Today, a disease such as epilepsy is very common among children. This pathology has been known to medicine for more than several centuries. In ancient Rome, epileptic seizures were mistaken for demonic possession and people tried to avoid sick people. In the modern world, the phenomenon in question has been carefully studied and successfully treated using complex methods. Let's look at the causes of epileptic seizures in children and figure out how to deal with this problem.

Epilepsy is a common neurological disease

Symptomatic epilepsy in children, what is it? In order to answer this question, it is necessary to delve deeper into the study of this disease. Most often, this diagnosis is made between the ages of five and six years. Slightly less often, symptoms characteristic of epilepsy appear at the end of puberty. However, experts draw attention to the fact that this disease can manifest itself at an earlier age. According to statistics, this disease is present in varying degrees of development in one percent of the world's population. That is why it is very important to know why epilepsy develops in children.

Numerous studies devoted to studying the nature of the pathology in question have not been able to give a clear answer to the question regarding the cause of the disease. According to scientists, epileptic seizures are associated with a disruption in the transmission of nerve impulses to neurons in the brain. It is precisely such disorders, caused by excess pressure exerted on the brain by the nervous system, that lead to the appearance of an epileptic crisis.

These dysfunctions of the central nervous system may be associated with the following factors:

1. Fetal development disorders. The development of epilepsy in newborns is facilitated by various pathologies that arise during gestation. There are several dozen both external and internal factors that influence the proper development of the brain. Quite often, such disorders are preceded by the woman’s use of potent medications, narcotic substances and alcoholic beverages during pregnancy. Among the internal factors, various infectious diseases and hypoxia should be highlighted. According to experts, a woman’s age is also of great importance. According to statistics, women over the age of forty significantly increase the risk of having children with various disabilities.
2. Birth anomalies. This category includes prolonged labor, asphyxia, the use of obstetric forceps and other birth injuries. Often the development of epilepsy is preceded by a long stay of the baby in the womb, where there is no amniotic fluid.
3. Infectious diseases. The development of an epileptic crisis can be one of the complications of colds and infectious diseases. According to experts, diseases such as meningitis, encephalitis and other infectious agents that affect the functioning of the brain can cause the development of the disease in question.
4. Heredity. Epilepsy is part of a group of genetic diseases. This suggests that the presence of this disease in one of the parents causes a predisposition to the disease in the baby.

Epilepsy in children is significantly different from epilepsy in adults

According to scientists, the development of epileptic seizures can be facilitated by traumatic brain injuries, concussions and cancer. Often, epileptic seizures occur when there is a lack of useful microelements in the body. These elements include: magnesium and zinc.

The first manifestations of an epileptic crisis

The first signs of epilepsy in infants have certain differences from the “adult” disease. That is why it is very important for parents to pay increased attention to the health of their children in the first years of life. There are several dozen types of epilepsy, and not all of the attacks are accompanied by convulsions characteristic of the disease. That is why such manifestations of the disease can be easily confused with other diseases. Among the most common symptoms are the following:

1. Screaming combined with trembling in the limbs. During an attack, the child spreads his arms wide and begins to wave them. The trembling itself is asymmetrical and affects only one limb.
2. “Frozen” in one position and lack of response to external stimuli for a short period of time. Often this condition is accompanied by muscle spasms on one side of the body. Small spasms begin in the face area, gradually moving to the lower half of the body.
3. During an epileptic crisis, a child may freeze in an awkward position for several seconds. In this situation, the baby experiences a sudden change in skin color. To a large extent, such changes affect the area of ​​the face, which turns purple or pale.

Important! The presence of one or more of the symptoms described above is a strong argument for seeking help from a specialist in the field of neurology.

Epilepsy is a chronic, long-term disease caused by various lesions of the central nervous system

The most common types of epilepsy

There are more than forty different forms of the disease in question, each of which has its own characteristic features. However, in most cases, patients exhibit one of the following forms of the disease:

