EPILEPSY IN CHILDREN: diagnosis and treatment

Epilepsy is a neurological disease that affects the brain. Characterized by periodically recurring attacks of convulsions. This condition reduces the quality of life and negatively affects other body systems. According to statistics, every 100 people on earth suffer from epilepsy. At present, it has not been possible to determine the definitive causes of the disease.

At the Yusupov Hospital, experienced neurologists and epileptologists diagnose and treat sleep epilepsy. For this purpose, modern medical equipment and proven quality drugs are used. Individually selected therapy allows you to achieve positive results in a minimum amount of time.

What is epilepsy

Epilepsy attacks often occur at night. In this case, a group of neurons in the focus of excitation is activated. This provokes the appearance of convulsive syndrome. Epileptic seizures occur more mildly during sleep. Depending on the period of sleep the seizures occur, the following types of seizures are distinguished:

• Generalized. Characteristic of the period of awakening. At the same time, patients shudder. This form of seizures occurs in people of different ages. Goes away on its own without treatment. One of the reasons for the development is considered to be a failure of the nervous system, which is eliminated with age.
• Frontal. The pathological focus is localized in the frontal parts of the brain. Cramps occur during sleep. This form of epilepsy is hereditary. Characteristic of adolescence. Among the causes of frontal lobe epilepsy are the effects of psycho-emotional stress.

Expert opinion

Author: Georgy Romanovich Popov

Neurologist, Candidate of Medical Sciences

Epilepsy is one of the common neurological pathologies. Doctors distinguish different forms of seizures. One of them is sleep epilepsy. According to statistics, nocturnal attacks occur in 30% of patients. Convulsions during sleep are characterized by less severity compared to other forms of the disease. Nocturnal epilepsy is typical for children over 5 years of age. In rare cases, the disease will persist into adulthood.

Doctors at the Yusupov Hospital carry out a full range of diagnostic measures necessary to detect nocturnal seizures. For this, modern methods are used - EEG, CT, MRI. Based on the examination results, neurologists and epileptologists at the Yusupov Hospital develop an individual treatment plan. The drugs used are included in the list of the latest European standards for the treatment of nocturnal epilepsy. In addition, patients are provided with personalized preventive recommendations to reduce the risk of developing relapses of convulsive syndrome during sleep. The hospital's doctors treat both adults and children. An individual approach allows you to achieve positive results in a minimum amount of time.

Epilepsy

In the minds of most people, the term epilepsy is associated with the term convulsive (convulsive) seizure. This association, although not correct, still reflects part of the truth: one of the most common manifestations of epilepsy is indeed seizures, but not all seizures are caused by epilepsy.

Epilepsy (primary epilepsy) is a chronic brain disease that causes spontaneous bursts of erratic brain cell activity. In children with epilepsy, very often it is not possible to find any cause for seizures, which distinguishes epilepsy from an epileptic or convulsive syndrome - in which the cause of seizures is often known and can be eliminated.

The variety of manifestations of epilepsy creates significant difficulties in making the correct diagnosis. Often the descriptions of a convulsive seizure given by parents are very similar to the description of epileptic seizures, however, upon a detailed examination of the child, facts are discovered that cast the diagnosis of epilepsy in great doubt. Meanwhile, making a correct diagnosis is extremely important for the child:

1. If a child has epilepsy, the cause of the disease will most likely never be identified, and the child will need long-term treatment
2. If the child does not have epilepsy, but a convulsive syndrome, then it is likely that the cause of the seizures will be identified and after it is eliminated, the child will be completely healthy and will no longer need any treatment.
3. If a child has febrile seizures, it is likely that he or she does not need any treatment at all.

A striking example of a non-epileptic seizure (convulsions) is the phenomenon of Febrile seizures . Although this disease may be very similar in appearance to epilepsy, it is still very different from it in terms of the causes of its occurrence, further development of the disease and treatment.

Due to the fact that parents of children suffering from one or another form of convulsive seizures are faced only with external manifestations of this disease and cannot know its cause (that is, they cannot distinguish true epilepsy from epileptic syndrome), further, in order to simplify the material, we We will use only the term “epilepsy” to refer to both epilepsy and all other cases of epileptic seizures.

