Epilepsy is a disease that is still scary, not least because it is still surrounded by prejudice and discrimination.
To the point that patients and their families often prefer to keep it hidden. And yet in most cases this disease is of interest from one person in every 100 to one in every 200 (WHO estimates) - can be safely kept under control and allows a practically normal life. AND in many cases it passes by itself when the child reaches puberty.
- what is epilepsy;
- how it manifests itself;
- the classic epileptic seizures; absences and nocturnal epilepsy;
- how the diagnosis is made;
- what it depends on;
- when epilepsy heals;
- how to intervene during a crisis;
- epileptic seizures, the possible consequences;
- possible therapies.
It is a brain disease characterized by the periodic repetition of seizures or absence: the so-called epileptic seizures. In the crisis of absence, the child seems absent or distracted for a few seconds.
"Epileptic seizures are an expression of abnormalities in the electrical activity of neurons, the brain cells, "he explains Federico Vigevano, head of the Neurology Operational Unit of the Bambin Gesù Pediatric Hospital in the city. "Neurons communicate with each other through electrical discharges, but it can happen that a more or less extended group of neurons discharges in an abnormal, excessive way: that's a epileptic focus, which gives rise to crises ".
But beware: in order to speak of epilepsy, epileptic seizures must be frequent and repeated.An isolated seizure or some sporadic seizure does not mean epilepsy. This is the case with febrile seizures, which may look similar to the seizures of epilepsy but have nothing to do with this disease. Read also: Fever in children, how to behave
Manifestations of the disease vary depending on how large the outbreak is and its location in the brain architecture.
For example, if the area of the brain that controls the movements of the right hand is involved, the seizure will be characterized by abnormal and involuntary movements of this hand. If the neurons involved in the control of eye movements discharge "badly", seizures with lateral deviation of the eyes may occur.
If, on the other hand, the electrical discharges are generalized, that is, they affect the whole brain, we will have them classic seizures, in which the patient loses consciousness, falls to the ground, stiffens, with the limbs jerking. They are the so-called crises tonic-clonic, which typically last 2-3 minutes maximum.
Then there is a mild form of the disease, what was once called "little bad", which manifests itself with the so-called absences: very briefly suspensions of consciousness, as if for a few seconds - usually about ten - the affected person gets distracted and pulls himself out of the context in which he finds himself. It's about a benign form, which tends to heal with pubertal development, and which does not affect the patient's quality of life. "Ditto for the forms they involve light nocturnal seizures, and which resolve with age "adds Vigevano.
The most severe forms, with intense and frequent crises, often drug resistant, on the other hand, they are disabling, because they reduce the possibility of a completely normal life. Additionally, these forms can associate with a delay in the child's cognitive and motor development, because they decrease the ability to concentrate and attention. "An effect aggravated by the drugs themselves, which are mainly sedatives," says the neurologist.
To make the diagnosis, as well as on the
- clinical manifestations
specialists are based
- on 'electroencephalogram, a test that records the electrical activity of the brain.
CT scan, magnetic resonance and genetic studies they can be used to better define the causes of the disease.
- genetic predispositions
- more or less extensive brain lesions
"About one in three cases is due to genetic predispositions"explains Vigevano." So in the same family you can find more people with the same problem ".
In two out of three cases the responsibility lies with more or less extensive brain lesions, which may depend on various circumstances:
- congenital brain malformations,
- suffering of the child during birth,
- head trauma,
- or cardiovascular disease.
"It must be said that it is not always possible to identify the lesion responsible for the disease" Vigevano points out.Read also: Infantile cerebral palsy: what it is, what it entails, how to intervene
A diagnosis of epilepsy is not necessarily "forever". There are forms that heal spontaneously: "It happens in 20-25% of cases, especially those of genetic origin and in general we know already from the moment of diagnosis how things will go in these cases" says the expert. Many other forms, however, do not heal completely, but they can be kept quietly under control with medications.
"What's important to point out is that very often with epilepsy you can live a normal life"Vigevano affirms." Or at least it could be done, if there were no prejudices and discrimination to complicate things. For example: many young patients can play sports, but have difficulty finding a doctor to issue a certificate of fitness. This is why it is important to sensitize everyone - schools, families but also health professionals - to this issue ".
Much depends on the type of crisis. If it is a simple episode of absence, nothing special needs to be done, if not make sure that there are no dangerous external conditions. Often the child does not even lose consciousness: it is important then don't scare him with his own agitation, reassure him and also reassure any people present.
Even in the case of seizure the first thing to do is to stay calm, especially to avoid inappropriate interventions. For the rest:
- if the child has fallen due to a convulsion, place a pillow under his head to prevent him from knocking him to the ground;
- move away furniture or objects against which it could bump and get hurt;
- turn it on its side, to allow the saliva that can accumulate in the mouth to drain.
Then there is a small list of things not to do absolutely:
- if the mouth is closed, don't try to open it - by the way, the idea that it can swallow your tongue is a legend! - also because it will be difficult to do so and you run the risk of biting your fingers (or breaking a child's tooth);
- do not try to resuscitate the baby with assisted breathing or cardiac massages. The crisis, as it came, ends on its own in a matter of minutes.
"The child does not always have to take medication"explains Vigevano." Whenever possible, we try to avoid it, because they are demanding drugs, which must be taken for years. If the child suffers from a form that tends to heal and has only some absence or a few brief crises during sleep, treatments are generally avoided. "
For the other cases, various drugs are available - there are about twenty, more or less recent - which are chosen patient by patient, and can be used alone or in combination with each other. Pharmacological therapy is successful in 65-70% of cases, but unfortunately they exist drug resistant forms, in which we must try other ways, which are mainly three:
- ketogenic diet
With a neurosurgery the brain focus responsible for the seizures is eliminated or isolated. This route is only feasible when it is possible to identify exactly the outbreak and remove or isolate it without causing harm to the child.
It is about providing the brain with electrical stimuli that are able to silence the abnormal discharges responsible for seizures. The most common form is the vagus nerve stimulation, which gives stimuli spread throughout the brain. Today, however, efforts are being made to work towards more targeted therapies.
It is an ad diet very high fat content (90% of the diet, compared to 30% of classic diets), which causes the excess production of substances - ketone bodies - with a positive effect on the disease. It is a very demanding diet, even for those who have to prepare it, and not very palatable. Typical foods are butter, mascarpone, olive oil, dairy products, cold cuts and sausages, fish, eggs.
Other sources for this article:
information material from the Great Ormond Street Hospital in London; article "Metabolism and epilepsy: Ketogenic diets as a homeostatic link" published in Brain Research; information material from the English Health Service; information material of the Bambin Gesù Pediatric Hospital in the city.
- epilepsy children
- 3-5 children years