1. Idiopathic. According to statistics, this form of the disease has the highest prevalence today. In the initial stages of the disease, patients experience convulsive spasms. During an attack, the baby straightens his limbs due to increased muscle tone. Often an epileptic crisis is accompanied by increased salivation. In severe forms of idiopathic epilepsy, the patient may lose consciousness for several minutes.
2. Rolandic. This form of the disease is a derivative form of idiopathic epilepsy. The first signs of this pathology appear between the ages of three and thirteen years. Experts draw attention to the fact that this disease can disappear on its own closer to the end of puberty. Symptoms of Rolandic epilepsy in children manifest themselves in the form of unilateral seizures, tingling and numbness in the tongue and lower jaw, and problems associated with the functioning of the speech apparatus. At the onset of puberty, these attacks may occur frequently, but at a certain stage of growing up they completely disappear.
3. Absence. In the case of this form of the disease, the characteristic clinical symptoms characteristic of the disease are completely absent. During an attack, the child freezes and stops responding to external stimuli. In this state, there is a sharp increase in muscle tone, which alternates with relaxation. In this condition, the child may suffer from cramps in the stomach area, severe headaches and bouts of nausea. Against the background of an epileptic crisis, there is a slight increase in body temperature and increased heart rate. According to statistics, the absence form of epilepsy in most cases occurs in girls between the ages of five and ten years.

The first signs of epilepsy in a child may appear several days before the onset of the crisis itself. A similar condition in medicine is described using the term “aura”. The main harbingers of the upcoming crisis are changes in behavior, problems with sleep, increased irritability and moodiness.

Danger of epileptic seizures

The danger of epilepsy is explained by the fact that the seizure itself can occur at any time of the day, which can lead to catastrophic consequences for the patient. Often, sudden onset attacks lead to falls and injuries. People around the child may not have time to react correctly, which causes a fall on hard surfaces.

Spasms throughout the body can cause the patient to hit his head on the floor, which leads to a concussion.

The manifestations of epilepsy are as varied as the causes that caused them.

Nocturnal epilepsy has an increased risk compared to daytime seizures. Left alone with himself, a child may die due to attacks of suffocation provoked by vomit entering the respiratory organs. In addition, emotional instability, which manifests itself in the form of increased irritability, causeless aggression and tearfulness, poses a danger to psycho-emotional health. Also, it is worth mentioning the high risk of status epilepticus, a condition in which the duration of an attack can last for thirty minutes.

In such a condition, destructive processes develop in the patient’s head, which negatively affect intellectual development. Status epilepticus disrupts neural connections in certain parts of the brain, which can lead to unpredictable consequences.

Treatment methods

Treatment of the disease in question involves an integrated approach. In the first stages of therapy, it is very important to create a favorable atmosphere for the child’s development. Experts recommend paying increased attention to the emotional state of the baby. Children suffering from epileptic seizures are not recommended to spend a lot of time watching TV or computer.

Medications should be used only after a correct diagnosis has been made. Often, patients need lifelong use of medications. Most often, in the initial stages of treatment of the disease, patients are prescribed anticonvulsants. The dosage and regimen are prescribed by the doctor based on the individual characteristics of the patient’s body and the severity of clinical symptoms. Depending on how the symptoms of epilepsy manifest in children, the doctor may supplement the treatment regimen with hormonal drugs and immunomodulators. Psychocorrection sessions play a significant role in the treatment of epilepsy.

What to do during an epileptic crisis

It is important for parents of children suffering from epileptic seizures to know how to deal with the manifestations of this disease. At the time of an attack, it is very important to provide competent assistance to the child and protect him from possible injuries. To do this, you should lay the baby on a soft surface with a pillow under his head.

In order to avoid attacks of suffocation due to vomit entering the respiratory organs, the child’s head should be positioned correctly. Experts recommend turning the patient's head to the side, placing a clean handkerchief on the tongue. In a situation where the patient's mouth is closed, no attempt should be made to disengage his teeth, as this can lead to injury to the lower jaw.

Seizures are the classic, most characteristic and striking manifestation of the disease.

It is very important to properly organize access to fresh air. To do this, it is recommended to completely remove outer clothing in order to relieve pressure on the neck. If the duration of the attack exceeds three minutes, you should immediately call an ambulance, as the risk of respiratory arrest increases.

A child diagnosed with epilepsy should never be left alone during water procedures. You should also constantly monitor the state of the immune system and take timely measures to treat colds. In general, the prognosis of this disease is very ambiguous. Timely contact with a specialist and regular use of medications can achieve long-term remission. In the event that symptoms characteristic of an epileptic crisis are absent for five years, drug treatment may be discontinued.

Children suffering from epilepsy need not only drug therapy, but also moral support from their immediate environment. People with a similar problem have difficulty adapting to society, so when raising children they should show maximum loyalty to various pranks. Parents, first of all, should teach their children to cope with stressful situations and manage their condition. Various relaxation techniques, physical therapy and yoga will help with this.

