Introduction
The basic definition of epilepsy in children is no different from that of adults. The disease of epilepsy describes a functional disorder of the brain in which groups of nerve cells synchronise for a short time and discharge very quickly, which then leads to an epileptic seizure. The exact type of epileptic seizure depends on the location of this group of nerve cells and can either affect the entire brain (generalised) or remain local (focal).
With a proportion of 0.5%, epilepsy is not a rare clinical picture in children. The clear distinction between fever fights should be mentioned here, as these are not automatically assigned to the form of epilepsy. An epilepsy which begins in childhood is associated with the risk of a reduction in intelligence. Approximately 30% of all affected children suffer from a reduction in intelligence in the course of their lives. It is also known that some epilepsy syndromes only develop in childhood and subside until the end of childhood, such as Rolando’s epilepsy or Landau-Kleffner syndrome.
The causes
The possible causes of childhood epilepsy are very diverse and in some cases not yet well understood. The causes are divided into the following three main groups: structural, genetic, idiopathic. The term structural causes covers all organic disorders of the brain, such as changes in anatomy, the condition following a craniocerebral trauma, tumours, cerebral haemorrhages, but also rare diseases such as tuberous sclerosis (TSC).
The proportion of patients with a defined genetic predisposition has been broken down more and more in recent years. Thus, individual genes have been identified which, when mutated, lead to the development of epilepsy or increase the risk of it. The group of idiopathic epilepsies includes all forms of epilepsy for which no exact cause can be identified. Depending on the form of epilepsy, this proportion is 70%. In recent decades, there has been a growing understanding that the development of epilepsy is usually not the result of a specific circumstance, but rather that many different favourable factors must come together to lead to its development.
The symptoms
The main symptom of epilepsy is always the presence of epileptic seizures. However, they vary considerably in their severity and range from small twitches, through brief twilight states, so-called absences, to grand mal seizures, which are accompanied by twitches and tenseness of the muscles affecting the whole body, as well as a loss of consciousness. It is therefore not always easy for parents to identify the epileptic seizures in their children as such.
This is particularly the case with very early forms of epilepsy, such as West’s syndrome. This is accompanied by so-called infantile spasms in which the arms are folded together in front of the chest and the head is tilted forward. For the untrained eye it is extremely complicated to distinguish this movement from normal motor activity.
Besides these motor seizures, there are also so-called absence epilepsies. These are accompanied by a brief twilight state which the affected person cannot remember. Often these states are noticed at school and the children are described as always digressive and unfocused.
However, reaching developmental stages too slowly or even losing what has already been learned can also be an indication of certain epilepsy syndromes and should be clarified with regard to this question. . There are numerous forms of epilepsy in children which occur only or more frequently from sleep.
One of the most common forms of epilepsy in children, the so-called Rolando’s epilepsy, for example, is characterised by cramps and twitches of the muscles of the throat, tongue and one half of the face at night, which can then spread to the whole body. However, other forms, such as Lennox-Gastaut Syndrome, are also associated with various nocturnal seizures. Other epilepsy syndromes that are associated with a nocturnal accumulation of seizures are CSWS or Ohtahara syndrome. It is currently assumed that the accumulation of seizures during the night is due to a stronger basic synchronisation of the nerve cells, which can thus switch over more quickly to a greater synchronisation