Children's absansny epilepsy – the form of idiopathic generalized epilepsy which is found at children of preschool and younger school age with characteristic symptomatology in the form of absans and patognomonichny signs on the electroencephalogram. It is shown by sudden and short-term switching off of consciousness, more often in the afternoon, without influence on the neurologic status and intelligence of the child. Children's absansny epilepsy is diagnosed clinically on a typical picture of a paroxysm with confirmation at the EEG-research. Patients need performing specific therapy by antiepileptic medicines.
Children's absansny epilepsy
The Children's Absansny Epilepsy (CAE) makes about 20% of all cases of epilepsy at children up to 18 years. The debut of a disease is the share of age from 3 to 8 years, the frequency of occurrence of pathology is slightly higher at girls. In 1789 Tissot described as a symptom. The detailed description of the EEG-picture of an absans was submitted in 1935. It allowed to carry authentically this type of paroxysms to group of epileptic syndromes, however in a separate nosological form children's absansny epilepsy was allocated only in 1989. A disease it is necessary urgent for pediatrics as parents can often not notice presence of absans at the child and long time to write off such state for a carelessness. In this regard late begun treatment can lead to development of the DAE resistant forms.
Reasons of children's absansny epilepsy
The disease develops under the influence of a complex of the reasons and provocative factors. Initially destruction of substance of a brain results from influence of various factors during the period before childbirth, injuries and a hypoxia in labor, and also in the post-natal period. In 15-40% of cases the hereditary otyagoshchennost takes place. Influence of a hypoglycemia, mitochondrial violations (including Alpers's disease) and accumulation diseases is also proved. Anyway, parameters of excitability of separate cortical neurons change that leads to formation of primary center of epileptic activity. Such cages are capable to generate the impulses causing attacks with a characteristic clinical picture, various depending on localization of these cages.
Symptoms of children's absansny epilepsy
Children's absansny epilepsy debuts at the age of 4-10 years (the peak of incidence – 3-8 years). It is shown in the form of paroxysms with a specific clinical picture. The attack () always begins suddenly and also unexpectedly comes to an end. During an attack the child as if stiffens. It does not react to the speech turned to it, the eye is turned in one party. Externally it can look frequent so as if the child just thought of something. The average duration of an absans makes about 10-15 seconds. The entire period of an attack amnezirutsya, as a rule, completely. The condition of weakness, drowsiness after a paroxysm is absent. Such type of an attack is called a simple absans and separately occurs approximately at a third of patients.
Much more often at structure of an absans there are additional elements. The tonic component, usually in the form of a head zaprokidyvaniye back or rolling of eyes can be added. The Atonichesky component in clinic of an attack is shown by loss of objects from hands and nods. Often avtomatizm, for example, stroking of hands, a licking, smacking, repetition of separate sounds join, is more rare than words. Such type of a paroxysm is called a difficult absans. Both simple, and difficult absansa belong to typical in clinic of children's absansny epilepsy, however atypical manifestations when consciousness is lost gradually and not completely, an attack more long are occasionally possible, and after it weakness and drowsiness is noted. These are signs of an adverse course of a disease.
High frequency of paroxysms – several tens-hundreds of times a day, usually in the afternoon is characteristic of DAE. Attacks are often provoked by a hyperventilation, the photosensitization sometimes meets. Approximately in 30-40% of cases generalized convulsive attacks with loss of consciousness and toniko-clonic spasms also take place. Often such form of an attack can even precede emergence of typical absans. Despite it, children's absansny epilepsy is considered good-quality as there are no neurologic changes and any influence on intelligence of the child. Together with it approximately at a quarter of children the syndrome of deficiency of attention meets a hyperactivity.
Diagnosis of children's absansny epilepsy
Diagnosis is based first of all on a clinical picture of a disease. Symptoms of children's absansny epilepsy are rather specific therefore diagnostics, as a rule, does not cause difficulties. The pediatrician can suspect a disease if parents complain of a carelessness, frequent thoughtfulness of the child, or the child does not cope with the school program. Survey of the children's neurologist allows to collect the careful anamnesis, including family and early neonatal when could take place of a trauma or other factors of development of children's absansny epilepsy. Also at survey neurologic symptoms are excluded and approximate compliance of intelligence to age norm comes to light. For these purposes carrying out additional tests is possible. Sometimes it is possible to register an attack visually.
Carrying out an electroencephalography is obligatory. Until recently the EEG-research confirmed the diagnosis of children's absansny epilepsy, however the accumulated experience showed that changes on the electroencephalogram can be absent, though in rare instances. Along with it existence of the center at total absence of symptomatology is possible. Nevertheless, EEG-diagnostics is obligatory and is carried out to 100% of cases. Patognomonichny changes on the electroencephalogram – regular complexes the peak wave with a frequency from 2,5 to 4 Hz (3 Hz are more often), approximately at a third of children is registered bioktsipitalny delay, delta activity in occipital shares meets less often when closing eyes.
Other researches (brain KT, MPT) for diagnosis of children's absansny epilepsy are not shown, however can be conducted for the purpose of an exception of symptomatic epilepsy when the tumor, a cyst, encephalitis, tubercular damage of a brain, distsirkulyatorny violations, etc. can be the reason of an attack.
Treatment of children's absansny epilepsy
For the prevention of absans medicinal therapy is shown, usually it is about monotherapy. Choice medicines for children are suktsinimida. In the presence of generalized toniko-clonic paroxysms it is preferable to use medicines of valproyevy acid. Treatment is appointed strictly by the neurologist or epileptology when the diagnosis "children's absansny epilepsy" is authentically confirmed. Cancellation of medicines is recommended after three years of permanent remission, that is lack of clinical manifestations. If toniko-clonic attacks take place, for the end of treatment it is recommended to sustain at least 4 years of remission. Application of barbiturates and group of derivatives of a karboksamid is contraindicated.
Forecast of children's absansny epilepsy favorable. The absolute recovery comes in 90-100% of cases. Seldom forms, atypical and resistant to treatment, and also "transformation" of a disease in youthful forms of idiopathic epilepsy meet. Prevention hereditarily of the caused cases of children's absansny epilepsy is absent. The general actions consist in the prevention of complications of pregnancy at mother, patrimonial injuries of newborns and traumatism at early children's age.