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September 13, 2019 Friday 11:44:02 AM IST

Childhood EPILEPSY

Health Monitor

Childhood epilepsy is a condition where children are susceptible to having increased electrical discharges in the brain. Like any other disease of chronic nature such as diabetes and asthma, epilepsy is a chronic illness with a wide spectrum of severity. A few children are seriously affected whereas a large number of children have a mild illness that is easily treated with medication and a significant number of them grow out of the problem. 

Unfortunately, in our society there is a lot of stigma attached to the diagnosis of epilepsy. This is primarily due to lack of awareness. The fear associated with this can be ameliorated through education and spreading awareness about the condition. A lot of childhood epilepsy syndromes are benign in nature and children grow out of this disorder with time unlike certain other chronic illnessessuch asType 1 diabetes, which is a life-long problem. There are some epilepsies that last a life-time and are very difficult to treat and are associated with other problems. But it will be unfair to group all children with a diagnosis of epilepsy under the same umbrella. 


Why does epilepsy happen? 

 


There can be various reasons as to why children develop epilepsy. Some of them may be due to genetic causes where the cells in the brain have an increased tendency to spontaneously generate excessive amount of electricity. In certain cases, the brain or part of the brain may have developed differently resulting in an increased tendency for producing excessive electric discharges.In certain other cases, the child’s normal brain may acquire an abnormality in the form of an infection, bleeding, stroke or inflammation with subsequent scarring which may lead to increased propensity for having seizures. 

 

In all the above cases, the child may exhibit symptoms of seizures. This may manifest in different ways depending on where the symptoms arise from the brain. For example, if the seizures arise from the part of the brain that control hand moment, it would result in jerking of the hand or weakness of the hand; if it is from that part of the brain which controls eye movement, it may result in the eye turning to one side. Sometimes this is associated with the loss of awareness and at times, with loss of consciousness. This can result in injuries and may be associated with the child passing urine or opening the bowels. 

 


How is epilepsy diagnosed? 

 

Unlike other medical conditions, there is no single test that could diagnose epilepsy in a child. The doctors rely heavily on the information provided by the care-givers. It is vital that a clear description of the events is obtained from the beginning to the end, ina sequential manner. Often, witnesses are terrified by the events and are not able to recollect vividly the sequence of events. Today, videos represent a very valuable tool for capturing this information. Teachers and friends can play a significant role in providing accurate information. 




The investigation including scans of the brain(looking at the structure of the brain) and EEG (monitoring electrical activity of the brain) can provide very usefulinformation. Doctors put all the information together to try and solve the puzzle.

 

Are there other conditions that look like seizures? 


Yes, a lot of other childhood conditions may give the impression of the child having seizures. This may range from simple episodes such as fainting to serious heart conditions. It is important that the right diagnosis is made. 


 

How do we treat it? 

 

The mainstay of treatment is medication.Certain children may not respond to medications and may need other types of treatment which include diet and surgery. The diet that is used in such cases is called ketogenic diet. Here, the brain uses an alternative fuel called ketone bodies. In some children when there is a structural abnormality of the brain which is responsible for the seizures, removing that abnormality could result in curing the child from the seizures. This is considered only after extensive evaluation considering the benefits and risks associated with the surgical option.


Do children with epilepsy have other problems?


Often, epilepsy is only a symptom of an underlying difference in the brain structure or function of that individual. Depending on what the underlying problem is, children may have other difficulties inbehaviour and social interaction though not all children have such problems. If they face such difficulties, assessments may need to be done to verify and manage them appropriately. 

 

Where can I look for more information that is reliable?


 

In the current digital world, carers may come across a deluge of information, some of which may not be accurate. This may misinform carers and cause considerable anxiety. It is important to know reliable websites to overcome this problem. Sites such as Indian Epilepsy Society (www.epilepsyindia.org), Epilepsy Action (www.epilepsy.org.uk), Young Epilepsy (www.youngepilepsy.org.uk)provide a lot of useful information. 


Dr.Darshan Jayaram Das

The writer is Consultant, Pediatric Neurology, Rajagiri Hospital, Aluva, Kerala .

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