Manifestations of epilepsy are always very frightening, especially for people encountering them for the first time. Symptoms of epilepsy depend on the form of the disease. The main symptoms and signs of convulsive epileptic seizures in children are as follows:

• Convulsions are rhythmic contractions of muscles throughout the body.
• Loss of consciousness
• Temporary cessation of breathing, involuntary loss of urine and feces
• Strong tension of the muscles of the whole body (bending the elbows, strongly straightening the legs) Erratic movements in one of the parts of the child’s body: twitching of the arms or legs, puckering or wrinkling of the lips, throwing the eyes back and forced turning of the head to one side.

In addition to the typical (convulsive) forms of epilepsy, there are some other forms of epilepsy symptoms, which have some features and cannot always be recognized by parents:

Absence epilepsy in children

The term absence epilepsy comes from the French word “absence,” which means “absence.” During absence seizures of epilepsy, the child does not fall or begin to convulse - it only suddenly freezes and stops responding to the events happening around it. The main signs of absence epilepsy are:

1. Sudden interruption of the child’s activity (he freezes mid-sentence or without completing the movement he started)
2. Staring or absent gaze, concentrated on one point
3. Inability to attract child's attention
4. After the attack stops, the child continues the action he started and does not remember anything about the attack that happened.

Most often, absence epilepsy begins at the age of 6-7 years. Girls suffer from absence epilepsy about twice as often as boys. In about a third of cases, children with absence epilepsy have relatives with epilepsy. The average duration of childhood absence epilepsy is six and a half years. As children grow older, absence seizures become less frequent and gradually disappear; in other cases, absence seizures develop into another form of epilepsy.

Atonic seizures in children

Atonic seizures are completely different from epileptic seizures, but they are also a form of epilepsy. Atonic seizures are characterized by a sudden loss of consciousness and severe relaxation of all the child’s muscles. Children with these attacks may suddenly fall or hit themselves and appear extremely lethargic and weak. Very often, atonic attacks are completely indistinguishable from fainting, so all children who have suffered several episodes of fainting should be shown to a doctor.

Baby spasm

Infantile spasm is a special form of epilepsy in which there is an involuntary and sudden bringing of the arms to the chest, tilting of the head or the entire torso forward and straightening of the legs. Often, attacks of infantile spasms occur in the morning, immediately after the child wakes up. Attacks of infant spasm may last only a few seconds and involve only a small part of the neck muscles (while the child will periodically nod his head unconsciously). Most often, children aged 2 to 3 years suffer from infantile spasms. By the age of 5, infantile spasm may disappear without a trace or turn into another form of epilepsy. A child suspected of having infantile spasms should be seen by a doctor as soon as possible. Infantile spasm can be a component of some serious diseases of the nervous system, which quickly lead to a decrease in the child’s intelligence and disability. Sodium valproate, clonazepam, topiramate, etc. are used in the treatment of infantile spasms.

The real danger to the child is not short epileptic seizures, but the loss of consciousness and the child falling during a seizure. In this regard, parents or people caring for children with epilepsy should be able to provide them with first aid during a seizure. First aid during an epileptic seizure in a child is as follows:

• If you notice a child having convulsions, place him on a wide bed or on the floor, away from sharp objects and furniture protrusions that the child could hit.
• Turn your baby on his side to help protect him from suffocation.
• You should not put anything in your child’s mouth or try to hold his tongue with your finger.
• In most cases, cramps last from a few seconds to 2-3 minutes.

After the seizures stop:

• Check if the child is breathing. If there is no breathing, start mouth-to-mouth artificial respiration. During convulsions, artificial respiration cannot be performed.
• Stay with your child until he is fully awake.
• Do not give your child anything to drink or any medication until he is fully awake
• If a child has a fever, give him a rectal suppository with paracetamol.

When to call an ambulance?