Signs of epilepsy in children, noticed for the first time, seriously frighten parents. Severe convulsive seizures that suddenly seize a healthy-looking baby seem like a bolt from the blue.

The first thing moms and dads need to do is pull themselves together and examine the baby. Then you need to learn as much as possible about epilepsy in children and master the techniques of effectively helping the patient. It is important to understand: the disease is serious and insidious, but it can be controlled and treated if adequate conditions are created for this.

What is epilepsy in children? Medical studies have shown that this pathology is neurologically chronic and is caused by abnormal brain activity. It affects every one of the hundred inhabitants of our planet. Children with epilepsy are diagnosed several times more often than adults. The main target of falling illness is babies under one year old.

The mechanism of development of epileptic seizures is associated with an increase in a certain area of ​​the brain in the bioelectrical activity of its functional structures - neurons. These cells form a focus of congestive pathological excitation, the so-called epileptic focus. When, for one reason or another, a bioelectric impulse is discharged, activating the cells of the entire brain, an attack of epilepsy occurs.

The child falls unconscious, his body shakes in convulsions. After a few minutes, the tension gives way to muscle weakness. This is a manifestation of the fact that the electrical activity of neurons fades and goes into a “sleeping” mode. With the return of consciousness, the patient does not remember what happened.

Causes of the disease

In order to choose the right strategy for correcting the disease, you need to find out its etiology. Doctors distinguish several causes of epilepsy in children:

1. Heredity. Scientists have identified a substance—dopamine—that is responsible for inhibiting overexcited neurons. Its volume is programmed in the genes: if parents have epileptic seizures, then there is a chance that their offspring will inherit them.
2. Malformations of the fetal brain. The health of the future person in the womb is influenced by everything: at what age she conceived (middle-aged first-born women are included in the risk group), what illness she had, how she was treated, whether she abused drugs or alcohol. Poisoning of the embryo with toxic substances is the main cause of brain pathologies.
3. Birth injuries. The causes of epilepsy often lie in the excesses that accompany the birth process. The baby's brain can be damaged by the midwife's forceps, prolonged labor, or squeezing the newborn's neck with the umbilical cord.
4. Inflammatory diseases of the brain and its membranes: encephalitis, meningitis, arachnoiditis.
5. Febrile convulsions during colds can reveal epilepsy in children with a family history.
6. Traumatic brain injuries. Mechanical blows to the head often lead to the appearance of epileptogenic foci in the brain.
7. Volumetric neoplasms. Tumors pressing on the brain can cause seizures in children.
8. Metabolic disorders manifested by hyponatremia, hypocalcemia, hypoglycemia.
9. Cerebral blood flow disorders.
10. Teenagers' addiction to ephedrine, amphetamines and other drugs.

Important: the inflammatory disease “meningitis” can be fatal! It is very important to be able to recognize it in time. How? Read the answer.

Types of disease

Depending on the pathogenesis, epilepsy in childhood is differentiated by specialists into three groups:

• idiopathic: stated if the symptoms of the disease appear as a result of a genetic factor, but without significant pathologies in the brain;
• symptomatic: considered a consequence of brain defects due to developmental anomalies, injuries, neoplasms;
• cryptogenic: recorded by doctors in cases where the disease appeared due to unidentified causes.

Symptomatic epilepsy in children differs in the area of ​​localization of the pathogenic focus.

And depending on its location, it manifests itself in several types:

• frontal;
• parietal;
• temporal;
• occipital;
• chronic progressive.

The listed types of epilepsy manifest themselves in different ways. For example, frontal occurs only at night; For the temporal lobe, blackouts of consciousness without pronounced convulsive symptoms are characteristic.

Finding out the causes of the disease and its type helps to choose an adequate line of combating it. However, this is not enough for successful treatment: it is important to promptly recognize the first signs of epilepsy in a child.

Main signs of the disease

Symptoms of epilepsy in children are sometimes mistaken by hapless adults for excessive physical activity. This is the main reason for the late detection of a dangerous disease. Another common mistake is to think that an epileptic seizure can only involve convulsions and foaming at the mouth.

In order not to waste precious time, parents of children need to have a detailed understanding of the clinical picture by which childhood epilepsy is recognized.

