Childhood epilepsy is a neurological disorder that causes a malfunction of the neuronal activity of the brain. This disease is notable for the epileptic seizures it causes in the child, leading to strong convulsions that affect the muscles in one or several areas of the body and that, on occasion, produce loss of consciousness and blows from falls.

Here we explain what childhood epilepsy is, what types of seizures there are and what their symptoms are, as well as the causes and available treatment.

What is childhood epilepsy?

Childhood epilepsy is a disease of the nervous system characterized by an abnormal discharge of electrical impulses in certain areas of the brain and cerebral cortex . Children with this chronic disorder have recurrent seizures, called epileptic seizures.

This disease usually manifests itself in various ways, depending on the brain structure affected and the region where the epileptic seizure originates. These seizures can be simple, without the child losing consciousness, or complex, in which there is a loss of consciousness. The seizures may be short and last only a few seconds, or they may be long and last several minutes.

The effects of childhood epilepsy on the child and his or her environment also vary depending on factors such as age, seizure types, the child’s response to treatment, or whether there are other concomitant health problems.

The incidence of childhood epilepsy is estimated to be between 40 and 100 cases per 100,000 children , and affects more than 10 million children worldwide. Forty per cent of all new cases are detected in children under 15 years of age.

Types of seizures (and their symptoms)

The seizures that occur in a disease such as childhood epilepsy can be classified into two large groups: those with focal or partial seizures and those that cause generalized seizures. Within each category, up to 30 seizure types have been described.

Focal or partial

Around 60% of children’s epilepsies have focal or partial seizures . These originate on only one side of the brain and are described in terms of the brain area in which they originate (e.g. frontal lobe or medial temporal lobe). They last between 1 and 2 minutes.

During this type of crisis, the child does not lose consciousness and may have strange sensations, such as intense memories, which may be expressed in different ways. Motor symptoms include various automatisms, blinking, tics, mouth movements, etc. The child may also experience intense emotions (of joy, anger, sadness, etc.) and sensory-perceptual disturbances.

In focal crises there may be some alteration of the level of consciousness , which generates in the patient a feeling of being in a cloud or a dream. In some cases, children feel an “aura” or prodrome, a sensation that allows them to anticipate the occurrence of an impending seizure.

The characteristic symptoms of focal seizures can confuse clinicians and be misinterpreted as signs of other illnesses, such as narcolepsy, fainting, or even some mental illnesses. This is why a good differential diagnosis and the application of different tests are required.

Generalized

In generalized epileptic seizures, abnormal electrical discharges occur on both sides of the brain . This type of seizure can lead to loss of consciousness, resulting in falls and widespread muscle spasms. There are different types:

  • Absence crisis: the child seems to be looking at a specific point. Mild muscle spasms may be present. It causes attention and concentration problems in the child.
  • Clonal crises: they cause sudden repetitive movements on both sides of the body.
  • Tonic crises: they produce muscular rigidity, especially in the back, arms and legs.
  • Myoclonic seizures-cause sudden jerking movements in the upper body, mainly in the arms and legs (and sometimes the whole body). Their duration is very short, just a few seconds.
  • Tonic-clonic crises: they cause a mixture of the symptoms that generate tonic and clonic crises, such as muscular rigidity and sudden movements in arms and legs. These are the most serious crises.
  • Atonic crises: they generate a great hypotonia (decrease in muscle tone), causing the child to suddenly fall or hit his head when falling under his own weight.

Causes

The most common causes of childhood epilepsy can be genetic and hereditary, from trauma, abnormalities of brain development, infections and diseases, metabolic disorders, tumors and other problems. In fact, any phenomenon that disrupts a normal pattern of brain activity can cause epilepsy.

Genetic factors, such as mutations, play an important role in some types of epilepsy that have a strong hereditary component. In some cases, alterations in genes may occur spontaneously and without a family history. For example, mutations affecting the ion channels have been described, such as those in the SCN1A gene, which is responsible for the seizures that occur in severe childhood myoclonic epilepsy or Dravet syndrome.

Brain damage can also be a determining factor in the development of childhood epilepsy. Epilepsy can originate in different stages of growth: during pregnancy, early childhood or adolescence . Blood vessel malformations and cerebrovascular diseases may also be factors responsible for producing an epileptic disorder.

Other diseases such as cerebral palsy or metabolic disorders such as phenylketonuria may be related to childhood epilepsy. About 20% of seizures are believed to be caused by neurodevelopmental disorders, and the most common seizures occur in children with autism spectrum disorders and severe intellectual impairment.

Treatment

To treat a child’s epilepsy, doses of antiepileptic drugs are used. These are usually administered according to the type of epilepsy, age and weight of the child affected, spread over two or three daily doses. The neurologist is responsible for following up the drug treatment , taking into account possible side effects and interactions with other medications. A correct diagnosis is also essential.

Most single-drug treatments (known as monotherapy) are effective in reducing and eliminating the incidence of seizures, without significant unwanted effects. However, periodic monitoring is usually done with tests such as electroencephalography, to collect data on the functioning of brain activity; and blood tests, to assess tolerance and drug levels in blood plasma.

Sometimes a small number of epilepsies can be difficult to control and several drugs need to be introduced at once, increasing the risk of interactions and side effects. In cases where drug treatment does not work and the child is resistant to its effects, surgery may be considered as an alternative.

The surgical intervention is planned taking into account the area of the brain where the seizures originate (epileptic focus). This area may be removed; several brain areas may be sectioned so that the seizures do not spread; a callosotomy may be performed, which involves sectioning the network of neuronal connections between hemispheres; or a hemispherectomy may be performed, in which half of the cerebral cortex or hemisphere is removed, a drastic technique used only as a last resort.

Bibliographic references:

  • Cerdá, J. M., Argani, M. T., Llerda, J. M., González, F. L., Puig, X. S., & Rieger, J. S. (2016). Official guide of the Spanish Society of Neurology for clinical practice in epilepsy. Neurology, 31(2), 121 – 129.
  • Travé, T. D., Petri, M. E. Y., & Victoriano, F. G. (2007). Descriptive study of childhood epilepsy. Journal of Neurology, 44(12), 720 – 724.