The Childhood epilepsy Appears due to an exaggerated increase of the activity of the neurons that is not related to a feverish process or by other acute alterations that affect the cerebral functioning as infections or traumatisms.
The epilepsy Is a disorder of the brain that is characterized by repeated seizures or seizures.
The convulsive seizure of epilepsy is produced by excessive and abrupt electrical discharges into the cells of the brain, ie neurons.
During crises, people do not control their movements, what they feel or what they do, so that, somehow, at that time it is totally governed by the electric shocks that occur in their brain.
It is possible to emphasize that to suffer a single seizure crisis does not imply to suffer epilepsy, since this disease is characterized to suffer attacks of repeated form and due to a condition or condition of the brain.
Also, it must be taken into account that epilepsy is not a psychiatric disorder or a mental disorder, but is a Neurological disorder Which has little to do with the psychological functioning of the person.
Electric shock-producing strokes can occur in a specific region of the brain (focal seizure) or in the whole brain simultaneously (generalized seizure).
Usually crises last a few seconds or minutes, and are often accompanied by a loss of knowledge.
In order to diagnose this disease, different tests must be performed, such as electroencephalogram Which measures the electrical activity of the brain, TAC If a brain anomaly is suspected and, in some cases, blood tests and genetic studies.
What are the crises of childhood epilepsy?
Before clarifying the characteristics of epileptic seizures, the term seizure crisis should be differentiated.
Most seizures are convulsive, ie, with uncontrolled and repetitive muscle twitching that can be generalized (loss of consciousness) or partial (without loss of consciousness).
However, not all crises occur with convulsions. There are tonic (generalized rigidity), hypotonic (causing fainting) or crisis without physical symptoms (excessive brain activity is detected for a few seconds).
Finally, some crises can occur with isolated muscle spasms (myoclonus), elaborate automatic movements, alterations of the senses and, in some cases, hallucinations.
Thus, we see that not all crises are the same nor are they all typical seizures, but all of them can demonstrate the presence of epilepsy.
This causes some crises to be very noticeable and easily identifiable, but other epileptic seizures may present a very short-lived symptomatology.
Despite this, most seizures usually end with the same symptoms: a period of postcritical drowsiness that can last for a few minutes or even more than an hour, in which the child is sleepy but with a normal response to the stimuli.
Also, crises can cause other associated signs such as sphincter relaxation, drooling, tongue bite, headaches, digestive discomfort, behavioral changes, etc.
These last symptoms as well as the period in which the child is drowsy are not part of the crisis, but consists of the physiological response after the attack.
Finally, once awakened, it is often common for the child not to remember what has happened to him or to be aware of what happened. This is known as postcritical amnesia.
Types of Childhood Epilepsy
Epilepsy is a disease that can be classified in the two types that have been discussed previously: focal or partial crises, and generalized seizures.
Focal seizures are often much weaker than general seizures, and can occur without seizures, while generalized seizures tend to be more serious.
Likewise, these two types of epileptic seizures can be divided into two more types: idiopathic epilepsies and cryptogenetic epilepsies.
Idiopathic epilepsies are the most common and are characterized by not having a known cause, while cryptogenetic epilepsies are much less prevalent and are characterized by a specific organic origin.
Causes
As we have said, epilepsy is a disease characterized by discharges of generalized and disordered impulses of the neurons.
These brain discharges are not produced by external agents, that is, it is the brain's own functioning that produces them.
Thus, the first doubt that opens this disease is clear, what is what causes the brain to perform such discharges?
The electrical shocks that characterize epileptic seizures are caused by alterations in the balance of Neurotransmitters , That is to say, in the chemical substances that connect the Neurons .
This imbalance may be due to the excess of excitatory neurotransmitters, to a decrease in modulators or to alterations in the receptors of the neurons that capture these chemicals.
Here it seems to be quite clear which are the processes that are verified in the brain when a person suffers an epileptic crisis, however, knowing why this happens is a more complex task.
Hereditary factor
First, a hereditary component is postulated in epilepsy.
In fact, some cases of epilepsy with a very clear inheritance have been described, however they have been very scarce.
As with most diseases, the diversity of genetic factors that may induce epileptic seizures makes the heritability of this disease less obvious.
Thus, it is postulated that the hereditary factor may be present in all epileptic seizures but only in a few cases is this factor clearly observable.
Many epileptic patients have a family history so this hypothesis gains strength, however, today the hereditary components of epilepsy have not yet been discovered.
Febrile convulsions
Apart from this, there is a small percentage of epilepsies that occur with febrile seizures.
This type of seizures caused by fever are not considered epileptic, that is, suffering from this type of crisis does not imply suffering epilepsy.