Its features are quite diverse:

1. Generalized convulsive seizures. They begin with an alarming harbinger - an aura. At this stage, the patient feels something like a breath running through the body or other unusual sensations. Then comes the stage of sharp muscle tension and holding the breath - the child falls screaming. The turn of convulsions comes, the eyes roll back, foam appears at the mouth, spontaneous urination and bowel movements may occur. Convulsive twitching can affect the entire body or muscle group. The attack lasts a maximum of 20 minutes. When the convulsions stop, the patient comes to his senses for a few moments and immediately falls asleep, exhausted.
2. Nonconvulsive (minor) seizures. These not always noticeable attacks of epilepsy in children are called absence seizures. It all starts with the baby suddenly freezing with a blank look. It happens that the patient’s eyes are closed and his head is thrown back. For 15-20 seconds he does not perceive anything. Having emerged from a painful stupor, he returns to the interrupted business. From the outside, such pauses may seem thoughtful or absent-minded.
3. Atonic seizures. The manifestation of attacks of this kind consists of a sudden loss of consciousness and muscle relaxation. They are often mistaken for fainting. The frequency of such conditions should be alarming.
4. Baby spasm. Epilepsy in a baby can be manifested by a sharp raising of the arms to the chest, an involuntary tilt of the head and body forward when straightening the legs. This happens most often with children 2-4 years old when waking up in the morning. The attack lasts for several seconds. By the age of 5, the alarming manifestations of the disease either disappear or take a different form.
5. Speech disturbance for several minutes while maintaining consciousness and the ability to move.
6. Frequent nightmares, causing the baby to wake up screaming and crying.
7. Sleepwalking.
8. Regular headaches, sometimes causing nausea and vomiting.
9. Sensory hallucinations: visual, olfactory, auditory, gustatory.

The last four signs do not necessarily indicate epilepsy. If such phenomena begin and begin to recur repeatedly, parents need to conduct a psychoneurological examination of the child.

The question of how to recognize epilepsy in a child under one year old is extremely important. In infancy, the disease often progresses atypically. Parents need to be extremely attentive to the condition and behavior of the newborn.

The initial stage of epilepsy in children under one year of age is characterized by the following signs:

• sudden fading;
• cessation of swallowing movements;
• throwing back the head;
• trembling eyelids;
• an empty, seeing nothing look;
• complete contactlessness.

After this, loss of consciousness and convulsions occur, not always accompanied by spontaneous bowel movements and urination. It should be noted that epilepsy in children under one year of age has a kind of prelude and completion. Harbingers of an attack are increased tearfulness, excessive excitability, and febrile temperature. After the seizure ends, the baby does not always fall asleep.

Diagnostic methods

Diagnosis of epilepsy in children involves a step-by-step examination of a small patient:

1. Taking an anamnesis: finding out the moment of the first attacks, symptoms accompanying the attack, conditions of intrauterine development and childbirth, the presence of neurological diseases and addictions in parents.
2. Basic instrumental technique: electroencephalographic study with video recording, which provides complete information about the bioelectric activity of the brain and the occurrence of defects in its structure.
3. Additional methods used to clarify the diagnosis and establish the cause of the disease: MRI and CT scan of the brain, blood tests to determine metabolic and immune status, lumbar puncture.
4. Studies as part of differential diagnosis: ophthalmoscopy, ultrasound of the cardiovascular system and other examinations prescribed by the attending physician.

Such an extensive diagnostic complex allows you to confidently confirm or exclude the presence of epilepsy.

On the road to healing

To the question of whether epilepsy in children can be treated, today's medicine gives a positive answer. The success of therapy depends both on the professionalism of the doctors and on the attitude of the parents.

The latter must be prepared for the fact that it will take a long time to treat epilepsy in a son or daughter, without interrupting the course even for a day.

What is required from parents:

• provide the baby with a diet with limited fluid and salt;
• organize a rational daily routine with leisure breaks;
• eliminate stressful situations;
• limit your child’s access to TV and computer;
• make it a habit to walk in the fresh air, but avoid prolonged exposure to the sun or independent swimming in a pond or bath;
• Encourage your child to play safe sports: badminton, tennis, cross-country skiing, etc.

During a seizure, you need to place the baby on his side in a safe place. You cannot restrain convulsions, unclench your jaws, or give medicine or water. The main task of the parents of an epileptic is to prevent him from harming himself.

Drug treatment of epilepsy in children is determined taking into account the age characteristics and condition of the patient. The main role is given to anticonvulsants.

In the symptomatic form of the pathology caused by a tumor in the brain, the patient can be cured surgically. Before the operation, a consultation of a neurosurgeon, neurologist and psychotherapist gathers, the risks of invasive intervention and the opinion of the parents are taken into account.

