Epilepsy & Seizure in Children

What is Epilepsy?

Electrical activity is happening in our brain all the time, as the cells in the brain send messages to each other. A seizure happens when there is a sudden burst of intense electrical activity in the brain. This causes a temporary disruption to the way the brain normally works. The result is an epileptic seizure. When a child has epilepsy, it means they have a tendency to have seizures. Anyone can have a one-off seizure, but this doesn’t always mean they have epilepsy.

Epilepsy in children is usually only diagnosed if someone has had more than one seizure. Epilepsy can start at any age and there are many different types. Some types of epilepsy last for a limited time and the person eventually stops having seizures. But for many people epilepsy is a lifelong condition.

What causes Epilepsy in Children?

    Sometimes, doctors can find a clear cause for a child epilepsy. Possible causes of epilepsy include:
  • Stroke
  • A brain infection, such as meningitis
  • Severe head injury
  • Problems during birth which caused the baby to get less oxygen

But in over half of all children with epilepsy, doctors don’t know what caused it. Some may have a family history of epilepsy, suggesting that they may have inherited it.

How is epilepsy diagnosed?

The main way doctors diagnose epilepsy is by taking a detailed description of the seizures. They may also arrange for some tests to help give them more information about the possible type and cause of the epilepsy. This can also help rule out any other conditions that could be causing seizures. These tests can include blood tests, an EEG (recording of the brainwaves) and brain scans. But there isn’t a single test that can prove if someone does or does not have epilepsy.

How is epilepsy treated?

The main treatment for epilepsy is epilepsy medicines. These are sometimes called anti-epileptic drugs or AEDs. The medicine doesn’t cure epilepsy, but helps to stop or reduce the number of seizures.

If epilepsy medicine doesn’t work well for someone, their doctor might suggest other types of treatment. Other types of treatment include brain surgery, another type of surgery called vagus nerve stimulation, and a special diet called the ketogenic diet which is sometimes used for children.

Cerebral Palsy Diagnosis & Treatment for Children

Cerebral palsy (CP) in children is a disorder that affects muscle tone, movement, and motor skills (the ability to move in a coordinated and purposeful way). CP usually is caused by brain damage that happens before or during a baby's birth, or during the first 3 to 5 years of a child's life. This brain damage also can lead to other health issues, including vision, hearing, and speech problems; and learning disabilities. There is no cure for CP, but treatment, therapy, special equipment, and, in some cases, surgery can help kids who have CP.

    There are primarily three types of CP:
  • spastic cerebral palsycauses stiffness and movement difficulties
  • dyskinetic (athetoid) cerebral palsyleads to involuntary and uncontrolled movements
  • ataxic cerebral palsycauses a problem with balance and depth perception

Because cerebral palsy affects muscle control and coordination, even simple movements — like standing still — are difficult. Other functions that also involve motor skills and muscles — such as breathing, bladder and bowel control, eating, and talking — also may be affected when a child has CP. Cerebral palsy does not get worse over time.

What Causes Cerebral Palsy?

The exact causes of CP aren't always known. But many cases are the result of problems during pregnancy when a fetus' brain is either damaged or doesn't develop normally. This can be due to infections, maternal health problems, a genetic disorder, or something else that interferes with normal brain development. Rarely, problems during labor and delivery can cause CP. Premature babies especially under 28 weeks gestation— have a higher chance of having CP than babies that are carried to term. So do other low-birthweight babies and multiple births, such as twins and triplets.

What Problems Does CP Cause?

Kids with CP have varying degrees of physical disability. Some have only mild impairment, while others are severely affected. This depends on the extent of the damage to the brain. For example, brain damage can be very limited, affecting only the part of the brain that controls walking, or it can be much more extensive, affecting muscle control of the entire body.

    The brain damage that causes CP also can affect other brain functions and lead to additional medical issues, such as:
  • visual impairment or blindness
  • hearing loss
  • food aspiration (the sucking of food or fluid into the lungs)
  • gastroesophageal reflux (spitting up)
  • speech problems
  • drooling
  • sleep disorders
  • osteoporosis (weak, brittle bones)
  • behavior problems

Epilepsy, speech and communication problems, and intellectual disabilities are more common among kids with CP. Many have problems that can require ongoing therapy and assistive devices such as braces or wheelchairs.

How Is Cerebral Palsy Treated?

Currently, there's no cure for cerebral palsy. But a variety of resources and therapies can provide help and immensely improve the quality of life for kids with CP.

Children with CP commonly need Physiotherapy, Speech therapy, Occupational therapy and sometime Behavioural therapy to improve their quality of life. Occasionally the children need orthopaedic surgeries to help increase tendon lengths, scoliosis etc

Spasticity Treatment in Children

Spasticity or Increase muscle tone is very commonly encountered in Pediatric Neurology practice. In simple terms Spacticity means increased muscle tone which causes resistance to any external movement. Spasticity is also commonly mentioned as a "dynamic increase in muscle tone" by the experienced physiotherapists. The most common cause of spasticity in children is Cerebral palsy, usually caused by antenatal or perinatal insult to the developing brain.

