Epilepsy in children - causes, symptoms, diagnosis and treatment
Epilepsy in children - Chronic cerebral disorder characterized by repetitive, stereotyped seizures that occur without obvious precipitating factors. The leading symptoms of epilepsy in children are seizures that may occur in the form of tonic-clonic seizures, absence seizures, myoclonic seizures with impaired consciousness or without its violation. Instrumental and laboratory diagnosis of epilepsy in children involves performing EEG, skull X-ray, CT, MRI and PET brain, biochemical analysis of blood and cerebrospinal fluid. General principles of treatment of epilepsy in children suggest observance of protective mode, anticonvulsant therapy, psychotherapy; if necessary - neurosurgical treatment.
Epilepsy in children
Pediatrics statistics, epilepsy occurs in 1-5% of children. In 75% of adults with epilepsy, the disease accounts for the debut of childhood or adolescence.
In children, along with benign forms of epilepsy, there are malignant (progressive and resistant to therapy) form. Often seizures in children is atypical, erased, and the clinical picture does not always correspond to changes in the electroencephalogram. The study of epilepsy in children engaged in pediatric neurology and its specialized section - Epileptology.
phenylketonuria, maple syrup urine disease, giperglitsinemiey, mitochondrial encephalomyopathies), chromosomal syndromes (Down syndrome), hereditary neurocutaneous syndromes (neurofibromatosis, tuberous sclerosis), and others.
Most in the structure of epilepsy in children occur symptomatic form of the disease, developing as a result of prenatal or postnatal brain damage. Among the prenatal factors play a leading role toxicosis of pregnancy, fetal hypoxia, intrauterine infection, fetal alcohol syndrome, intracranial birth trauma, severe neonatal jaundice. Early organic brain damage that leads to the manifestation of epilepsy in children may be associated with congenital anomalies of the brain, a child migrated neuroinfections (meningitis, encephalitis, arachnoiditis), traumatic brain injury; common complications of infectious diseases (influenza, pneumonia, sepsis, and others.), post-vaccination complications and so forth. In children with cerebral palsy epilepsy is detected in 20-33% of cases.
Cryptogenic epilepsy in children are supposedly symptomatic origin, but they are valid reasons and remain outstanding even with the use of modern methods of neuroimaging.
impaired consciousness)
2. Epilepsy in children with generalized seizures flowing:
3. Epilepsy in children, occurring with ungraded seizures (repeat, random, reflex, status epilepticus, and so forth.).
Localization-conditioned and generalized forms of epilepsy in children, taking into account the etiology are divided into idiopathic, symptomatic, and cryptogenic. Among the focal idiopathic forms of the disease in children is most common benign rolandic epilepsy, epilepsy with occipital paroxysms, epilepsy reading; including idiopathic generalized forms - benign neonatal seizures, myoclonic and absence epilepsy children and youth, etc.
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palpitations, sweating, fever; mental disorders.
Long epilepsy leads to a change of mental status of children: many of them observed hyperactivity and attention deficit, learning difficulties, behavioral disorders. Some forms of epilepsy in children with reduced flow intelligence.
Pediatric Neurology or epileptologa need to know the frequency, duration, time of occurrence of attacks, the presence and nature of the aura, especially the flow seizure postpristupnogo and interictal period. Particular attention is drawn to the existence of perinatal pathology, early organic brain damage in children with epilepsy in relatives.
To determine the portion of increased excitability in the brain and epilepsy electroencephalography is performed. Typical of epilepsy in children is the presence of EEG signs: the peaks, sharp wave complexes "peak-wave" paroxysmal rhythm. Because epileptic phenomena are not always found in peace, there is often a need for EEG recording with functional tests (light stimulation, hyperventilation, sleep deprivation, pharmacological tests, and so on. D.) The night EEG monitoring or long-term EEG-video monitoring, increasing the probability of detection of pathological changes.
To determine the morphological substrate of epilepsy in children carried the skull X-ray, CT, MRI, PET of the brain; Consultation children ophthalmologist, ophthalmoscope. In order to avoid the paroxysms of cardiac origin is performed ECG and ECG monitoring child. To determine the etiologic nature of epilepsy in children may be required to study the biochemical and immunological blood markers, conducting a lumbar puncture with cerebrospinal fluid examination, identification of the chromosomal karyotype.
Epilepsy is necessary to differentiate with seizures in children, spazmofiliey, febrile convulsions and other epileptiform seizures.
psychotherapy, biofeedback therapy. Positively proven epilepsy in children refractory to anticonvulsant drugs, such alternative methods, such as hormone replacement therapy (ACTH), ketogenic diet, immunotherapy.
Neurosurgical treatment of epilepsy in children is not widely used. Nevertheless, there is evidence of the successful surgical treatment of treatment-resistant forms of epilepsy in children through hemispherectomy, anterior temporal lobectomy, ekstratemporalnoy neocortical resection, limited temporal resection, vagus nerve stimulation using implantable devices. Selection of patients for surgical treatment is carried out jointly with the participation of neurosurgeons, pediatric neurologists, psychologists with a careful assessment of the possible risks and the effectiveness of the proposed intervention.
Parents of children with epilepsy should be able to provide emergency care to the child with seizures. In the event of attack precursors should be to lay the child on her back, releasing from the tight clothing and ensure free access of air. To avoid sticking of language and aspiration of saliva baby's head must be turned on its side. With a view to prolonged seizures may cupping rectal administration of diazepam (in the form of suppositories, solution).
Prediction and prevention of epilepsy in children
The successes of modern pharmacotherapy of epilepsy can achieve complete seizure control in most children. With regular use of anti-epileptic drugs, children and adolescents with epilepsy can lead a normal life. Upon reaching complete remission (absence of seizures and EEG normalization) in 3-4 years your doctor may gradually abolish receiving anti-epileptic drugs. After the cancellation of 60% of patients in the later episodes are not renewed.
Less favorable prognosis has epilepsy in children, characterized by early onset of seizures, status epilepticus, decreased intelligence, lack of effect of the acceptance of basic medicines.
Prevention of epilepsy in children should begin during pregnancy planning and continue after birth. In the case of the disease is necessary to early treatment, compliance with treatment regimen and recommended lifestyle, watching the child at epileptologa. Teachers who work with children suffering from epilepsy should be informed about the child's illness and the steps of providing first aid for epileptic seizures.