If the danger of the operation is too high, the question is “how to treat the patient?” decided in favor of drug therapy.

Disease prognosis

In 80% of cases, persistent and long-term treatment of epilepsy in children leads to relief from a serious illness. The immediate environment of little epileptics should help them develop normally and find their place in society. Patience, wisdom and love of parents play a huge role in this.

Epilepsy is a polyetiological disease characterized by repeated epileptic seizures (a stereotypical behavioral disorder, which is confirmed by electroencephalographic changes). The incidence of disease per year on a global scale is 0.04%, with fluctuations observed at different periods of life: in early childhood, 9 people out of 10,000 get sick, on average - 2 people, and after 60 years - 6 people out of 10,000 Every 150th person suffers from an epileptic disease, and in 20%-30% of them this condition accompanies them throughout their lives.

Description

Symptomatic epilepsy is a pathological condition that arose as a “complication” of various injuries, infectious and other diseases. Therefore it is considered secondary. Common to this group of conditions are poorly controlled seizures of various types: tonic-clonic, atonic, myotonic and simple partial and anamnestic findings.

According to ICD 10, symptomatic epilepsy is divided into generalized and those forms in which the focus of pathological excitation is localized. The first group consists of West syndrome, Lennox-Gastaut syndrome, epilepsy with myoclonic-astatic seizure and epilepsy with a predominance of myoclonic absence.

The latter include Kozhevnikov syndrome, seizures and forms of epilepsy with a known localization of the epileptic focus (frontal, temporal, parietal, occipital).

Etiology of the disease

Traumatic brain injury is considered a common cause of symptomatic epilepsy. It was found that the statute of limitations for receiving the damage does not matter, which means that attacks can debut even after a long time. Among children, symptomatic epilepsy can be detected as a consequence of birth damage to the central nervous system, intrauterine infection of the fetus, or congenital developmental anomalies. Brain tumors are considered one of the common reasons for diagnosing epilepsy in adulthood.

According to the study, it was revealed that most often the epileptoid focus was located in the frontal-parietal region of the cerebral cortex. But it is also possible to simultaneously form several areas of pathological excitation in several lobes of the brain.

Forms of the disease with localized brain damage

Symptomatic partial epilepsy with a clearly localized focus is the most common type. An electroencephalogram is used to determine the location of pathological impulses, and magnetic resonance imaging is used to determine the size and shape. But, unfortunately, MRI does not visualize the lesion in cases where it is small. In the absence of contraindications to surgical interventions, this type of treatment is used quite successfully, and the remission rate is more than half.

Symptomatic frontal lobe epilepsy accounts for 20-30% of all symptomatic and cryptogenic partial forms of the disease. Within its framework, the following epileptic syndromes are distinguished: motor frontal epilepsy, dorsolateral, anterior and frontobasal, cingulate frontal epilepsy. They differ in the location of the focus in the cerebral cortex, so the clinical picture of the attacks also varies. An aura of an uncertain nature with a feeling of fear is noted. The feeling of control over one’s own behavior disappears, the patient complains of “thoughts being made,” “that someone has gotten into his head.” There is a marked violation of intellectual and mnestic functions: memory, speech, writing; handwriting changes. Frontobasal epilepsy is characterized by attacks of olfactory hallucinations. Quite often, peculiar paroxysms with complex motor acts and vocalizations occur. The structure of the attacks contains sexual automatisms. Gesture automatisms are characteristic of all epileptic syndromes; sometimes they are accompanied by emotional upsurge and vocalization.

Temporal and parietal localization of the pathological focus.

Symptomatic temporal lobe epilepsy is more responsive to treatment than frontal lobe epilepsy. It is characterized by simple myoclonic seizures (the so-called aura) and complex ones. Patients report the appearance of taste or olfactory hallucinations. There are also often complaints of strange discomfort in the abdominal area that spreads upward.

The mental state is also disturbed: the patient is depersonalized, loses the sense of time and space. May note “thoughts imposed by someone”, feelings of fear, anxiety. Complex partial seizures manifest themselves in the form of motor automatisms: constant swallowing, nodding, sucking movements, stereotypical movements of the arms and hands.

Symptomatic partial epilepsy can occur when the lesion is located in the occipital lobe. Manifestation of the disease is possible at any age. Clinical manifestations include visual disorders (hallucinations, illusions, paroxysmal retinal damage, narrowing of visual fields), oculomotor and autonomic disorders and associative manifestations (acalculia, anosognosia, apraxia). Patients often complain of a headache that resembles a migraine.

