What happens during an attack
Nerve cells in the cerebral cortex communicate using electrical signals. In epilepsy, a group of cells suddenly discharge in unison and too much force, and the discharge spreads throughout the brain. What exactly happens to the child depends on the zone in which the discharge began: when the motor cortex is involved, convulsions occur, when a discharge in deep structures occurs, freezing occurs, when the temporal lobe is affected, strange smells, fear, or the feeling of what has already been seen. Usually the attack lasts from a few seconds to 1-2 minutes and ends on its own.
- Focal seizures—start in one area of the brain
- Generalized - immediately covers both hemispheres
- Absence seizures are short freezes with a stop of gaze
- Myoclonus - sudden shaking of the arms and shoulders
- Tonic-clonic seizures with falling and convulsions
- Specific childhood syndromes with typical age of onset
Causes and provoking factors
In about half of children, the cause cannot be found, and then they talk about genetically determined forms: they are not associated with brain damage and often respond well to treatment. For others, attacks are caused by structural changes or previous illnesses. Separately, febrile convulsions at high temperatures in children stand out: most often this is a benign condition that does not develop into epilepsy. Provocateurs themselves do not cause the disease, but they significantly increase the risk of another attack.
- Hereditary predisposition
- Malformations of the cerebral cortex
- Consequences of hypoxia during childbirth and head injuries
- Past meningitis and encephalitis
- Metabolic and genetic syndromes
- Provocateurs: lack of sleep, high temperature, flickering light, missing medication
How to recognize a seizure in a child
Parents often notice only vivid convulsive episodes, and short seizures are mistaken for inattention and laziness. Repeated identical episodes should alert you: the child freezes for a few seconds and does not respond, drops an object, makes similar movements with his lips or hand, suddenly turns pale and falls. Video recording of an attack on a phone is very helpful - it is often more informative than any description. It is important to note the start time, duration and condition of the child after.
- Freezing with gaze at one point, interruption of play or speech
- Rhythmic twitching of an arm, leg, or half of the face
- Morning shuddering with objects falling out of hands
- Sudden falls without warning
- Night attacks: screams, strange positions, wet bed
- After an attack - drowsiness, confusion, headache
Survey
The diagnosis is based primarily on a detailed account of eyewitnesses and a recording of the attack. Electroencephalography records the electrical activity of the brain and helps determine the form of epilepsy; however, a normal EEG outside an attack does not exclude the diagnosis, so sometimes a study is performed after sleep deprivation or long-term video monitoring. MRI of the brain is needed to look for structural causes, especially in focal seizures. Blood tests rule out metabolic disorders and low levels of sugar, calcium or sodium.
- Detailed description and video recording of the attack
- EEG, if necessary - after sleep deprivation
- Video-EEG monitoring, including night monitoring
- MRI of the brain
- General and biochemical blood tests, electrolytes
- ECG to exclude syncope of cardiac origin
- Genetic testing for some syndromes
Treatment and first aid
The basis of treatment is antiepileptic drugs, which are selected by a neurologist taking into account the form of epilepsy, age and tolerance; They need to be taken daily and for a long time, and canceled only gradually and according to the doctor’s decision. Abrupt spontaneous refusal is dangerous due to a series of attacks. If two properly selected drugs do not help, a ketogenic diet, vagus nerve stimulation, or surgical treatment are discussed. It is important for parents to know in advance what to do during an attack and safety rules at home.
- Lay the child on his side, put something soft under his head
- Remove hard and sharp objects, note the time
- Do not put anything in your mouth or hold it by force.
- Call 103 if attack lasts longer than 5 minutes or recurs
- Don't skip taking your medication and get enough sleep
- Do not swim without adult supervision, do not lock the bathroom door