The term 'epilepsy' is derived from the Greek and means 'seized' or 'gripped'. This is a good description of the fact that 'something happens' to the person affected that they cannot control themselves.
Around 5 percent of all people suffer an epileptic seizure in the course of their lives. A single seizure is not yet synonymous with epilepsy. Under certain conditions, anyone can suffer an epileptic seizure, e.g. after a severe head injury or an acute illness.
Epilepsy is only diagnosed when epileptic seizures recur without external provocation.
More than half of all epilepsies begin in childhood.
If epilepsy is not recognized, the child may be at high risk of injury, depending on the type of seizure. In other cases, unrecognized seizures can lead to learning problems and even school failure.
It is therefore important to recognize signs of epilepsy in childhood at an early stage. This enables doctors to initiate appropriate pediatric neurological treatment.
The occurrence of epileptic seizures can also be the first symptom of another illness. This could be, for example
In these cases, rapid and specialized diagnostics are particularly important.
A "grand mal seizure" in a child © Satjawat | AdobeStock
Epileptic seizures are often caused by a short-lived dysfunction of nerve cells in the brain. They can manifest themselves as
- sudden motor phenomena and
- changes in consciousness, behavior and feeling.
behavior and feelings. There are two main groups of seizures:
- generalized seizures, which affect the whole brain, and
- focal seizures, in which the dysfunction only begins in a circumscribed area of the brain.
In some cases, the dysfunction in focal seizures can also spread to the whole brain during the course of the seizure. This is called secondary generalization.
Many people initially think of epilepsy in terms of dramatic seizures with
- muscle twitching (clonic),
- cramped muscles (tonic) and
- loss of consciousness
These are known as grand mal seizures.
But epileptic seizures can also look very different:
- Unmotivated fiddling with an item of clothing for a few moments,
- Short-term swallowing and smacking for no reason,
- Twitching of a hand/extremity,
- occurrence of strange, inexplicable sensory perceptions (auras),
- Being "out of it" for a short time (absence).
Not all seizures result in a loss of consciousness. In some epileptic seizures, consciousness is completely preserved, in others consciousness is impaired.
Perception of aura symptoms
Focal epileptic seizures often begin with a so-called aura: the affected children notice unusual sensory impressions, such as
- Tingling in an extremity,
- visual disturbances,
- hallucinations or
- strange sensations of taste or smell.
Others feel strange sensations in the abdomen or rising from the abdomen (epigastric sensations). Some children recognize from the aura that a major seizure is imminent. However, an aura can just as easily be and remain the only symptom of a seizure.
An aura is a brief seizure that occurs in a very limited region of the brain. It cannot usually be observed by outsiders, as it is a purely sensory perception.
Aura symptoms allow conclusions to be drawn about the region of the brain triggering the seizure. It is therefore important to ask children with epilepsy about this in detail.
Absence seizures
Absence seizures are very inconspicuous epileptic seizures. They may therefore initially go unnoticed. They are characterized by a brief absence with a lack of responsiveness and a memory gap.
Absence seizures occur most frequently in young children and schoolchildren. They are also by far the most common form of epileptic seizure in children. They also occur in adolescents and adults. However, they become increasingly rare with increasing age.
Because absences are so short and those affected do not notice them themselves, they often go unrecognized for a long time. They are misunderstood as inattention ("dreamy" children, "Hans Guck-in-die-Luft") or - especially at school - as a concentration disorder or lack of willpower.
Infantile epilepsies
In infancy, epileptic seizures can look very uncharacteristic. In very young infants, they often manifest as a pause in breathing (apnea) or brief pauses, sometimes accompanied by
- deviation of the eyes to one side (eye deviation),
- eyelid fluttering or
- rolling/twitching eye movements(nystagmus).
If muscle twitches (cloni) occur, these often only affect a circumscribed body region, which can also change in the course of a seizure. Other seizure symptoms may include repeated smacking or pushing the tongue forward.
In another type of seizure in infants, children suddenly open their eyes in a startled manner and pull both arms up to the side. This is repeated in series with short pauses.
These so-called BNS seizures (West syndrome) can lead to developmental arrest or even developmental delay if left untreated. This is why they must be recognized as a form of epilepsy at an early stage.
Epileptic seizures are not always easy to recognize, especially in young infants, even for experts. Parents should therefore try to document the conditions in question in a video.
Episodes that are more likely to be seizures are those that
- are repeated several times in the same way and appear atypical for the child's age,
- cannot be stopped by touching the child and, on the other hand, cannot be triggered solely by a change in the child's position.
Infant myoclonus
Much more common than epileptic seizures are a variety of benign non-epileptic motor phenomena in infants. These include sleep myoclonus. These are short rhythmic twitches that only occur during sleep. They can be interrupted by waking the child.
Even if convulsions (myoclonus) can be interrupted by holding the affected limb, this is an indication of an epileptic phenomenon.
Every first epileptic seizure can be the first and possibly the only sign of acute brain damage for a long time. Therefore, it must always be the reason for an examination by a pediatrician or pediatric neurologist as soon as possible.
All further decisions depend on the results of this examination. The diagnosis includes
- Measurement of the brain wave curves (electroencephalography = EEG),
- a blood test and
- often an electrocardiogram (ECG) to rule out another cause.
Depending on the findings, further examinations such as magnetic resonance imaging(MRI) may be necessary. In individual cases, a lumbar puncture is used to examine the cerebrospinal fluid.
A normal EEG cannot rule out epilepsy with certainty. In some children, repeated EEG recordings or even special EEG examinations such as
- a sleep EEG or
- a long-term EEG
are necessary.
The primary treatment for epilepsy in children is medication. The choice of antiepileptic drug depends primarily on the epilepsy syndrome present. The more precisely the child's epilepsy can be assigned to a specific epilepsy syndrome, the more targeted the treatment can be.
With optimal therapy, more than 70 percent of children become permanently seizure-free.
If there is no improvement with medication, epilepsy surgery may be considered. This is only possible in the case of focal epilepsy, i.e. epilepsy that originates in a completely circumscribed region of the brain.
Another treatment option is a special diet (ketogenic diet). Patients consume a low-carbohydrate, very high-fat diet. As this diet has a major impact on quality of life, it is only used for very severe forms of epilepsy.
As a rule, seizure freedom is not possible, but a significant reduction in seizures can be achieved with the help of an electrical stimulator. It is implanted under the skin like a pacemaker under the collarbone (vagus nerve stimulator = VNS). By regularly stimulating a cranial nerve, the vagus nerve, epileptic seizures can be suppressed.
The diagnosis of epilepsy in a child is a drastic event for most families. Wherever possible, the family should take part in special training.
The modular training program Epilepsy for Families (FAMOSES) offers separate parent and child training courses for affected families. The parents
- receive information about the diagnosis of epilepsy
- reflect on prevailing attitudes and opinions and
- develop strategies and behaviors for everyday life.
In the children's environment (circle of friends, but also kindergarten and school) there is often a great deal of uncertainty regarding the diagnosis and how to deal with a child with epilepsy.
The first thing to convey is that there is no ONE epilepsy. Rather, it is a very heterogeneous clinical picture with individual courses and environmental conditions.
The majority of children with epilepsy are normally intelligent. However, partial performance disorders or attention problems can occur more frequently. This is partly due to the epilepsy itself, but also partly to the side effects of the therapy.
If the environment is prepared, this can be recognized at an early stage and the child can be supported with appropriate measures.