Kozhevnikov syndrome

According to the ICD, this complex, rapidly progressing pathological condition of the brain belongs to special epileptic syndromes. It is caused by infectious agents. It manifests itself with clonic twitching of the muscles of the arm and face in combination with increasing disturbances of mental functions and paralysis of one half of the body. The etiology of the disease is currently not fully understood. Presumably it is of viral etiology, however, blood and cerebrospinal fluid tests for the pathogen did not give definite results. There are three main causes of the pathological process: acute and chronic infectious diseases,
caused by viruses and autoimmune damage to cells of the cerebral cortex.

The onset of Kozhevnikov syndrome is preceded by previous infectious diseases. It begins with simple motor attacks without loss of consciousness or seizures that occur in one muscle group and tend to spread. In the first stages of the disease, unstable hemiparesis develops, which later becomes permanent. As the disease progresses, 60% of patients develop “Kozhevnikov epilepsy”: myoclonic seizures localized in one half of the body and limbs, which can develop into general convulsive seizures. This condition is initially paroxysmal in nature and then becomes permanent.

There are three stages of disease development:

1. Begins with focal motor seizures without impairment of consciousness, preceded by a somatosensory aura. Transient hemiparesis and myoclonic seizures on one side may occur. The frequency of registration of attacks is increasing. This stage lasts from several weeks to several months;
2. The attacks appear more frequently and last longer. Hemimyoclonus affects more and more muscle groups. After an attack, symptoms of prolapse are often detected, which last for quite a long time. Hemiparesis changes from temporary to permanent. Higher intellectual functions and speech deteriorate, visual fields disappear. Sensitivity on the side opposite to the lesion is impaired;
3. At this stage, neurological disorders progress and the number of attacks decreases. In a quarter of cases, endocrine disorders appear: pathological weight gain, early puberty. This stage occurs within three years.

An MRI study of the brain visualizes foci of hemiartrophy, which are usually localized in the temporal region in the form of a locally widened Sylvian fissure. PET is informative already at the initial stage. There is interictal hypoperfusion and decreased metabolism in the affected areas.

Unfortunately, this type of epilepsy is one of the types that is resistant to treatment. Drug therapy is more symptomatic and supportive. There is no etiotropic treatment. Neurosurgical intervention is considered the only method that can significantly increase the patient’s chances. But this is possible only at the very beginning of the disease. Postoperative remission is 25-30%.

Generalized forms

Epilepsy, in which the structures of the brain are not damaged and which has clear specific changes in the normal encephalogram, is called generalized. According to ICD 10, these include West and Lennox-Gastaut syndromes, epilepsy with myoclonic astatic seizure and epilepsy with myoclonic absence seizures. The causes of their occurrence are birth injuries, infectious diseases suffered by the mother during pregnancy, TORCH infections.

Lennox-Gastaut syndrome develops in children at an early age. It is manifested by a variety of attacks, distinctive changes in the electroencephalogram and pronounced impairments of such important functions as memory, speech, attention, coordination. Treatment of this disease is complex and not always successful.

The onset of the disease occurs between the ages of three and five years. Seizures are characterized by high polymorphism; the most common combination is considered to be tonic axial, atypical absences and falls in combination with status epilepticus; most seizures occur in the early hours after waking up. The pathognomonic sign of the syndrome is impairment of memory and higher brain functions. The ability to perceive and remember new material decreases. The prognosis is often unfavorable, but with timely surgical intervention and adequate drug treatment, it is possible to improve the patient’s condition.

Epilepsy with a predominance of myoclonic-astatic seizures is diagnosed in a small percentage of cases. It mainly affects males, and the disease manifests itself before 12 months from birth. The most common onset of the disease is myoclonic spasms, which affect only one half of the body with the addition of autonomic disorders and impaired consciousness. In other cases, convulsions occur due to an increase in body temperature.

Tissardi syndrome or epilepsy with myoclonic absences, respectively, ICD, refers to benign forms of this pathology. This disease accounts for only 1% of all generalized epilepsies. It is characterized by attacks in the form of short, jerky twitches of the muscles of the shoulder girdle and arms. They are symmetrical and synchronous. Myoclonus of the neck muscles manifests itself in the form of rhythmic nodding movements. Facial muscles are not involved. The attacks last up to one minute and occur quite often. Hyperventilation may be a provoking factor. Tissardi syndrome is a treatment-resistant form. When valproic acid is used in large doses, persistent improvement is achieved in half of the patients. But due to significant intellectual and mnestic impairments, adaptation to society in these patients presents certain difficulties.

