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What is it about ?
Epilepsy is a condition of the brain accompanied by seizures. Epilepsy is when a person has two or more seizures in a year. The first attacks often begin during childhood and early adulthood (around 20 years). An epileptic fit is also known as a seizure or convulsive fit. It is the result of a sudden and temporary disturbance of the electrical balance in the brain. It is as if there is a ‘short circuit’ in the brain.
A child who has had a seizure does not necessarily have epilepsy. Indeed, certain situations can trigger an epileptic seizure without there being any question of epilepsy. We think eg. high fever, hemorrhage and / or lesions in the brain, whatever the cause (infection, accident, etc.).
Not all seizures are also due to epilepsy, although epilepsy can be accompanied by seizures. The difference, for example, between a seizure of fever and an epileptic fit is that the fever convulsion occurs only when there is a fever, mainly in young children up to about 6 years of age. It generally does not have negative consequences on the development of the child. A child should also be examined by a doctor after a seizure of fever.
In children, there are mild forms of epilepsy which do not interfere with the development of the child and disappear spontaneously in adulthood. The reason for this is that a child’s brain is not yet fully developed.
What is its frequency?
Epilepsy affects about 4 in 1,000 children. In 20% of cases it is considered severe, with seizures that continue to occur despite the correct medication. About a third of children with epilepsy suffer from neurological problems such as developmental delays, learning difficulties or motor disorders (limited movement).
How to recognize it?
The first time you witness a seizure it can be very scary. Some forms of crisis are very spectacular, others are rather subtle and hardly noticeable. It depends on where in the brain the disturbance starts. Some seizures start in a specific region of the brain (focal or partial seizures), while others start more diffuse in both hemispheres of the brain (generalized seizures).
A seizure can manifest itself in several ways:
- complete or partial disturbance of consciousness. The child may appear to be ‘cut off from the world around him’. Absence is a characteristic form, in which the child stares into space for a few moments (a few seconds). Due to the brevity of this type of seizure, the diagnosis can take a long time to be made;
- involuntary movements (jerky, stiff, rhythmic) that the child cannot control;
- automatic gestures (the child can swallow, chew, scratch an item of clothing or an object without realizing it);
- sudden loss of strength, eg. suddenly falling to the ground or dropping an object suddenly and involuntarily;
- sensory experiences: the child feels, hears or sees things that are not there;
- muscle spasms: the child bends and stretches the arms and legs quickly and repeatedly;
- a ‘tonic-clonic crisis’ or what most people think of as an ‘epileptic fit’: first the muscles stiffen (tonic phase). The vocal cords (which are also muscles) contract, causing the child to cry out. Then he loses consciousness. Then begins the clonic phase: the arms and legs then contract rhythmically. The crisis stops after a few minutes. Uncontrolled loss of urine and stool is possible. The child gradually regains consciousness. After a seizure, the child feels tired, confused and somewhat dizzy.
How is the diagnosis made?
Despite the many and varied signs, the doctor will quickly think of epilepsy. Early diagnosis is important and improves the prognosis.
A large number of tests are usually done to identify the cause of epilepsy. The diagnosis is based on a detailed review of the seizures, including a precise description of their course, their number and the factors that trigger them. Sometimes a hospital admission is required to organize video surveillance and record a seizure.
An EEG (electroencephalogram) and a brain scan are also essential to make the diagnosis. The EEG records electrical waves from the brain, while the scanner checks for any visible abnormality in the brain. In some cases, an additional examination is performed through a blood test or genetic analysis. In addition, the motor and intellectual development of the child is examined and monitored.
What can you do ?
The diagnosis of epilepsy is extremely upsetting for parents and children. The most important thing is to aim for the best possible general development of the child. Respect a regular rhythm of life (regular meal and sleep pattern), avoiding pressure and stress as much as possible.
Factors such as lack of sleep, alcohol, stress, and flashes of light can trigger a seizure without actually being the cause. It is important to teach the child to avoid these factors: do not spend too much time in front of the television or on the computer, ensure good background lighting, maintain a sufficient distance between the eyes and the screen, wear sunglasses when the sun is shining brightly, ….
Make sure that the bathroom or toilet door is never locked. Prefer showers for the child, avoiding baths in a filled tub. Use a thermostatic valve to exclude the risk of burns. Use a plastic cup instead of a glass. Do not allow children to climb ladders or trees, and make sure they are wearing a helmet when riding a bicycle and playing certain sports. You can travel without problem. Some medicines (eg against malaria) can lower the threshold for onset of attacks. Discuss this with your doctor beforehand.
If your child has a seizure, make sure all dangerous items are out of reach and their airways are clear. Put the child on his side and undo the tight clothes. Do not put anything in their mouth or between their teeth. Also, don’t try to contain jerky movements. If this is a first seizure or a generalized seizure lasting more than 5 minutes, it is best to contact the emergency room immediately (112).
What can your doctor do?
Medicines do not cure epilepsy. But they reduce susceptibility to seizures and can therefore prevent them.
There are several types of epilepsy medications, each with their own unique characteristics and side effects. The pediatric neurologist decides which medication to take depending on the type of epilepsy. Some medications require regular monitoring (weight, blood tests).
Since epilepsy in children can often be associated with developmental and learning disabilities, the follow-up will preferably be multidisciplinary in nature. This means that several caregivers will be involved in the care.
In children, the use of surgery is reserved for a few very exceptional cases, because the brain is not yet fully developed.
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