The diagnosis | Childhood epilepsy

The diagnosis

In most cases, epilepsy is diagnosed after an event has occurred, in the sense of an epileptic seizure. The beginning of every epilepsy diagnosis is always a detailed medical history and a precise description of the seizures by the parents or other observers. In addition, the presence of a family history of epileptic seizures is checked, which would indicate a genetic cause.

Then, in almost all cases, an electroencephalography, or EEG for short, is performed, in which the electrical signals of the nerve cells are recorded. This is often performed at night or over several hours. Certain patterns and signal frequencies can provide good information about the basic presence of epilepsy, the possible location of an epileptic focus (triggering region) and a specific classification of the epilepsy syndrome. In many cases, an MRI is performed to identify structural, i.e. organically manifested, causes. Depending on the history of the disease, the EEG or the absence of structural abnormalities, in some cases the search is extended to genetic causes.

The treatment

There are now more than 25 different drugs used to treat epilepsy. The type of medication a child is taking depends largely on the type of epilepsy. For example, Sulitam is only approved for use in Rolando’s epilepsy.

It is not uncommon for the first drug therapy not to be able to completely suppress the development of the seizures. Often the dosage is then first increased or the related drug is combined with other anti-epileptic drugs. In rare cases this means that patients have to take up to three different antiepileptic drugs.

Most of the therapies involve long-term treatment that has to be taken for several years. But there are also many drugs for acute seizures, such as midazolam, which most parents always carry with them as an emergency medication. In recent years, other forms of therapy have been added to the classic antiepileptic drugs.

These include a special form of diet (ketogenic diet) and shock therapy with steroids. These are applied in very high concentrations for a few weeks and achieve good results for certain forms of epilepsy. Like all other therapy options, however, this steroid therapy is accompanied by significant side effects such as sleep disorders, weight gain and changes in mood. In some patients with a structural cause, surgical intervention may also be a possible treatment option. In the meantime, separate centres have been established in Germany for this special field, as sometimes very drastic interventions are necessary.

The duration

The exact duration of epilepsies in childhood is difficult to describe, since it depends on the exact form of the epilepsy and can vary greatly from one individual to another. In contrast to epilepsies in adulthood, however, it can be stated that many early forms are limited in time to childhood and adolescence and subside on their own. A very early occurring epilepsy syndrome, the West Syndrome, for example, usually begins within the first year of life and lasts only until the third year of life. But it is also an example of how early forms of epilepsy can develop into other forms that can then continue into adulthood.