There are two main types of seizure: focal seizures and generalized seizures. Focal seizures affect only one side of the brain and generalized seizures affect both sides of the brain.
Generally, adults and children have the same types of seizure, although some may be more common in childhood than adulthood. For example, absence seizures which can be very brief and are often mistaken for ‘daydreaming’ or not paying attention.
During seizures following things may be noted:
In some types of seizure, a child may be aware of what is happening. In other types, a child will be unconscious and have no memory of the seizure afterwards.
Some children may have seizures when they are sleeping (sometimes called ‘asleep’ or ‘nocturnal’ seizures). Seizures during sleep can affect sleep patterns and may leave a child feeling tired and confused the next day.
Some children develop epilepsy as a result of their brain being injured in some way. This could be due to a severe head injury, difficulties at birth, or an infection which affects the brain such as meningitis. Epilepsy with a known structural cause like this is called structural epilepsy.
For some children, their epilepsy has a genetic cause. This may be inherited from one or both parents or it may be a change that happened in the child’s genes (before they were born). Epilepsy with a likely genetic cause is called as genetic epilepsy.
Sometimes no cause is found then this is called as unknown epilepsy. Everyone has a level of resistance to seizures called a seizure threshold. This is included in the genes passed from parent to child. A child with a low seizure threshold may start having seizures for no obvious reason. However, having a low seizure threshold doesn’t always mean that seizures will start.
Other children in the family may have a similar seizure threshold but may not develop epilepsy.
Epilepsy is a clinical diagnosis. A diagnosis of epilepsy may be considered if your child has had more than one seizure. You and your child (if they can) may be asked to describe in detail what happened before, during and after the seizure. Having a video recording of the seizure can help us understand what is happening.
A few tests can be suggested to help with the diagnosis. The tests alone cannot confirm or rule out epilepsy, but they can give extra information to help find out why your child is having seizures. Those tests include electroencephalogram (EEG) and brain imaging like MRI. An EEG test is painless, and it records the electrical activity of the brain.
If your child is diagnosed with a childhood epilepsy syndrome this means their seizures have specific characteristics. These can include the type of seizure or seizures they have, the age when the seizures started and the specific results of EEG and the child’s neuro-developmental profile.
Syndromes follow a particular pattern, which means that the child neurologist may be able to predict how your child’s condition will progress. Syndromes can vary greatly. Some are called ‘benign’ which means they will have a good outcome and usually go away once the child reaches a certain age. Other syndromes are severe and difficult to treat. Some may include other disabilities and may affect a child’s development.
Epilepsy in children requires specialized treatment that focuses on managing seizures and supporting overall development, enabling children to lead healthy, active lives. Here are some epilepsy treatment options for children:
Most people with epilepsy take anti-epileptic drugs to control their seizures. The child neurologist can discuss with you whether AEDs are the best option for your child. Although AEDs aim to stop seizures from happening, they do not stop seizures while they are happening, and they do not cure epilepsy.
Most children stop having seizures once they are on AEDs that suit them. Like all drugs, AEDs can cause side effects for some children. Some side effects go away as the body gets used to the medication, or if the dose is adjusted. If you are concerned about your child taking AEDs you can talk to the doctor. Changing or stopping your child’s medication without first talking to the doctor can cause seizures to start again or make seizures worse.
Although AEDs work well for many children, this doesn’t happen for every child. If AEDs don’t help your child, the child neurologist may consider other ways to treat their epilepsy.
For some children who still have seizures even though they have tried AEDs, the ketogenic diet may help to reduce the number or severity of their seizures. The diet is a medical treatment, often started alongside AEDs and is supervised by trained child neurologist and dietitians.
This involves removing or separating a part of the brain to stop or reduce the number of seizures a child has. It may be possible for some children to have surgery depending on the type of epilepsy they have and where in the brain their seizures start.
As a parent, you may not be able to predict how epilepsy will affect your child’s life. However, helping your child to manage their seizures and be open about their feelings can make a positive difference.
There can be triggers such as stress, excitement, boredom, missed medication or lack of sleep. Keeping a diary of their seizures can help to see if there are any patterns to when seizures happen. If you can recognize triggers, avoiding them as far as possible may help to reduce the number of seizures your child has. Getting enough sleep, and well-balanced meals, will help keep your child healthy and may help to reduce their seizures.
Some parents are nervous about immunization, whether or not their child has epilepsy. It is recommended that every child is immunized against infectious diseases. This includes children who have epilepsy. If you are concerned about immunizations, a doctor can give you more information.
It depends on every child. For some children, having epilepsy and taking AEDs will not affect their behaviour. However, some people may notice a change in their child’s mood or behaviour such as becoming irritable or withdrawn. Some children may be responding to how they feel about having epilepsy and how it affects them.
They may also want to be treated the same as their siblings or friends and to feel that having epilepsy isn’t holding them back. Encouraging your child to talk about epilepsy may help them feel better. Behaviour changes and problems can happen for all children regardless of having epilepsy and for many, may just be part of growing up. In a few children, irritable or hyperactive behaviour may be a side effect of AEDs.
If you have concerns about changes in your child’s behaviour, you may want to talk to the doctor
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