Epilepsy in children

and Martina Feichter, medical editor and biologist

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

Epilepsy in children: forms

Epilepsy in children - as in adults - can express itself very differently. The range of types of seizures is wide. For example, some children are mentally absent for just a few seconds during the seizure. Others pass out, are very stiff at first and are then shaken by muscle twitching all over their body for several minutes (grand mal seizure). If the epileptic seizure is confined to a limited region of the brain, it is a focal seizure. If the whole brain is affected, it is a generalized seizure.

The seizures can seemingly arise out of nowhere. Often, however, they are triggered by triggers such as flickering light, but also lack of sleep.

The causes of epilepsy are as varied as the types of seizures. In children and adults alike, a genetic predisposition, brain injuries (e.g. during childbirth or an accident) and underlying diseases (such as meningitis, metabolic disorders, etc.) can be responsible for epileptic seizures. Sometimes, however, the cause of the epilepsy cannot be found either.

Tip: For a description of the different types of seizures and symptoms, see Epileptic seizure. For more about the possible causes of the condition, see Epilepsy: Causes.

In the following we will introduce you to some special forms of epilepsy in children. Some of them start in certain age groups.

Absence Epilepsy of School Children

One of the most common generalized forms of epilepsy in children is absence epilepsy of school children (pycnolepsy). It is genetic and usually shows up between the ages of five and eight. Girls are more often affected than boys.

The little patients experience up to 100 absences a day. Absences are short pauses in awareness - the child is not unconscious, but does not notice its surroundings for a short time. It suddenly pauses in its current activity (playing, talking, running, etc.) and continues after a few seconds as if nothing had happened. Most of the time, the child does not even know that he has just "stepped away" for a short time.

This form of epilepsy in school-age children generally has a good prognosis. In about a third of young patients, the absences come to a standstill, in a further third they persist into adulthood. Finally, in the last third of patients, there are large epileptic seizures.

Juvenile absence epilepsy

Absence epilepsy in children between the ages of 9 and 15 is called juvenile absence epilepsy. Girls and boys are affected roughly equally. The patients experience only a few absences a day. On the other hand, these are often associated with a tonic-clonic seizure (grand mal = "major seizure"). That means: First the child's body suddenly becomes stiff (tonic phase), before breaking out into rhythmic muscle twitching after a few seconds (clonic phase). The seizure is usually over after a few minutes.

The prognosis for juvenile absence epilepsy is less favorable. This is especially true for patients who are not treated properly and who lead an irregular lifestyle (frequent lack of sleep, etc.). They can often have major seizures.

Rolandic epilepsy

Rolando epilepsy is one of the most common forms of childhood epilepsy. It often manifests itself in the course of nocturnal seizures, whereby the children are torn from their sleep: Parasitic sensations and twitching occur, usually in one half of the face. The children have problems speaking and swallowing and are increasingly secreting saliva. Sometimes this focal seizure spreads to other parts of the body. A grand mal seizure (generalized tonic-clonic seizure) develops from this less often.

The seizures in Rolandic epilepsy occur only sporadically. Treatment with medication is not always necessary. This form of epilepsy often comes to a standstill in children after the age of 15.

Primary reading epilepsy

Primary reading epilepsy usually begins between the ages of 17 and 18. However, it is also possible in children before puberty. The epileptic seizures are triggered here by reading loudly or quietly: In those affected, the tongue, jaw, lips, face and neck muscles suddenly begin to twitch briefly. This type of epilepsy has a good prognosis.

West syndrome (BNS epilepsy)

West syndrome is a rare, serious epilepsy in infancy children. It usually begins between two and eight months of age. Boys are more often affected than girls. The small patients usually suffer several epileptic seizures in a row (in series). Each individual attack only lasts a few seconds. Three characteristic types of cramps can be identified, which usually occur in combination. They also give the West Syndrome the second name Blitz-Nick-Salaam epilepsy (BNS epilepsy):

The sudden (lightning-like) muscle twitching of the entire body or individual limbs is called lightning attacks.
The neck and throat muscles cramp during the nodding attacks. As a result, like a nodding movement, the chin is pulled jerkily towards the chest.
During the salaam attacks, the child bends his head and trunk forward. At the same time, they often open their arms and row their hands or bring them together in front of their chest - which is reminiscent of the oriental greeting “Salaam”.

The seizures often occur shortly after waking up or before falling asleep. The measurement of brain waves (EEG) in those affected shows a typical pattern (so-called hypsarrhythmia).

West syndrome is caused, for example, by a malformation or damage to the brain, an infection or a metabolic disorder. The prognosis depends on this cause. Usually it is unfavorable. Most of the children affected suffer from developmental disorders.

Lennox-Gastaut syndrome

Lennox-Gastaut syndrome (LGS) is another rare form of epilepsy in children. It usually occurs between the 3rdFirst and 5th years of age appearing for the first time. Boys are more often affected than girls.

Patients often have multiple seizures a day, sometimes at night. Typically, different types of seizures occur: Sometimes the body suddenly tenses up completely or partially for several seconds (tonic seizure). The muscles can also suddenly relax (atonic attack). In both cases there is a risk of falling. A combined tonic-clonic seizure and other forms of seizure (such as pauses in consciousness = absences) are also possible in Lennox-Gastaut syndrome.

Occasionally the seizures in LGS turn into a potentially life-threatening status epilepticus. This is a prolonged seizure or a series of seizures in very rapid succession between which the child is unconscious.

Often this form of epilepsy occurs in children with malformations or brain damage. The brain damage can be the result of birth complications, for example. But there are also LGS patients in whom the brain structure is normally developed and shows no damage.

Lennox-Gastaut syndrome is difficult to treat. The development of the affected children is usually more or less impaired.

Juvenile myoclonic epilepsy

Typically, juvenile myoclonic epilepsy occurs for the first time in children / adolescents aged 12 to 18 years. Characteristic features are more or less pronounced muscle twitching (myoclonus). During the seizure, the arms move violently and in an uncoordinated manner. In doing so, the patient can unwittingly toss away objects that he is holding in his hand. Sometimes the legs buckle too.

The seizures often occur after waking up, but also with sleep deprivation. Many sufferers develop generalized seizures or loss of consciousness (absences).

Juvenile myoclonic epilepsy can often be treated quite well with medication. In this way, many patients can live free from seizures. However, the medication often has to be taken for life.

Dravet syndrome

A very rare and severe form of epilepsy in children is Dravet syndrome. It is also called Early Myoclonic Encephalopathy or Early Infantile Epileptic Encephalopathy. Usually children get sick between the 3rd and 12th month of life, rarely later. Boys are more often affected than girls.

At first, the little patients get tonic-clonic seizures with a fever (first the body stiffens briefly, then uncontrolled, slow muscle twitches set in). The seizures can turn into a dangerous status epilepticus! As the disease progresses, the seizures occur even without a fever. Sometimes other forms of seizure (in addition to tonic-clonic attacks) such as myclonic seizures (rapid twitching of individual muscle groups) are also evident. The seizures are often triggered by external stimuli, such as temperature changes, light stimuli or excitement.

The cause of Dravet syndrome is often a genetic change (gene mutation): The so-called SCN1A gene, which provides the blueprint for a specific sodium channel in the brain, is affected. The function of these channels is crucial for the excitation of the nerve cells.

Dravet syndrome is difficult to treat. Medicines often don't work that well. With increasing age, the epileptic seizures become less frequent. However, because they often result in cognitive limitations and behavioral problems, this form of epilepsy in children still has an unfavorable prognosis. In addition, it can be associated with sudden infant death syndrome (especially between the ages of 2 and 4).

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