However, febrile seizures have been shown to be a predictor of epilepsy, as some children with febrile seizures may experience epilepsy during adulthood (although this percentage is very small).
As we see, epilepsy is a neurological disease with quite unknown causes and origins, making it difficult to predict its occurrence.
Evolution of childhood epilepsies
The main factor that determines the course and evolution of epilepsy is the early care of this disease.
In general, epilepsies that are controlled and treated early, that is, as soon as the first seizures appear, are usually cured effectively.
Likewise, idiopathic epilepsies are less malignant, that is to say, those epilepsies that are not accompanied by lesions in the nervous system.
Thus, children who suffer from Idiopathic epilepsy And who receive treatment immediately can live a completely normal life and will not suffer alterations in their mental or psychomotor development.
Cryptogenetic epilepsies, on the other hand, have a much worse prognosis, since they are produced by processes that affect brain functioning.
In these cases, Antiepileptic drugs Are less effective and the evolution of the disease will depend on the disease causing the epilepsy and the treatment that is made to this pathology.
In addition, in these cases, each crisis that is suffered damages some region of the brain, so that with the passage of time and the suffering of crisis, the child can see his nervous system affected progressively.
Thus, cryptogenetic epilepsy can lead to damage to the child's brain resulting in psychomotor or intellectual alterations.
In all cases of epilepsy and especially in cryptogenetic epilepsies, medical follow-up is essential to prevent damage and repercussions in the child's development and life.
How to deal with a crisis
Epileptic seizures are often highly unpleasant and stressful events for family members or people who meet the child when he or she experiences the crisis.
The apparateness of the symptoms that produce epileptic seizures can alarm the relatives of the child and these can be very distressed not knowing what to do.
The first thing to keep in mind is that, although the state in which the child is during the crisis is usually very shocking, epileptic seizures almost never cause injuries.
In this way, we must try to remain calm and be aware that the state of the child during the crisis can be very alarming but that this does not have to mean a lesion or highly negative consequences.
Likewise, the crises give way alone after a few seconds or minutes, so do not try to do anything to interrupt the attack or get the child back to a normal state.
The most important thing to do in these situations is to knock the child on a safe surface and set it aside so that the seizure does not cause obstructions in the airways.
Also, it is important not to introduce any object into the child's mouth, to notify an emergency department and wait for the crisis to send to be able to transfer to a health center where medical monitoring of their condition.
How are they treated?
The main treatment of this disease is the administration of antiepileptic drugs.
These drugs must be received by a neurologist, who will indicate the most appropriate dose and medication in each case.
Currently there are many antiepileptic drugs, however, most of them are equally effective at eliminating crises as soon as possible without producing significant side effects. The choice of drug and dose will be made based on the age and characteristics of the child.
Only a few cases of epilepsy (the minority) are difficult to control and require the administration of several drugs. Epilepsy can usually be treated appropriately with the administration of a single antiepileptic drug.
Can crises be prevented?
Although the causes of the seizures are little known today, some patterns have been established that may reduce the risk of seizures in a child with epilepsy.
In general, it is recommended that the child sleep a sufficient number of hours (between 8 and 10), and a regular sleep pattern, lying down and getting up at the same time each day.
Also, it is not recommended that children with epilepsy watch television less than two meters away and it is important to try to avoid viewing electronic devices in the dark.
On the other hand, although watching television or playing computer games and videogame consoles are not prohibited activities for children with epilepsy, it is recommended that healthy use be made of such activities and limit the time spent in performing them .
Finally, the consumption of stimulant beverages should also be limited and taken only occasionally, as these substances may increase the risk of a crisis.
In young people with epilepsy, alcohol consumption, stimulants and other drugs that act on the nervous system are contraindicated, so you should be very cautious about the use of these substances.
Similarly, places that can cause over-stimulation of the nervous system such as discotheques or rooms with intrusive lights and noises may also increase the risk of a crisis, so it is not recommended that people with epilepsy regularly attend These spaces.
References
- Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electrographic classification of epileptic seizures. Epilepsy 1981; 22: 489-501
- Ferrie CD. Terminology and organization of seizures and epilepsies: radical changes not justified by new evidence. Epilepsy 2010; 51: 713-4
- Gómez-Alonso J, Muñoz D, Sánchez-Herrero J, Gómara S. Classification of epilepsies: an invitation to disorder. Neurology 2005; 20: 156-7.
- Leutmezer F, Lurger S, Baumgartner C. Focal features in patients with idiopathic generalized epilepsy. Epilepsy Res 2002; 50: 293-300
- Medina-Malo C. Epilepsy: classification for a diagnostic approach according to etiology and complexities. Rev Neurol 2010; 50 (Suppl 3): S25-30.