Epilepsy in children

Definition of epilepsy

Epilepsy is a chronic disease (such as diabetes or asthma) characterized by recurrent epileptic seizures. Epileptic seizures are transient clinical symptoms and signs that result from excessive, abnormal or synchronous activity of neurons (the basic unit of brain functioning).

Epilepsy is a brain disease characterized by a long-term predisposition to the generation of epileptic seizures, which can result in neurobiological, cognitive, psychological and social disorders.

Diagnosis of epilepsy

The diagnosis of epilepsy is purely clinical, which means that it is most authoritative to carefully and thoroughly take all the information about the type, onset and characteristics of the epileptic attack from the patients (if they are able to describe the events) or their companions (parents, partners, eyewitnesses).

What is necessary to make a diagnosis of epilepsy:

1. Two unprovoked or reflex epileptic seizures more than 24 hours apart. Unprovoked means that it was not preceded by provoking factors such as fever, mild head trauma (concussion), sleepless night (sleep deprivation), alcohol consumption, or alcohol withdrawal. A provoked seizure implies the mentioned factors that lower the threshold for emitting epileptic seizures in the field of healthy brain tissue, and therefore the diagnosis of epilepsy in these cases is not adequate. Unprovoked seizures indicate the absence of transitory or reversible provoking factors that lower the threshold for epileptic discharge. On the other hand, reflex attacks include epileptic attacks that occur as a result of special stimuli such as, for example, light of the appropriate spectrum and frequency. In the case of reflex epilepsy caused by light stimuli, there is a provocative factor, but the willingness of the brain to generate epileptic seizures is great, and this is the reason that epilepsy is diagnosed after seizures caused by such stimulation.
2. A diagnosis of epilepsy can also be made if the patient has had one epileptic seizure, but the probability of having another seizure is the same as the risk of recurrence of seizures in the general population after two unprovoked seizures (at least 60%), for the next 10-year period. We will explain what this practically means on the example of the following patients. For example. a patient who had a stroke and after a month had the first epileptic seizure or a child who had the first epileptic seizure, the basis of which is a malformation of cortical development (such as tuberous sclerosis, focal cortical dysplasia or heterotopia, etc.). In such cases, which we call symptomatic epilepsy (there is a clear cause-pathology in the brain tissue) there is a high risk of repeated attacks, sooner or later, and this gives us the right to diagnose epilepsy even after the first unprovoked attack. Speaking in the language of a child neurologist - an epileptologist who has been dealing with this problem for more than 30 years for mental hygiene reasons, for a definitive diagnosis of epilepsy it is usual to wait for a second attack, which will inevitably happen.
3. When it is a specific Epileptic syndrome that abounds in the infantile period, the period of childhood and adolescence. If it is a clear epileptic syndrome, regardless of the low frequency of epileptic attacks, the diagnosis of epilepsy is established. The best example in this group is SeLECT-Self limited Epilepsy with Centro Temporal Spikes, formerly known as Rolandic epilepsy or BECTS. The diagnosis of the syndrome can also be made when seizures do not dominate the clinical picture, as in the case of Landau Kleffner syndrome (Acquired epileptic aphasia) or ESES (Electronic status epilepticus), but the epileptiform activity is so pronounced that the diagnosis of specific epileptic syndromes can be made.