What is epilepsy?
Epilepsy is a brain disease that causes recurring, unprovoked seizures. Seizures involve sudden, temporary, bursts of electrical activity in the brain that change or disrupt the way messages are sent between brain cells. These electrical bursts can cause involuntary changes in body movement or function, sensation, behaviour or awareness. Diagnosis of epilepsy is established if you have two unprovoked seizures or one unprovoked seizure with a high risk of more. Epilepsy affects one in 200 children in the UAE. It is the fourth most common neurological disorder in the world.
Types of seizures
There are many different types of seizure:
- Generalised seizures- affect both sides of the brain from the start
- Focal seizures- start in one side of the brain
- .Unknown onset seizures
Epilepsy syndromes are defined by a collection of features which include:
- Type or types of seizures
- Age at which the seizures begin
- Causes of the seizures
- How severe and how frequent the seizures are
- Certain patterns on the EEG (electroencephalogram), during and between seizures
- Brain imaging findings
- Genetic information
Children may have different manifestations depending on the type of seizure, such as:
- Jerking movements of the arms and legs
- Stiffening of the body
- Loss of consciousness
- Breathing problems or breathing stops
- Loss of bowel or bladder control
- Falling suddenly for no apparent reason, especially when associated with loss of consciousness
- Not responding to noise or words for brief periods
- Appearing confused or in a haze
- Nodding the head rhythmically, when associated with loss of awareness or loss of consciousness
- Rapid eye blinking and staring
- During the seizure, the child's lips may become bluish and breathing may not be normal
- Seizures are often followed by a period of sleep or disorientation
Seizures are caused by the following:
- Birth/brain trauma
- Brain malformation
- Metabolic or chemical imbalances in the body
- Alcohol or drugs
- Genetic factors
- Brain tumour
- Complete medical history of the child and family
- Blood tests
- Electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp
- Magnetic resonance imaging (MRI) - a diagnostic procedure that produces detailed images of brain
- Digital video EEG and videotemetry in epilepsy monitoring unit (EMU)
- Positron emission tomography (PET)
Specific treatment for a seizure will be determined based on:
- Your child's age, and medical history
- Extent of the condition
- Type of seizure
- Your child's tolerance for specific medications
- Expectations for the course of the condition
- Your opinion or preference
The goal of seizure management is to control, stop, or decrease the frequency of the seizures without interfering with the child's normal growth and development. The major goals of seizure management include the following:
- Proper identification of the type of seizure and epilepsy/epilepsy syndrome
- Using medication specific to the type of epilepsy
- Using the least amount of medication to achieve adequate control
- Maintaining good medicating levels and minimise side effects
Treatment may include:
- Medications - there are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, age of the child, side effects, the cost of the medication, and the adherence with the use of the medication. It is important to give your child his/her medication on time and as prescribed by your child's physician. All medications can have side effects, although some children may not experience side effects. Discuss your child's medication side effects with his/her physician
- Ketogenic diet - This type of diet is low in carbohydrates and high in protein and fat
- Vagal nerve stimulator
- Surgical treatment for epilepsy
Epilepsy clinic and complex epilepsy service at Mediclinic hospitals
The epilepsy programme at Mediclinic hospitals serves patients with seizures and related disorders. The service sees patients in all phases of their illness, from assessment after an initial event through evaluation of refractory epilepsy in patients who have not been easily controlled seizures.
State-of-the-art neurophysiology and neuroradiological diagnostic facilities supplement expert consultation. To assist in accurate diagnosis and treatment, inpatient and ambulatory long-term video-EEG monitoring using digital technology with computer assisted event detection, sophisticated MRI imaging and spectroscopy, functional imaging using MRI and PET scanning, and detailed neuropsychological testing are available.
At Mediclinic, the epilepsy clinic and complex epilepsy service
is led by Prof. Sunny Philip, Consultant Paediatric Neurologist and Epileptologist.
This service provides comprehensive epilepsy care with:
- Epilepsy clinics
- Specialised Neurophysiology and EEG
- Latest generation MRI brain scan
- Epilepsy monitoring unit
- PET scan
- Paediatric neuropsychology and neuropsychiatry
- Vagal nerve stimulator implantation and monitoring
- Ketogenic diet
- Specialised laboratory testing
- Links with children’s epilepsy surgery programme
EEG has long been used to aid in the diagnosis of epilepsy, but it relies heavily on ictal capture as a normal inter-ictal EEG does not refute a diagnosis of epilepsy and neither does an abnormal EEG fully confirm the diagnosis.
For these reasons ictal EEG is considered a much more accurate diagnostic tool.
In children, seizure frequency may be high and an attack may be captured on a routine outpatient recording. However, long-term EEG monitoring is often required to obtain an ictal recording.
Inpatient video telemetry (VT) is considered the gold standard for ictal recording as it provides both EEG data during seizures and also invaluable clinical information on seizure semiology.
Ambulatory EEG with synchronised video in the patient’s home is an option for long-term EEG recording and has the advantage of keeping the child in the home environment where the paroxysmal events are reported to occur, as well as avoiding disruption to the parents’ routine and childcare arrangements.