An ambulance should be called if:

• The child had seizures for the first time
• the seizures lasted more than 5 minutes or occurred again within a short time
• the child was injured during a seizure
• after convulsions, the child breathes heavily and unevenly

All children who have epileptic seizures (convulsions) for the first time should be urgently taken to the hospital for examination. If seizures recur in a child who is already taking antiepileptic treatment, the child's parents should again show the child to a neurologist and consult about changing treatment.

Not all children who have had one or more episodes of seizures or seizures require treatment. In many cases, treatment can be stopped because the child is well and the risk of further seizures has been eliminated. There are many anticonvulsant medications . In each case, treatment for epilepsy is selected individually depending on the type of epilepsy. Some antiepileptic drugs help well with one form of epilepsy and are completely useless with another.

• Most children with epilepsy require treatment with only one antiepileptic drug
• In more than 80% of cases, taking medications completely eliminates seizures
• Many antiepileptic drugs can cause drowsiness, decreased attention, and decreased performance at school.
• In no case should you abruptly stop treatment or change the dosage of medications without your doctor's knowledge - this may increase the side effects of treatment or cause new seizures
• It is very important to follow the treatment program established by your doctor. Parents should know what to do if their child does not take one dose of medication
• You should try to teach your child to take medications on his own, but you should never leave this entirely under his responsibility.

Febrile seizures are said to occur when convulsive seizures occur against a background of a temperature above 38 C, in children under 6 years of age who have never had seizures before. Treatment of febrile seizures in children depends on their duration: if the seizures last less than 15 minutes, symptomatic treatment of the temperature with antipyretic medications and monitoring of the child is sufficient. In case of febrile seizures lasting more than 15 minutes, treatment with special anticonvulsant medications is necessary. Febrile seizures are not epilepsy.

What are febrile seizures in a child?

Febrile (fever) seizures are convulsive seizures that occur in children under 6 years of age who have never previously had seizures without fever. Febrile seizures should be distinguished from childhood epilepsy, which can occur at any age and requires much more complex treatment than febrile seizures. If seizures occur in children over 6 years of age, then most likely the child has epilepsy.

Febrile seizures affect up to 5% of all children under 6 years of age. Most often, febrile seizures occur in children aged 6 months to 3 years.

Causes of febrile seizures in children

The causes of febrile seizures in a child are not completely known. It has been established that one of the factors contributing to the occurrence of febrile seizures in children is the immaturity of the nervous system and the weakness of inhibitory processes in the brain, which creates conditions for the transfer of excitation between brain cells and the occurrence of seizures. It is for this reason that febrile seizures are only spoken of in children under 6 years of age. If seizures are observed in a child over 6 years of age or the child has previously had seizures without fever, then most likely he has epilepsy or another form of epileptic seizures.

Febrile seizures always occur against a background of elevated temperature (above 38 C). Febrile convulsions can be triggered by the common cold, acute respiratory viral infections, and some vaccinations. An important factor in the development of febrile seizures is a hereditary predisposition to seizures. For example, the risk of developing febrile seizures in a child is much higher if his parents or other blood relatives suffer from epilepsy.

Symptoms and signs of febrile seizures

As mentioned above, febrile seizures are not a form of epilepsy, but they have some common features with this disease. In particular, the external manifestations (symptoms) of febrile seizures and epileptic seizures in children are very similar. Febrile seizures in children are manifested by seizures of the following types:

• Tonic convulsions: strong tension of all the muscles of the child’s body (throwing the head and eyes back, bending the arms to the chest, straightening the legs), which is replaced by rhythmic twitching or shuddering, which gradually becomes more rare and disappears.
• Atonic convulsions: sudden relaxation of all muscles of the child’s body, involuntary loss of urine and feces.
• Local convulsions: twitching of arms or legs, rolling back of the eyes.

In most cases, during seizures, the child completely loses contact with the outside world, does not respond to the words and actions of the parents, stops crying, may hold his breath and turn blue. Febrile seizures rarely last more than 15 minutes. In some cases they may occur in series. In about one in three children, febrile seizures may recur during subsequent episodes of fever.

Diagnosis of febrile seizures

After an episode of seizures, the child should be seen by a pediatric neurologist. Diagnosis of febrile seizures consists of excluding all other causes of seizures, in particular various forms of epilepsy.