If spasticity is caused by Cerebral palsy, the underlying brain problem which is static(does not change with time), however the spasticity may get worse with time. It is therefore important to "remain ahead in the game" by managing spasticity at the earliest. The most common treatment of spasticity is Physiotherapy. An experienced pediatric physiotherapist will assess your child and formulate a therapy program depending on the severity of the spasticity.

The Pediatric Neurologist mat choose to start the child on a muscle relaxant, usually Baclofen, which is given orally and in severe cases Baclofen can also be given via an implantable device known as "Baclofen Pump".

The doctor may also decide to give Botulinum toxin (Botox) injections to the spastic muscles as a targeted therapy. This is usually given after 2 years of age.

If medical management fails, children may also need tendon lengthening surgeries in the hands of expert pediatric orthopedic surgeons. In some selective cases a novel procedure called "Selective Dorsal Rhizotomy" is carried out to relieve spasticity. This is usually done in a Tertiary or Quaternary Pediatric Center.

Autism in children

Autism or Autistic Spectrum Disorder (ASD) is a common entity encountered in the Pediatric Neurology clinic. Some recent studies suggest that up to 1 in 68 children may have Autism. classically, ASD is diagnosed around 5 years of age, but the signs and symptoms can be recognized as early as 2 years of age. ASD can present with varied symptoms which include, poor response by the child when called, lack of pointing towards objects of interest, poor eye contact, abnormal speech patterns e.g repetition of words. If a child is not speaking, or has "lost gained words" at 2 years of age, a behavioural assessment should be carried out to see if the child needs early intervention for a working diagnosis of ASD. Children with ASD have extreme lack of interest in their surroundings, peers and like to stay "in a world of their own".

The diagnosis of ASD is usually carried out by an experienced Child Neurologist, Psychologist or Neuro-Developmental Pediatrician. The assessment to diagnose ASD can be tedious and occasionally the clinician decides to "break it up" into few sessions to ensure the child is completely engaged during the diagnostic assessments. The management of ASD involves "Early intervention approach" which involved various specialized professionals including Behaviour analyst, Behavioural Therapy, Occupational Therapy, Speech therapy etc. In older children Clinical Psychologist and Child Psychiatrist may also be needed in case the child needs medications to manage extreme behaviours.

Pediatric Neuro – Rehabilitation

Neurorehabilitation, also commonly referred as Neuro-Rehab, is a Mutli-Disciplinary specialized process aimed at recovery of Child's Central and Peripheral Nervous system. Neuro-Rehab is carried out for various complex Neurological disorders in children which include Head Injuries, Cerebral Palsy, Multiple sclerosis, Spinal cord injury, Peripheral nerve disorders like GBS, Neuropathies, as well as Muscle disorders e.g Muscular dystrophies and Myopathies. It is characterized by holistic approach towards the child with a single aim to ensure that the child reached the maximum potential of his/her recovery.

The Neuro-Rehab is carried out by highly specialized team of professionals which include Pediatric or Child Neurologist, Physiotherapist, Occupational Therapist, Speech Therapist, Child Psychologist, Dietician etc amongst others. The Pediatric Neurologist usually oversees the goals of recovery and monitors the progress of the child with regular MDT meetings with the parents and the proffesionals involved in the child's care.

Headaches in Children - Diagnosis & Treatment

Headaches in Children are very common and it isn't serious like in adults, In some cases, kids headaches are caused by an infection, high levels of stress or anxiety, or minor head trauma. it is important to concentrate to your child's headache symptoms and consult a doctor if the headache worsens or happens oftentimes.

Headaches are one of the most common types of pediatric pain prompting referral to pediatric neurology clinic. The prevalence of headache ranges from 20% in children younger than 5 years, 37 to 51% in seven-year-old children, gradually increasing to 57–82% by 15 years of age. Before puberty, boys are affected more frequently than girls, but after puberty, headaches occur more frequently in girls. Headache may result in significant disability, including missed school days and extra-curricular activities, suboptimal participation in regular activities, and loss of productivity.

Types of Headaches in Children

There are various types of childhood headaches but the common ones which are encountered in Pediatric Neurology Clinic include Migraine, Tension Headache, Cluster Headache and Chronic Daily Headache.

It is very important that the parents seek advice of a Child Neurologist who will carry out a proper history taking and simple bedside tests which include checking for fundi (back of the eyes) before making a diagnosis of Migraine. Neuroimaging e.g. CT or MRI Brain is not needed once a convincing history and normal neurological examination is established.

When to consult a doctor?

  • Wake your kid from sleep
  • Worsen or become additional frequent
  • Change your child's temperament
  • Follow associate injury, like a blow to the top
  • Feature persistent reflex or visual changes
  • Are accompanied by fever and neck pain or stiffness