Childhood Epilepsy
"Most of the child's epilepsies are controlled with antiepileptic drugs that hardly cause any side effects on learning, although it is very important to follow up".
DR. ALBERTO VIECO GARCÍA
SPECIALIST. NEUROPEDIATRICS UNIT
Childhood epilepsy is a chronic neurological disorder characterised by a predisposition to seizures, caused by abnormal and excessive electrical activity of neurons, mainly in the cerebral cortex. There are many forms of epilepsy in childhood, often benign and self-limiting, but others may be more severe or refractory. Approximately 70% of these are effectively controlled with antiepileptic drugs, and in many cases it is possible to achieve sustained remission of seizures.
The professionals at the Clínica Universidad de Navarra who treat childhood epilepsy form part of the Neuropaediatrics Unit and coordinate with the other members of the Epilepsy Unit (neurologists, neurophysiologists, neurosurgeons, neuroradiologists and neuropsychologists) to carry out a comprehensive assessment and treatment of the child. They also evaluate its influence on the child's cognitive and academic performance.
When epilepsy does not respond to antiepileptic drugs and significantly affects children's quality of life, surgical treatment may be considered.
In addition, in some cases of refractory epilepsy, especially between the ages of 3 and 5 years, the ketogenic diet, which consists of a high-fat, very low-carbohydrate, moderate-protein diet designed to induce a state of ketosis, which can reduce seizure frequency, may be used. The fat/carbohydrate/protein ratio is usually 4:1 or 3:1.
Symptoms of childhood epilepsy
Partial or focal seizures
- Simple (without loss of consciousness).
- Complex (with loss of consciousness).
Manifestations are related to brain function in the region where the seizure originates.
Widespread crises
- Absences. Brief loss of consciousness, the child becomes disconnected and ceases activity.
- Atonic. Sudden loss of muscle tone, with sudden drops.
- Generalised tonic spasms. Sustained muscle contractions.
- Bilateral tonic-clonic. Muscle rigidity followed by generalised twitching.
- Myoclonic: brief, sharp jerks of muscles or muscle groups.
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
What are the causes of childhood epilepsy?
Epilepsies can be due to multiple factors, and in many cases no specific cause is identified. Known risk factors are:
- Family history of epilepsy or febrile seizures.
- Skin abnormalities in the child, such as hypopigmented (light-coloured) patches, which may be associated with diseases such as tuberous sclerosis or Bourneville's disease.
- Complications during pregnancy or childbirth.
- Infections affecting the nervous system such as meningitis.
- Head injuries, etc.
However, in most epilepsies there is no obvious cause. The neuropaediatrician's evaluation is essential to establish an accurate diagnosis.
What is the prognosis of childhood epilepsy?
Prognosis varies according to the type of epilepsy:
- 70% of children with idiopathic generalised epilepsies (such as absence, or tonic-clonic awakening seizures) can go into sustained remission and discontinue medication after 2-5 years without seizures.
- In focal epilepsies, approximately 50% of patients with good pharmacological control can withdraw medication after several years.
- Some epilepsies, such as juvenile myoclonic epilepsy, respond well to treatment, but have a high tendency to recur if medication is discontinued.
How is childhood epilepsy diagnosed?
Diagnosis is based on:
Detailed clinical history, including age of onset, triggering factors, duration, frequency and type of seizures.
Complete physical and neurological examination, with special attention to skin, psychomotor development and neurological findings.
Electroencephalogram: allows recording of the brain's electrical activity in order to obtain information on the onset and development of the seizure. It is useful to perform this test during sleep, as it facilitates the detection of abnormalities. In order to ensure that the child falls asleep during the test, it is advisable to wake him/her up early on the day of the test or to adapt the study to nap time, etc.
Prolonged video-EEG: used when it is necessary to record a seizure in order to correlate it with brain activity, given the difficulty in doing so in shorter electroencephalography studies, or seizures that tend to manifest themselves during sleep.
Other complementary tests: analytical tests, brain MRI with specific sequences, genetic studies, analytical and neuropsychological evaluation.
How is childhood epilepsy treated?
Epilepsy is one of the most effectively treated diseases of the central nervous system in children, but it comprises a range of clinical entities with different prognoses and approaches.
We must classify the type of seizure and epileptic syndrome of each child in order to maximise treatment efficacy and minimise adverse effects. If side effects occur, the physician should be informed in order to assess adjustments.
Approximately 70-75% of children achieve good control with antiepileptic medication. 64% of children who have had epilepsy will be in remission in adulthood, and only a small percentage of 16% will continue to need drug treatment.
1-5% of children with epilepsy are candidates for surgery, depending on the severity and type of epilepsy. They would represent 10-20% of children with drug-resistant epilepsy (epilepsies that do not respond adequately to two well-chosen and administered drugs).
Pre-surgical evaluation depends on refractoriness of seizures, developmental or quality of life impairment, and clear and unique location of the epileptic focus not linked to eloquent brain areas responsible for essential neurocognitive functions. With surgery, up to 75% of candidates may be seizure-free.
The ketogenic diet is also used as an alternative in cases of refractory epilepsy. Its implementation should be supervised by a specialised team, due to its complexity, potential low adherence and possible side effects. It is used especially between 3 and 5 years of age. It is based on reversing the ratio of fats to carbohydrates given to the child.
In recent years, clinical research in childhood epilepsy has been able to delineate different syndromes and establish the prognosis and the most effective drugs for their treatment.
In recent years, new therapies are being developed, such as gene therapy for some epileptic syndromes (Dravet, CDKL5 syndrome, SCN2A, PCDH19 and other genetic encephalopathies), neuromodulation or antisense therapies.
All these options are not yet widely available as standard treatments, but are in experimental phases or early clinical trials.
Will treatment affect the child's learning?
Parents often have doubts about whether antiepileptic treatment will interfere with their child's learning.
In general, well-chosen antiepileptic drugs adjusted to the required doses do not significantly interfere with cognitive performance and thus with learning. Some uncontrolled epilepsies can affect learning, so effective treatment may even be beneficial.
However, neuropsychological assessments are desirable for children with certain types of epilepsy in order to adjust treatment and support the child's academic development.
What clinical trials do we have on Childhood Epilepsy?
Where do we treat it?
IN NAVARRE AND MADRID
The Neuropediatrics Unit
of the Clínica Universidad de Navarra
The Unit is part of the Department of Pediatrics and works closely with specialists from other departments to provide integrated care for children and adolescents with risk factors or diseases affecting the central nervous system and neuromuscular system.
It is made up of a team of neuropediatric specialists and psychopedagogues.
Diseases we treat
- Early development and its deviations.
- Motor control disorders.
- Global developmental disorders. Autism.
- Epilepsy in children. Dravet syndrome.
- Sleep disorders.
- Attention deficit and hyperactivity disorders. ADHD.
Why at the Clinica?
- Teamwork to offer a valuation in 24 hours.
- Most experienced nationally in Dravet Syndrome.
Our team of experts in childhood epilepsy