A set of examinations for a child with febrile seizures includes:

• Spinal tap and cerebrospinal fluid analysis to rule out meningitis or encephalitis
• General and biochemical analysis of blood and urine
• Nuclear magnetic resonance or computed tomography
• Electroencephalogram (EEG)

Treatment of febrile seizures in children

If a child experiences febrile seizures, call an ambulance. Before the ambulance arrives, parents must provide first aid to the child:

1. If you are alone with a child, call for help.
2. A child with convulsions is placed on a flat, hard surface and his head is turned to the side.
3. You should monitor the child's breathing rhythm. If the child is not breathing and is very tense, wait until the convulsions end and begin artificial respiration. Carrying out artificial respiration during an attack is useless.
4. Do not try to open the child's mouth or insert a finger, spoon or other objects into his mouth - this can only harm the child
5. Undress the child and ensure the room is ventilated. The air temperature in the room should not exceed 20 C.
6. Use physical methods to reduce your temperature.
7. Give your child an antipyretic.
8. Until the febrile seizures stop, do not leave the child alone or try to give him water to drink or swallow medicine

If seizures are rare and last less than 15 minutes, no other treatment is necessary. In case of longer and more frequent febrile seizures, it may be necessary to administer special anticonvulsant drugs intravenously by doctors from the emergency team. Preventive treatment for febrile seizures is prescribed only in cases of very frequent and prolonged seizures. The decision on the need for preventive treatment is made by a neurologist.

Does a child with febrile seizures mean they will have epilepsy?

Not all children who suffer from febrile seizures will develop epilepsy as adults. The risk of developing epilepsy in children with febrile seizures is about 2%.

Causes of epilepsy during sleep

To date, the definitive causes of nocturnal epilepsy attacks have not been fully studied. Among the main provoking factors are:

• insufficient oxygen supply to the brain;
• history of birth trauma;
• brain tumors;
• infectious and inflammatory diseases;
• intrauterine development disorder;
• history of traumatic brain injury.

Patients suffering from nocturnal epilepsy are advised not to reduce their sleep duration. This can provoke an exacerbation of the disease. At the Yusupov Hospital, doctors pay special attention to the causes of attacks. In this way, it is possible to influence the etiological factor and provide more effective treatment.

Causes of epilepsy in children. The role of a sense of security and safety in the family

Until the age of 6-7 years, a child has a close psychological connection with his mother, so he unconsciously takes on all her negative states. Against the background of poor conditions of the mother, the child can develop not only behavioral deviations, but also neurotic and psychosomatic diseases.

In the totality of the causes of epilepsy in children, the loss of a sense of security and safety from the mother is of particular importance. The fact is that when a child unconsciously adopts good psychological states from his mother, he can develop harmoniously. What if the feeling of security is lost? Then its development is slowed down; in severe cases, symptoms of epilepsy may occur in children with an anal vector or with anal-sonic ligament vectors.

Symptoms of nocturnal epilepsy attacks

Among the main pathological signs of nocturnal epilepsy are:

• cramps, which can also occur during the daytime;
• nausea, possible vomiting;
• indigestion;
• severe headaches;
• sudden awakenings;
• reproduction of unusual sounds during sleep;
• facial distortion.

The duration of seizures varies. On average, cramps last for 2-5 minutes. Most often, patients do not remember what happened at night. In rare cases, patients are able to describe the sensations they experience. Other symptoms of nocturnal epilepsy include:

• muscle pain;
• bruises and abrasions on the body, the origin of which patients do not remember;
• involuntary urination during seizures;
• tongue bite;
• traces of blood on the pillow after waking up.

If the above symptoms appear, it is recommended to consult a doctor for examination.

Classification of epilepsy attacks during sleep

Epilepsy during sleep is classified into the following types of seizures:

• Frontal. They are characterized by dystonic symptoms, complex motor activity, and rotational movements. In rare cases, they are accompanied by vocal manifestations.
• Occipital. This type of epilepsy during sleep is characterized by blurred vision, vomiting and severe headaches.
• Temporal. Accompanied by complex motor manifestations.