Diagnostics

The diagnostic standard for detecting epilepsy is a neurological examination, electroencephalogram and MRI. All other methods are optional and not particularly informative.

Due to the variety of manifestations, diagnosis is very difficult. A neurological examination reveals signs of pyramidal insufficiency and coordination disorders (instability in the Romberg position, inability to perform a finger-nose test, dichdiadochokinesis). Intelligence decreases, and it is difficult to perform those logical tasks that the patient previously solved with ease.

Magnetic resonance imaging is important for the differential diagnosis of symptomatic epilepsy with brain tumors, congenital structural anomalies, vascular diseases of the head, cysts, multiple sclerosis and other pathological conditions.

The electroencephalogram shows changes that are provoked by epileptic activity. With its help, you can determine the localization of the focus and the form of epilepsy.

Principles of therapy

It is preferable to start treatment with carbamazepine monotherapy; if it is ineffective, Finlepsin, Topamax, Depakine can be used. The use of valproate has worked well for generalized attacks.

The symptomatic form implies the presence of an anatomical defect of the brain, the data of which is confirmed by the results of electroencephalography or symptoms of epileptic seizures, depending on the location of the damaged area.

Pathogenesis of symptomatic epilepsy

In this state of the body, a pathologically active focus of neuronal excitation is formed at the cellular level in one of the hemispheres of the brain. This focus is surrounded by a “protective wall” with the direct participation of antiepileptic structures, which for some time restrain the excess electrical charge. But there comes a moment when the charge, having accumulated, becomes excessive, and the “protective shaft” breaks through. The result of this is a rapid spread of excitation to both hemispheres and... an epileptic seizure. In childhood, the excitability of brain structures is significantly increased, which explains the high incidence among children before the onset of puberty: more than 80% of first-time attacks are recorded in the first few years of life.

Making a diagnosis

To make a diagnosis of “symptomatic”, the following tests must be performed.

— Magnetic resonance imaging of the brain. This study allows us to determine the area of ​​the brain where these changes occurred, as well as the extent of these changes.

— Video-electroencephalographic monitoring, which can record local epileptic activity. The most successful option is considered to be recording epileptic seizures that begin partially.

— If it is not possible to record the attacks themselves, then the affected area can be determined by the symptoms of the attacks. However, such a characterization may not be accurate, since sometimes there are cases when an attack begins in the temporal region and continues in the frontal region.

Also, the main methods for diagnosing symptomatic epilepsy include: computed tomography, craniography, echoelectroencephalography, angiography, pneumoencephalography, examination of the fundus and cerebrospinal fluid.

Causes of symptomatic epilepsy in children

There are several reasons that provoke the development of symptomatic epilepsy in children.

The largest number of diseases are a consequence of hypoxia, both intrauterine and asphyxia during childbirth and congenital malformation of the brain. According to statistics, over 75% of children suffering from brain dysplasia have epileptic seizures in the clinic, which occur before the age of 5 when the body temperature rises above 38⁰C. Previous infectious and specific meningitis, encephalitis, as well as received traumatic brain injuries - concussions and bruises of the brain, can provoke the development of symptomatic epilepsy. Epilepsy is often caused by severe infections and intoxications, as well as brain tumors and various genetic diseases, such as neurofibromatosis, Sturge-Weber disease, hepatolenticular degeneration (Wilson-Konovalov disease), tuberous sclerosis. Among the causes of epilepsy, doctors also identify cerebrovascular accidents and leukoencephalitis.

Classification of symptomatic epilepsy

The following forms of epilepsy are determined by the prevalence of the pathological process in the brain:

- localized form - the epileptic focus is localized in a separate area of ​​the cerebral cortex (temporal, frontal, parietal, multifocal, occipital);

- generalized - characterized by pathologically increased excitability of all parts of the brain;

Lennox-Gastaut syndrome.

Lennox-Gastaut syndrome (LGS) is an epileptic encephalopathy of childhood, characterized by polymorphism of seizures, specific EEG changes and resistance to therapy. The frequency of LGS is 3-5% among all epileptic syndromes in children and adolescents; Boys get sick more often.

The disease debuts mainly at the age of 2-8 years (usually 4-6 years). If LGS develops during transformation from West syndrome, then there are 2 options:

Infantile spasms are transformed into tonic seizures in the absence of a latent period and smoothly turn into LGS.

