Epilepsy in childhood

General information
Seizures or convulsions are fairly common, occurring in about 3-5% of
children. Epilepsy, having two or more seizures of unknown cause, is
less common and only occurs in about 1% of children. It begins in
childhood in about 70% of cases. Seizures in children can range from
febrile seizures and occasional non-febrile seizures to infantile spasms
that can occur daily and are difficult to treat. Seizures, especially the first
seizure that a child has, can be very frightening for both children and their
parents.

Although seizures can sometimes be caused by specific medical
problems, including fever, head trauma, poisonings, infections,
especially meningitis and encephalitis, and brain tumors, the cause of
most seizures is often not found (idiopathic seizures).

Types of childhood epilepsy
The main types of seizures are Partial Seizures and Generalized seizures.

Generalized seizures include the convulsive, tonic-clonic, or Grand mal,
type of seizures which people are most familiar, in which a child falls
down and has jerking movements. Other types of generalized seizures
include atonic seizures, which cause 'drop attacks', and absence
seizures (petit mal). Absence seizures cause a brief loss of awareness
and are one of the causes of staring spells. These staring spells are
usually brief, lasting only about 10-15 seconds, with a return to normal
awareness after the seizure and they may occur several times a day.
Absence seizures can be brought on by hyperventilation and they have a
characteristic EEG, with a 3-per-second spike and wave pattern.

The other main type of seizures are the partial seizures, which have a
focal or local onset (starting in the right leg, for example, in contrast to a
generalized seizure, which begins in all parts of the body at the same
time). Partial seizures may be simple, in which there is no loss of
consciousness, including seizures in which a child jerks one arm or
deviates his eye to one side. Children can also have partial complex
seizures, which also have a focal onset, but which do involve a loss of
consciousness. They are similar to absence seizures in that they also
cause staring spells, but with partial complex seizures, the staring spell
is usually longer, lasting about 30 seconds to several minutes and the
child may be confused after the seizure. In addition to just staring, these
children may seem confused during the episode and may wander
around.

Cognitive/neuropsychological complications of
childhood epilepsy

From a neuropsychological standpoint, epilepsy is a very heterogeneous
condition. Epilepsies are divided into two categories (focal and
generalized) that are differentiated by the neuropsychological symptoms
that are present. Cognitive difficulties present in children suffering from
focal epilepsy are usually specific to the cerebral area involved, while
generalized epilepsies are linked to a diffuse neuropsychological deficit
profile as well as to a more limited intellectual functioning.

Much research on children with epilepsy has demonstrated an
association between epilepsy and cognitive deficits. Some research has
indicated that intelligence scores of children with epilepsy are in the
normal range, tending to cluster towards the lower end, especially in
symptomatic epilepsy. The frequency of mental retardation in children
with epilepsy has been reported to be 24–41%.

In childhood epilepsy several seizure-related characteristics have been
reported to be associated with impaired cognitive performance: non-
controllable seizures or high seizure frequency, long duration and severe
seizures, symptomatic aetiology, early onset of epilepsy and treatment
related factors. Atypical absences and other minor-motor seizures have
also been found to be frequently associated with cognitive problems.

Emotional, social & behavioral complications of epilepsy
There is significant emotional distress experienced by children with
epilepsy. Children are often concerned about social embarrassment, fear
of seizures, and injuries. Peer acceptance is an important concern in
children with epilepsy. Children with epilepsy often report being teased
about their seizures and bullied by their peers. The unpredictable nature
of seizures may contribute to the development of a more general sense
of helplessness and loss of control. In an effort to avoid potential
embarrassment and stigma, children may socially withdraw from their
peers, isolating themselves and limiting their social interaction.
Limitations in activities and feelings of being different may also result in
social isolation.

Children may have some difficulty regulating affect and behavior. Low
affect, irritability, and frustration are symptoms that are risk factors for
depression and anxiety. Under-diagnosis of depression in epilepsy is
unfortunately common.