The following conditions can be classified as nocturnal epilepsy:

• Sleepwalking. The symptoms of the disease are known to many. Sleepwalking is accompanied by sleepwalking, nocturnal enuresis, and nightmares. Most often occurs in childhood. In rare cases, sleepwalking occurs throughout life. Aggressive behavior upon awakening is considered a characteristic sign of the disease. Patients do not remember the events that occurred during the attack.
• Parasomnia. This condition is characterized by twitching of the lower extremities when falling asleep, as well as temporary immobility during awakening.
• Nocturnal enuresis. Classified separately in the absence of other pathological symptoms. Boys under 14 years of age are most often affected.

Signs and symptoms of epilepsy in children

Epilepsy manifests itself differently in childhood than in adults. It is incorrect to consider seizures as the only symptom.

In order to recognize the signs of the disease in time and begin adequate treatment, you should know all the manifestations of the disease:

• Convulsive contractions. At the very beginning of the attack, the muscles begin to tense, and breathing is interrupted with resumption and delays. Each convulsion can last from 10 to 20 seconds. Sometimes a child may empty their bladder involuntarily. When the attack passes, the baby falls asleep, as he is unable to fight fatigue and exhaustion.
• Absence seizures or so-called seizures without convulsive muscle contractions. Children are most often susceptible to them. They may not be so clearly expressed and sometimes go unnoticed. You need to pay attention to sudden twitching of the eyelids and the presence of a thoughtless, empty gaze. Sometimes the head leans back, but the eyes remain closed. The child does not blink. No matter how the parents try to attract the baby’s attention, he will remain indifferent until the end of the attack. Once the seizure is over, the child will not fall asleep. He will most likely return to the interrupted task and continue the abandoned game. Absence seizures do not last long, no more than 20 seconds. If you don’t know about this sign, then you can attribute such manifestations to the baby’s pampering and absent-mindedness.
• Atonic seizure. In this case, the symptoms are more vivid. The child completely loses consciousness, and all muscles completely relax. This should not be confused with fainting, especially since atonic attacks tend to recur regularly. This should definitely alert any parent, and after the first such incident it is necessary to seek advice from a pediatrician.
• It is important to pay attention to how the child behaves immediately after waking up. The so-called infantile spasm can be expressed in pulling the arms towards the chest and tilting the head forward. At the same time, the torso moves forward and the legs are extended into a line. The state of tension passes quickly, lasting a few seconds. Such attacks are observed in children 2-5 years old. Sometimes they can disappear without a trace, but sometimes they develop into a serious illness.
• At night, the baby may be tormented by nightmares. He will wake up with his eyes wide open in horror and screaming loudly.
• Often children with epilepsy suffer from sleepwalking; they begin to walk in their sleep, and after waking up they do not remember anything.
• Headache is another common symptom that accompanies childhood epilepsy. As a rule, it is accompanied by nausea and even vomiting.
• It is important to pay attention to the child’s speech characteristics. With epilepsy, he speaks normally, but from time to time he has speech disorders. At the same time, the child continues to play, is fully conscious, but cannot pronounce words.

Diagnosis of epilepsy in sleep

Epilepsy during sleep requires a comprehensive approach. Various instrumental diagnostic methods are used to identify the disease. At your first appointment with a doctor, you need to determine the following indicators:

• time of onset of the first seizure;
• whether there have been similar cases before;
• suspected causes of symptoms;
• associated complaints and diseases;
• history of traumatic brain injury.

Clarification of the above factors allows for a differential diagnosis of sleep epilepsy with other diseases. In addition, the following methods are used for the purpose of research:

• MRI. Brain tomography allows you to establish the localization of pathological foci. It is considered the most effective diagnostic method.
• EEG. Conducted at night. Records electrical activity of the brain. Allows you to identify deviations from the norm.
• Daytime and nighttime sleep deprivation test. The following stimuli are used for this:
• turning the light on and off;
• loud noise;
• deep breathing;
• light flashes.

Sleep epilepsy is more easily diagnosed in children. Night attacks become noticeable to parents. With adults, the examination is much more difficult.

