Symptoms of epilepsy in a child. Causes, diagnosis, treatment
The term "epilepsy" refers to a chronic brain disease characterized by disordered outbreaks of activity of its cells. In children, this disease occurs more often than in adults. In most cases, it manifests itself in the form of convulsive seizures.
Possible causes of
It's not always possible to pinpoint why a child suffers from epilepsy. But this does not mean that babies do not have sense to survey. Depending on what the causes of epilepsy in a child, the types of this disease are also different.
The trigger mechanism is called injuries, infectious lesions. It is also said that this is an autoimmune disease. This version is confirmed by the fact that autoantibodies to neuroantigens are found in the blood of patients.
In children, the following causes can trigger the onset of the disease.
1. Heredity. But scientists say it is wrong to say that epilepsy is transmitted. By inheritance, you can only get a predisposition for its appearance. Each person has a certain level of convulsive activity, but whether epilepsy develops depends on a number of other reasons.
2. Brain disorders. Problems in the work of the central nervous system arise from the effect on the fetus of harmful substances, diseases of the mother during pregnancy. They are also caused by genetic disorders.
3. Infectious lesions. The disease can occur after suffering meningitis or encephalitis. In this case, the younger the child, the higher the probability of epileptic seizures in the future, the harder they will be. However, if the baby has a high congenital level of convulsive activity, then any infection can provoke the disease.
4. Injuries. Any stroke can trigger the onset of epilepsy. But the relationship is not always possible to establish, because the disease does not begin immediately.
Knowing what are the causes of epilepsy in a child, you can decide on the tactics of further examination and treatment.
Classification of the disease
Specialists distinguish several subspecies of this disease, depending on what caused the occurrence of seizures.
If the problem has developed due to structural defects in the brain, then it will be symptomatic epilepsy. It can occur due to the formation of a cyst, a tumor or a hemorrhage in this organ. About idiopathic epilepsy it comes in those cases when there are no visible changes in the brain, but the child has a hereditary predisposition to the development of this disease.
But there are cases when the symptoms of epilepsy in a child are pronounced, and the cause of this condition can not be established. This type of disease is called cryptogenic.
Specialists also identify localized and generalized forms of the disease. In the first case, foci of activity in the brain are strictly limited. They are always formed in the same areas of the brain tissue. And with generalized forms, almost the whole cortex of the brain is involved in the pathological process.
Separately distinguish a mixed version. Initially, epileptic seizures begin as localized, but the focus of excitement quickly spreads throughout the cortex.
First Calls to
All parents should know what are the signs of epilepsy in a child. After all, this problem is detected in 3% of toddlers under the age of 9 years. In infants it can be confused with the usual motor activity. The child turns his head, actively stirs his hands and feet. The convulsive component is not always present.
Seizures can occur at any age. But most often they arise when the brain and the nervous system are not fully ripe. Pathological areas of excitation in such cases appear simpler.
Some seizures may not be noticeable to others. Even parents can not pay attention to them. They are manifested in states of "hang", which last only a few seconds. The most common form of the disease in children is absense epilepsy( picnolepsy).During an attack in a child, the consciousness disappears, the impulsive movements of the head are noticeable, the eyes can roll upward. When the attack ends, automatic pharyngo-oral movements often appear. It can be lip licking, smacking, sucking. Such attacks usually last no more than 30 seconds. But they can be repeated many times even during one day.
Parents should know that these are symptoms of epilepsy in a child. Provoke attacks can sleep disorder, reduced or, conversely, too active brain activity, photostimulation.
Forms of the disease
Specialists identify not only localized and generalized types of epilepsy. Depending on the factors that trigger the onset of the disease, the following forms are distinguished:
- primary: occurs against the background of increased convulsive activity of the brain;
- secondary: appears as a result of an infectious or traumatic lesion;
- reflex: arises as a reaction to the stimulus, it can be a certain noise, flickering light, a smell.
Depending on the age at which the first signs of the disease appeared and the characteristic clinical signs, these types of seizures are distinguished:
- propulsive insignificant, they are characteristic for infantile age;
- myoclonic - this is an early pediatric form;
- impulsive, occur during puberty;
- psychomotor - they can be accompanied by cramps or go without them, it can be sensory, auditory, advertsive attacks, fits of laughter.
Depending on the incidence and rhythm of seizures, these types of epilepsy are distinguished:
- with rare( less than 1 time per month), frequent( up to several times a week) seizures;
- with irregular and growing seizures.
By the time of appearance, there are different forms of epilepsy:
- generalized( attacks appear at any time).
Foci of excitement can be found in the occipital, cortical, temporal, diencephalic and other areas of the brain.
The main symptoms of
Depending on the site of the primary lesion, there will be signs of epilepsy in the child. After all, the disease is not always manifested by cramps. To guard should temporary loss of consciousness, motor disorders, disorientation in space, impaired perception( taste, sound or visual), aggressiveness, sudden changes in mood. Also, older children can say about the numbness of certain areas of the body.
These symptoms of epilepsy in a child are not always noticeable, so parents do not always pay attention to them. In older children, they can take them for the usual absent-mindedness. But there are signs that attract attention. This is the stopping of breathing, the tension of the muscles of the body, which is accompanied by the fact that the child is bending and unbending limbs, convulsive contractions, involuntary defecation, urination are observed. The patient can bite the tongue, some during the attacks scream.
Sometimes, people during seizures can only observe the trembling of the eyelids, throwing back the head, looking at one point. They do not react to external stimuli. But many are unable to recognize epileptic seizures unless they are accompanied by convulsions and a swinging on the floor.
