Epilepsy at children – the chronic cerebral frustration which is characterized by the repeating, stereotypic attacks arising without obvious provocative factors. As the leading displays of epilepsy at children serve epileptic seizures which can proceed in the form of toniko-clonic spasms, absans, mioklonichesky spasms with violation of consciousness or without its violation. Tool and laboratory diagnosis of epilepsy at children includes carrying out EEG, X-ray analysis of a skull, KT, MRT and PET of a brain, biochemical blood test and cerebrospinal fluid. The general principles of treatment of epilepsy at children assume observance of the guarding mode, therapy by antikonvulsant, psychotherapy; if necessary – neurosurgical treatment.
Epilepsy at children
Epilepsy at children – the chronic pathology of a brain proceeding with periodically repeating unprovoked spasms or their vegetative, mental, touch equivalents caused by hypersynchronous electric activity of neurons of a brain. It agrees to the statistics which is available in pediatrics, epilepsy occurs at 1-5% of children. At 75% of the adults having epilepsy, the debut of a disease is the share of children's or teenage age.
Forms occur at children, along with good-quality forms of epilepsy, malignant (progressing and resistant to the carried-out therapy). Quite often epileptic seizures at children proceed atypically, is erased, and the clinical picture not always corresponds to changes on the electroencephalogram. At children the children's neurology and its specialized section – an epileptologiya is engaged in studying of epilepsy.
The epilepsy reasons at children
As factor of an epileptogenez at children's age the immaturity of a brain which is characterized by prevalence of the processes of excitement necessary for formation of functional interneural communications acts. Besides, the epileptization of neurons is promoted by the premorbidny organic damages of a brain (genetic or acquired) causing the increased convulsive readiness. In an etiology and pathogenesis of epilepsy at children a considerable role is played the hereditary or acquired predisposition to a disease.
Development of idiopathic forms of epilepsy in children is in most cases connected with genetically caused instability of membranes of neurons and violation of neuromediator balance. It is known that in the presence of idiopathic epilepsy at one of parents, the risk of development of epilepsy in the child makes about 10%. Epilepsy at children can be associated with hereditary defects of a metabolism (a fenilketonuriya, leytsinozy, a giperglitsinemiya, mitochondrial entsefalomiopatiya), chromosomal syndromes (Down syndrome), hereditary neuroskin syndromes (a neurofibromatosis, a tuberozny sclerosis), etc.
In structure of epilepsy at children the symptomatic forms of a disease developing owing to prenatal or post-natal damage of a brain meet more often. Among prenatal factors the leading role is played by pregnancy toxicoses, a fruit hypoxia, pre-natal infections, a fetalny alcoholic syndrome, intra cranial patrimonial injuries, heavy jaundice of newborns. The early organic damage of a brain leading to an epilepsy demonstration at children can be connected with the congenital anomalies of a brain transferred the child neuroinfections (meningitis, encephalitis, arakhnoidita), ChMT; complications of the general infectious diseases (flu, pneumonia, sepsis, etc.), vaccine-challenged complications and so forth. At children with a cerebral palsy epilepsy comes to light in 20-33% of cases.
At children presumably symptomatic origin, however their reliable reasons have the cryptogene forms of epilepsy and remain obscure even when using modern methods of neurovisualization.
Classification of epilepsy at children
Depending on the nature of epileptic seizures, allocate:
1. The focal epilepsy at children proceeding with focal (local, partial) attacks:
- simple (with motive, vegetative, somatosensorny, mental components)
- difficult (with consciousness violation)
- with secondary generalization (passing into generalized toniko-clonic attacks)
2. The generalized epilepsy at children proceeding with primary and generalized attacks:
- absansam (typical, atypical)
- clonic attacks
- toniko-clonic attacks
- mioklonichesky attacks
- atonichesky attacks
3. The epilepsy at children proceeding with not classified attacks (repeated, casual, reflex, the epileptic status and so forth).
The localization caused and generalized forms of epilepsy at children taking into account an etiology are subdivided on idiopathic, symptomatic and cryptogene. Among idiopathic focal forms of a disease at children benign rolandichesky epilepsy, epilepsy most often meets occipital paroxysms, reading epilepsy; among generalized idiopathic forms – benign spasms of newborns, mioklonichesky and absansny epilepsy of children's and youthful age, etc.
Epilepsy symptoms at children
Clinical displays of epilepsy at children are diverse, depend on a form of a disease and types of attacks. In this regard we will stop only on some epileptic seizures which are found at children's age.
In the prodromalny period of an epileptic seizure the harbingers including affective violations (irritability, a headache, fear) and aura are usually noted (somatosensorny, acoustical, visual, flavoring, olfactory, mental).
At a "big" (generalized) attack the child having epilepsy suddenly faints and falls with groan or shout. The tonic phase of an attack lasts several seconds and is followed by muscles tension: a head zaprokidyvaniye, tightening of jaws, , cyanosis of the person, expansion of pupils, bending of hands in elbows, extension of legs. Then the tonic phase is replaced by clonic spasms which last 1-2 minutes. In a clonic phase of an attack noisy breath, release of foam from a mouth is noted, it is frequent – biting of language, an involuntary urination and defecation. After subsiding of spasms children usually do not react to surrounding irritants, fall asleep and recover in a condition of amnesia.
