V. Burd S. G. Avakyan G. G. Classification of epilepsy of the International League Against Epilepsy: revision and update 2021. Epilepsy and paroxysmal conditions. 2017; 9 (1): 6–25. DOI: 10.17749/2077–8333.2017.9. 1.006–025.
4. Zenkov L.R. Clinical electroencephalography (with elements of epileptology). – M.: MEDpress-inform, – 2001. – 368 p.