By Abha Ranjan Khanna
Approximately one out of 150 children is diagnosed with epilepsy during the first 10 years of life, with the highest incidence rate observed during infancy. Children account for 25 per cent of all new cases of epilepsy.
Though there are very few research studies looking at the rate and long-term outcomes of epilepsy, especially in early childhood (0-3years) from India, international studies provide promising information.
Recent studies from the developed world state that with optimal treatment, 70 per cent of children diagnosed with epilepsy will become seizure free. In the long run, antiepileptic drugs can be discontinued in almost half of the children and they grow to have normal cognitive development. This information about a good prognosis contrasts with persistent stigma surrounding the condition.
The most common type of epileptic seizure occurring in childhood is the febrile seizure. Febrile seizures or “fits” that occur when a child has a high temperature are seizures provoked by an elevation of body temperature. They do not indicate the presence of epilepsy, even if they occur repeatedly. Children who are developmentally delayed or who have spent more than 28 days in a neonatal intensive care unit are also more likely to have a febrile seizure.
Seizures in children and neonatal period have variety of causes, however, most childhood seizures are idiopathic, that is, without a known cause. Studies indicate that seizures occur more commonly in the neonatal period (within the first 28 days) and decrease as children grow older. This is because of the relative lack of inhibitory neurotransmitters and immature brain pathways in early life.
Most children stop having seizures once they are on an Anti-Epileptic Drug (AED) that suits them. Like all drugs, AEDs can cause side-effects for some children. Some side-effects go away as the body gets used to the medication, or if the dose is adjusted. Changing or stopping medication without first consulting with the doctor can cause seizures to start again or make seizures worse. Although most children with early childhood epilepsy become seizures free by adulthood, they are at high risk for social and educational problems.
Some children’s seizures happen in response to triggers such as stress, excitement, boredom, missed medication or lack of sleep. Learning about and avoiding them as far as possible may help to reduce the number of seizures a child has. Getting enough sleep and well-balanced meals may help to reduce their seizures.
Often, a child with epilepsy is excluded from schools and educational systems and other daily life activities. It is essential that school system have trainings and sensitisation workshops for all staff so that an environment of support and safety is provided to the child.
In fact, although witnessing a seizure for the first time is alarming, knowing what to do when a child is having a seizure is very simple. Following are steps for “Epilepsy First Aid”:
- Stay calm and remain with the child.
- DO NOT hold the child to stop/restrain/control movements.
- DO NOT force anything into the mouth.
- DO NOT give the child water, pills or food until they are fully alert.
- Protect from injury; remove any hard objects from the area.
- Protect the head. Place something soft under their head and loosen any tight clothing.
- Gently roll the child on their side as soon as possible as the tongue can move back to block breathing.
- Stay with the child until the seizure ends naturally and calmly talk to them when he/she regains consciousness, usually within a few minutes.
(The writer is an occupational therapist.)