"Small" attacks (absans) at the children having epilepsy are characterized short-term (for 4-20 seconds) by consciousness switching off: dying down of a look, a stop of movements and speeches with the subsequent continuation of the interrupted activity and amnesia. At difficult absansa motor phenomena (mioklonichesky twitchings, rolling of eyeballs, reductions of face muscles), vasomotorial violations (reddening or pobledneny persons, a salivation, perspiration), motive avtomatizm can take place. Attacks of absans repeat daily and with a big frequency.
Simple focal attacks at epilepsy at children can be followed by twitchings of separate muscular groups; unusual feelings (acoustical, visual, flavoring, somatosensorny); attacks of head and abdominal pains, nausea, tachycardia, perspiration, temperature increase; mental violations.
The long course of epilepsy leads to change of the psychological status of children: at many of them the syndrome of a hyperactivity and deficiency of attention, difficulty in training, violations of behavior is observed. Some forms of epilepsy at children proceed with decrease in intelligence.
Diagnosis of epilepsy at children
Modern approach to diagnosis of epilepsy at children is based on careful studying of the anamnesis, assessment of the neurologic status, carrying out tool and laboratory researches. The children's neurologist or an epileptolog needs to know the frequency, duration, time of emergence of attacks, existence and the nature of aura, feature of a course of an attack, the postpristupny and mezhpristupny periods. Special attention is paid on presence of perinatal pathology, early organic damage of a brain at children, epilepsies at relatives.
For the purpose of definition of the site of hypererethism in a brain and forms of epilepsy the electroencephalography is carried out. At children existence of EEG-signs serves typical for epilepsy: peaks, sharp waves, peak wave complexes, paroksizmalny rhythms. As epileptic phenomena are not always found at rest, quite often there is a need of record EEG with functional tests (light stimulation, a hyperventilation, a dream deprivation, pharmacological tests etc.) of the night EEG-monitoring or long EEG-videomonitoring increasing probability of identification of pathological changes.
For definition of a morphological substratum of epilepsy at children the X-ray analysis of a skull, brain KT, MRT, PET is carried out; consultation of the children's oculist, oftalmoskopiya. For the purpose of an exception of paroxysms of a cardiogenic origin the electrocardiography and daily monitoring of the ECG to the child is carried out. For clarification of etiologichesky nature of epilepsy at children the research of biochemical and immunological markers of blood, carrying out a lyumbalny puncture with a research of tserebrospinalny liquid, definition of a chromosomal karyotype can be required.
Treatment of epilepsy at children
At the organization of the regime of the child sick with epilepsy, it is necessary to avoid overloads, disorders, in some cases – long insolation, viewing of the TV or work at the computer.
Therapy by individually picked up anticonvulsive medicines is necessary for the children having epilepsy long (sometimes lifelong). Antikonvulsanta are appointed in the monotherapy mode with gradual building of a dose before achievement of control over attacks. Traditionally for treatment of epilepsy at children various derivatives of valproyevy acid, carbamazepine, phenobarbital, benzodiazepines (diazepam), and also antikonvulsant of new generation are used (, , , to levetiratseta, etc.). At inefficiency of monotherapy additional antiepileptic medicine on doctor's orders is selected.
From non-drug methods of treatment of epilepsy at children the psychotherapy can be applied, it is BAREFOOT - therapy. Positively proved at epilepsy at children, resistant to anticonvulsive medicines, such alternative methods as hormonal therapy (AKTG), a ketogene diet, an immunotherapy.
Neurosurgical methods of treatment of epilepsy did not find broad application for children yet. Nevertheless, children have data on successful surgical treatment of epilepsy forms, resistant to therapy, by means of a gemisferektomiya, forward temporal lobectomy, an ekstratemporalny neokortikalny resection, a limited temporal resection, stimulation of the wandering nerve by means of the implanted devices. Selection of patients for expeditious treatment is made jointly with participation of neurosurgeons, children's neurologists, psychologists with careful assessment of possible risks and estimated efficiency of intervention.
Parents of the children having epilepsy have to be able to give to the child emergency aid at an epileptic seizure. At emergence of harbingers of an attack it is necessary to lay the child on a back, having exempted from close clothes and having provided free access of air. In order to avoid sticking of language and aspiration of saliva the head of the child needs to be turned on one side. For the purpose of knocking over of long spasms perhaps rectal introduction of diazepam (in the form of suppositories, solution).
The forecast and prevention of epilepsy at children
Achievements of modern pharmacotherapy of epilepsy allow to achieve complete control over attacks from most of children. At regular reception of antiepileptic medicines children and teenagers with epilepsy can lead a usual life. At achievement of full remission (lack of attacks and normalization of EEG) in 3-4 years the doctor can cancel reception of anti-epileptic medicines gradually completely. After cancellation at 60% of patients attacks do not renew further.
The epilepsy at children which is characterized by an early debut of attacks, the epileptic statuses, decrease in intelligence, lack of effect of reception of basic medicines has less favorable forecast.
Prevention of epilepsy at children has to begin even during planning of pregnancy and proceed after the child's birth. In case of development of a disease the early initiation of treatment, observance of the scheme of therapy and the recommended way of life, observation of the child at an epileptolog is necessary. The teachers working with the children having epilepsy have to be informed on a disease of the child and on measures of first-aid treatment at epileptic attacks.