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Epilepsy Diary

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Leading experts in the treatment of epilepsy in children

Epilepsy in children

Epilepsy is a polietiologic progredient neuropsychological disorder caused by a variety of central nervous system lesions. The main cause of epilepsy is formation of the “seizure focus” in the neural network, mainly. This “focus” generates electrical impulses affecting different areas of the brain making it to respond with excessive synchronization. That leads to development of epileptic seizure (or paroxysm).

70% of patients experience their first seizure in their infancy. Herewith, children’s epilepsy can be malignant or benign. The clinical picture of malignant form contains not only seizures, but also leads to mental retardation. Benign childhood epilepsy does not require serious treatment and passes itself as patients grow older. Also, the child may develop a delayed form of the disease. In this instance, the attacks, which began in the neonatal period, could have disappeared for a while, and later resume at adult age.

The main manifestation of childhood epilepsy includes convulsions, lasting from 1 to 5 minutes, which are accompanied by:

• brief faint and subsequent amnesia;
• strong muscle tension followed by involuntary flexion of the joints;
• sudden muscle relaxation at the end of the paroxysm;
• uncontrollable urination or even defecation;

Above mentioned, there may be absences - non-convulsive seizures, which are distinctive for childhood age (the child stops his previous actions, his gaze freezes like he’s staring at something, the face becomes pale).

In the presence of certain provoking factors (e.g., fever), a child may suffer at least one seizure. Such paroxysms, aroused from different triggers (head injury, poisoning, hypoxia etc.) are considered as epileptiform reaction and do not need specific medication. That is why the question whether the child may have or may not have epilepsy can be determined after at least two or more episodes that have happened for no apparent reason.

How epilepsy is treated abroad

The treatment of children’s epilepsy in other countries engages a whole team of doctors led by a pediatric neurologist. In this case, the modern high-precision methods of diagnostics are becoming very important, and that’s why such team of doctors also involves the experts in the field of radiology. Only comprehensive study of the child's body helps to establish the cause and type of epilepsy, as well as selection of the most effective treatment.

Pharmacological treatment of epilepsy in children

Pharmacotherapy is the most prevalent and efficient method of epilepsy treatment, which is suitable for all ages.

Fundamentals of anticonvulsant drugs use and management

Monotherapy: seizures are controlled by one the most suitable drug with minimal side effects;

Polytherapy: is assigned only in case of no medical compliance to a single-drug-method; interaction of multiple drugs may be more toxic comparing to monopharmacy.

Treatment always begins with the prescription of a single drug in a small dosage. Over time, the dose is being increased as long as the seizures cannot be brought under control. Unless this happens, the neurologist selects additional anticonvulsants or replaces initial medicine.

As a general rule, selection of drug therapy begins only after the second epileptic seizure. A suitable medication is selected based on medical diagnostic data according to the type of attacks (partial or generalized epileptic seizure), form of the disease and the presence of comorbidities.

Surgical treatment of epilepsy abroad

Operative treatment is carried out on 10% of patients with epilepsy. Before performing brain surgery, it is necessary to pass a detailed neuroimaging and electrophysiological examination (MRI, EEG), that is why the efficiency of this method of treatment depends largely on the grade of medical equipment and qualification of neurosurgeons.

Operations in epilepsy:

• removal or isolation of a small clearly limited area of the brain that does not affect vital functions, but stands as a trigger for seizures;
• removal of abnormal growths (tumors, aneurysms), which became the cause of the disease;
• setting the stimulator to impact on the deep brain structure.

Indications for operative treatment of epilepsy in children:

• unmanageable epilepsy (other choices have proved to be ineffective);
• drug therapy is effective, but side effects reduce the patient's quality of life;
• discovered form of epilepsy is only amenable to surgical treatment (partial seizures, multifocal epilepsy);
• detected convulsive focus can be removed without significant damage to health.

Surgery is determined as an option on the basis of thorough preoperative diagnostics. A team of specialists in pediatric neurology and neurosurgery evaluates all risks, possible outcomes and the feasibility of the operation.

The ketogenic diet

The ketogenic diet for epilepsy in children involves high-fat-low-carbohydrates regime. It is assigned for medically refractory epilepsy. A clear limitation of nutrition helps significantly reduce the frequency of epileptic seizures, or even completely get rid of them.

The operating principle of the ketogenic diet

The ketogenic diet is based on the formation of ketones (decay products of fats). Typically, the human body gets the necessary energy from carbohydrates. The use of such dietary pattern reduces carbohydrates (principally, glucose) blood level and cells start to use fats to produce energy. As a result, increased ketones concentration specifically influences on the epileptic circuit and thereby the amount of seizures may be decreased or even totally vanished.

Since the ketogenic diet requires a strict limiting of nutrients, it can only be assigned by the attending physician after a thorough examination. The first few days the child should be in a hospital under the supervision of medical staff.

This nutrition regimen is contraindicated for children under 1 year.

Children's Epilepsy treatment process

A full set of procedures for the selection of medication for the treatment of epilepsy takes about 5 days. The child must be consulted by the children's neurologist, psychologist, and neurosurgeon who specializes in the epilepsy treatment (if necessary).

Specialists of the clinic conduct the necessary diagnostic investigations, which must include brain MRI with contrast material administration, long-term EEG in resting awake state with a transition to sleep state (for several days) and laboratory blood tests. Additional investigations can be assigned depending on the individual characteristics of the disease.

After the diagnostics are completed, the optimal treatment option is selected for the child. If necessary, a subsequent correction of the treatment can be performed during remote consultations with a therapist.

Important to know

Any chosen way of treatment may not be sufficiently effective. Sometimes it happens due to the disease’s resistance to pharmacological therapy.

However, in 30% of cases we are talking about pseudo-resistant epilepsy. It is associated with incorrect diagnosis, incorrect selection of anticonvulsant or its dosage.

That is why a qualified doctor, accuracy of conducted diagnostics, and quality of medical equipment are momentous factors that determine the treatment outcome of epilepsy.

Free consultation on epilepsy treatment

International Patients Support Center Bookimed helps to choose the right foreign clinic for treating your child's epilepsy. Our doctors-coordinators will prompt what medical center is worth to apply to and will find the best expert for each individual case.

Applying to Bookimed, you get a guarantee of high quality service and transparent pricing policy of foreign clinics. Our coordinators monitor all stages of your treatment abroad, beginning from the stage of treatment in a medical facility and ending with the returning back home. If it is needed, we also arrange subsequent remote consultation for the correction of the selected treatment.

All services in Bookimed Patients Support Center are provided for free.