Infantile spasms disappear; the child’s psychomotor development improves somewhat; the EEG picture gradually normalizes. Then, after a certain latent period of time, which varies in different patients, attacks of sudden falls, atypical absences appear, and diffuse slow peak-wave activity on the EEG increases.

LSH is characterized by a triad of attacks: paroxysms of falls (atonic- and myoclonic-astatic); tonic seizures and atypical absence seizures. The most typical attacks are sudden falls caused by tonic, myoclonic or atonic (negative myoclonus) paroxysms. Consciousness can be maintained or switched off briefly. After the fall, there are no convulsions, and the child gets up immediately. Frequent attacks of falls lead to severe trauma and disability of patients.

Tonic seizures can be axial, proximal or total; symmetrical or clearly lateralized. Attacks include sudden flexion of the neck and torso, raising the arms in a state of semiflexion or extension, straightening the legs, contraction of the facial muscles, rotational movements of the eyeballs, apnea, and facial flushing. They can occur both during the daytime and, especially often, at night.

Atypical absence seizures are also characteristic of LGS. Their manifestations are diverse. The impairment of consciousness is incomplete. Some degree of motor and speech activity may remain. Hypomimia and drooling are observed; myoclonus of the eyelids, mouth; atonic phenomena (the head falls on the chest, the mouth is slightly open). Atypical absence seizures are usually accompanied by a decrease in muscle tone, which causes the body to “go limp,” starting with the muscles of the face and neck.

The neurological status shows manifestations of pyramidal insufficiency and coordination disorders. A decrease in intelligence is characteristic, but does not reach a severe degree. Intellectual deficit is detected from an early age, preceding the disease (symptomatic forms) or develops immediately after the onset of attacks (cryptogenic forms).

An EEG study in a large percentage of cases reveals irregular diffuse, often with amplitude asymmetry, slow peak-wave activity with a frequency of 1.5-2.5 Hz during wakefulness and fast rhythmic discharges with a frequency of about 10 Hz during sleep.

Neuroimaging may reveal various structural abnormalities in the cerebral cortex, including developmental defects: hypoplasia of the corpus callosum, hemimegalencephaly, cortical dysplasia, etc.

Drugs that suppress cognitive function (barbiturates) should be avoided in the treatment of LGS. The most commonly used drugs for LSH are valproate, carbamazepine, benzodiazepines, and lamictal. Treatment begins with valproic acid derivatives, gradually increasing them to the maximum tolerated dose (70-100 mg/kg/day and above). Carbamazepine is effective for tonic seizures - 15-30 mg/kg/day, but can increase absence seizures and myoclonic paroxysms. A number of patients respond to an increase in the dose of carbamazepine with a paradoxical increase in attacks. Benzodiazepines are effective for all types of seizures, but the effect is temporary. In the group of benzodiazepines, clonazepam, clobazam (Frisium) and nitrazepam (radedorm) are used. For atypical absence seizures, suxilep may be effective (but not as monotherapy). The combination of valproate with lamictal (2-5 mg/kg/day and higher) has been shown to be highly effective. In the United States, the combination of valproate and felbamate (thalox) is widely used.

The prognosis for LGS is severe. Stable control of attacks is achieved only in 10-20% of patients. The predominance of myoclonic seizures and the absence of gross structural changes in the brain are prognostically favorable; negative factors are the dominance of tonic seizures and severe intellectual deficit.

Epilepsy with myoclonic-astatic seizures.

Myoclonic-astatic epilepsy (MAE) is one of the forms of cryptogenic generalized epilepsy, characterized mainly by myoclonic and myoclonic-astatic seizures with onset in preschool age.

The debut of MAE varies from 10 months. up to 5 years, averaging 2.3 years. In 80% of cases, the onset of attacks occurs within the age range of 1-3 years. In the vast majority of patients, the disease begins with GSP, followed by the addition of myoclonic and myoclonic-astatic seizures at the age of about 4 years.

Clinical manifestations of MAE are polymorphic and include various types of seizures: myoclonic, myoclonic-astatic, typical absences, DBS with the possibility of partial paroxysms. The “core” of MAE are myoclonic and myoclonic-astatic seizures: short, lightning-fast twitches of small amplitude in the legs and arms; “nods” with slight propulsion of the body; “kicks to the knees.” The frequency of myoclonic attacks is high, especially in the morning after patients awaken. GSP is observed in almost all patients, absence seizures – in half. The addition of partial seizures is possible in 20% of cases.