One should also know that the immunity of epileptics is rather weak. They often suffer from various psychoemotional disorders. They may develop anxiety, depression may begin. They are distinguished by petty and petulant character, they often have attacks of aggression. People with epilepsy differ in excessive filthiness, vindictiveness, rancor. Experts call this epileptic character.
Diagnosis of the disease
Having noticed the child's periods of fading or convulsive movements, you should immediately go to the doctor. Only a full examination and selection of the right treatment can return a person to a normal life.
Special laboratory and instrumental examinations are needed to diagnose "epilepsy" with 100% certainty. The disability group is established once before adulthood. After the approach of the eighteenth birthday, a re-commission will be necessary.
One of the main methods of examination is electroencephalography. However, almost half of patients in the period between attacks on it may not have any changes. In carrying out functional tests( hyperventilation, sleep deprivation, photostimulation), characteristic symptoms of epilepsy appear in 90% of patients.
In addition to the EEG, neuronimaging is also used. This study can reveal the brain damage, establish a diagnosis, determine the prognosis and further treatment tactics. These methods include computer and magnetic resonance imaging. Also, patients take urine and blood for analysis. Determine the level of immunoglobulins, transaminases, albumin, electrolytes, calcium, alkaline phosphatase, magnesium, glucose, iron, prolactin, thyroid hormones and others.
Additional studies include ECG monitoring, dopplerography of brachiocephalic vessels, analysis of cerebrospinal fluid.
Choice of treatment tactics
Normalize the child's condition and reduce the frequency of seizures, and even eliminate them at all in the case of well-chosen therapy. However, it is not worth counting on getting rid of problems in the first month. Sometimes you have to take pills for several years, so that mental epilepsy receded, and the attacks completely stopped.
Therapy should be comprehensive. In addition to mandatory intake of prescribed medications, in some cases neurosurgical treatment is necessary. It is also difficult to do without psychotherapeutic support. With the right approach, persistent remission can be achieved in 75% of small patients.
In addition to medical therapy, doctors advise to establish a clear regime for the child's day and transfer it to a special diet. This way of life must become a habit. After all, the regime minimizes the probability of occurrence of foci of excitation in the brain. Doctors also note that the ketogenic diet provides good results. The essence of it is that you need to eat foods that are high in fat. Simultaneously, it is necessary to reduce the amount of carbohydrates.
Features of drug therapy
To determine how to treat epilepsy in each specific case, should only a doctor with sufficient experience. After all, it is important to choose the medicines so that they bring the maximum benefit with a minimum of undesirable consequences. Treatment begins only after the diagnosis is established. To appoint a particular drug, the doctor must determine the nature of seizures, take into account the features of the course of the disease. The role is played by the age at which seizures began, their frequency, the patient's intelligence, the presence of neurologic symptoms. It also takes into account the toxicity of medications and the likelihood of side effects. Choosing drugs( with epilepsy prescribed mainly anticonvulsant), the doctor should pay more attention to the nature of seizures, the form of the disease is less important.
For therapeutic purposes, patients are given the usual age-appropriate dose. However, the doctor should draw a scheme of reception. After all, start to drink antiepileptic drugs with a lower dose. If the effect of their reception does not appear, or it will be barely noticeable, it is necessary to gradually increase the dosage. The peculiarity of the treatment of this disease is precisely the fact that it is undesirable to change preparations. If the body does not react, you just need to increase the amount of once taken medicine. Although approximately 1-3% of patients can achieve remission with a reduced average dosage.
Selection of medicines
There are times when the prescribed medication does not help. This is evidenced by the lack of improvements during the month, provided that the maximum age-related dosage is achieved. In this situation, it is necessary to change the drug. But this is not so easy. There is a special scheme for treating epilepsy with various medications.
For the replacement of funds, the second prescribed drug is gradually administered, while the previous one is also canceled. But this is done smoothly. Sometimes the drug is delayed for several weeks. If the patient develops a marked withdrawal syndrome, then it is desirable to give benzodiazepines and barbiturates as a complex therapy.
In the vast majority of cases, you can cure epilepsy. The doctor individually selects anticonvulsants and anticonvulsants. Often appoint "Diazepam", "Phenobarbital", "Carbamazepine".It is preferable to give preference to agents in which active substances are released slowly. After all, their use reduces the risk of side effects. These drugs include derivatives of valproic acid and carbamazepine. They include tablets "Valparin HR", "Convulsofin", "Enkorat", "Konvuleks", "Depakin Enteric 300", "Finlepsin", "Apo-carbamazepine".Possible complications of
Correctly selected therapy can completely remove the symptoms of epilepsy in a child within a few years. In some cases, consistent monotherapy does not stop seizures. This is possible with drug resistance. Most often, it is observed in those patients who have early onset seizures, a month there are more than 4 seizures, there is a decrease in intelligence and brain dysgenesis. In such cases, epilepsy of the brain should be treated in a slightly different way. A doctor can prescribe simultaneous reception of two drugs.
Treatment according to the selected scheme should be carried out for several years and even after the complete cessation of seizures. Depending on the form of epilepsy, this period can be from 2 to 4 years. But premature cancellation of drugs can cause deterioration. Seizures may resume again. Even after the end of this period, the withdrawal of funds should be made gradually over 3-6 months. It is important to regularly monitor the condition with EEG.In some cases, therapy is carried out throughout life.
It should be understood that the earlier the disease began, the more serious the consequences of epilepsy may be. This is due to the fact that at an early age the human brain is still immature and, as a consequence, more vulnerable. Parents need to be serious about the prescribed treatment, because if you do not adhere to the selected therapy, skip the pill or cancel them yourself, the child may resume seizures until the appearance of an epileptic status. This condition is characterized by the fact that the child seizures go one after another without interruptions, the consciousness between them does not clear up.