Treatment of nocturnal epilepsy

Medications are used to eliminate nocturnal epilepsy attacks. Among the prescribed pharmacological groups there are:

• Anticonvulsants. Medicines act on the source of epilepsy. Convulsive syndrome is suppressed in this way.
• Psychotropic. Reduce the severity of excitement, affecting the activity of the nervous system.
• Nootropics. Stabilize brain activity and improve cerebral circulation.
• Neurotropic. Prevents the transmission of impulses emanating from the source of excitation.

At the Yusupov Hospital, doctors develop an individual treatment plan for each patient. In this case, the peculiarities of the course of the disease are taken into account. In this way, it is possible to achieve positive results in a minimum amount of time. The success of the treatment depends on many factors. Doctors advise following the following recommendations, which are designed to reduce the risk of recurrent attacks:

• exclude caffeine-containing drinks from the diet;
• go to bed at approximately the same time;
• maintain a sleep-wake schedule;
• If you experience drowsiness during the day, consult a doctor.

First aid for nocturnal epilepsy seizures

Proper care for an epileptic seizure that occurs at night can reduce the risk of injury and other complications. It is as follows:

• try to prevent the patient from falling and catch him in time;
• put a pillow under your head;
• facilitate breathing, provide a flow of fresh air;
• carefully turn the patient’s head on its side to minimize the risk of throwing up one’s own saliva or vomit;
• do not restrain attacks, this can lead to injury;
• if there is an open mouth, put a handkerchief or cloth in it so that the patient does not bite his tongue;
• do not open your mouth forcibly;
• If breathing stops for a long time, it is necessary to carry out resuscitation measures.

During an attack, involuntary urination or bowel movements may occur. You shouldn't be afraid of this. These symptoms are considered normal. Most often, patients do not remember cases of nocturnal epilepsy. Delayed assistance can lead to the development of the following complications:

• injuries;
• hypoxia;
• muscle pain;
• decreased protective functions of the body;
• chronic lack of sleep;
• nightmares.

Epilepsy in children under one year of age

As for infants, in the context of the development of this disease, adults should be extremely careful. Of course, epilepsy can appear at any age, but often the first signs are noticeable in children under one year old. If you do not understand the signs of the disease, you can confuse them with manifestations of other pathologies. This is precisely the insidiousness of infant epilepsy.

Often the trigger is an increase in body temperature during illness, severe fear and other environmental factors.

Parents should definitely pay attention to:

• Frequent screams accompanied by shuddering. At the same time, the baby’s hands will tremble, and the baby can swing them widely.
• Sometimes the upper and lower limbs begin to tremble and twitch. This does not happen synchronously or rhythmically.
• The child's lively and mobile gaze becomes absent for a short time. At the same time, he stops moving, freezes and seems to “withdraw into himself.”
• The facial muscles on one half begin to tense, and then shudder and contract. These contractions move to the same half of the body, as well as to the arm and leg.
• The child may suddenly turn his arm, head and eyes in a certain direction. They will remain motionless in this position for several seconds.
• Even the baby’s usual movements and actions can be a symptom of epilepsy. You should be wary if, while sucking or smacking, the child’s skin color changes; they may become red, bluish, or simply pale. This is especially noticeable on the skin of the face. Such attacks are regular and often occur at the same time.

Prevention of nocturnal epilepsy attacks

In order to achieve stable remission of nocturnal epilepsy, you must follow the following recommendations:

• adhere to a rational and balanced diet;
• take walks in the fresh air;
• reduce psycho-emotional stress;
• to live an active lifestyle;
• eliminate alcohol consumption;
• get enough sleep.

To make it easier to fall asleep, it is necessary to ventilate the room in advance, choose a comfortable mattress and bed. The height of the pillow is also selected based on personal preference. Sleepwear should be comfortable and not restrict movement. Before going to bed, you can drink a glass of warm milk. Herbal teas with mint and chamomile have a sedative effect.

At the Yusupov Hospital you can undergo a full course of examination and treatment of sleep epilepsy. The clinics have the latest medical equipment and a professional team of doctors at their disposal. You can make an appointment for a consultation and learn more about the cost of services by phone.