What is epilepsy?
Epilepsy is characterised by unusual electrical activity in the brain that causes seizures. According to the Red Cross War Memorial Children’s Hospital (RCWMCH), Head of Paediatric Neurology, Prof Jo Wilmshurst, around 50 million people worldwide have different types of epilepsies. In children, an estimated 0.6% of 0–17-year-olds are affected. But in Africa, there may be more, as many children remain undiagnosed and there are more risk factors that make them more susceptible than kids in high-income settings. In the studies exploring this, the prevalence varies, but in general, it is 2-3 times more frequent in Africa than in high-income countries.
Causes of epilepsy in children
In children, epilepsy can be caused by a variety of factors. This depends on the age of the child and the type of epilepsy they are affected by, but overall, the most common causes are genetic, especially in high-income settings. “The child is often not the first person affected in a family; this is referred to as “de novo”. In the African setting, up to 25% of epilepsies should be preventable with the avoidance of birth complications, head trauma, and infections that impact the brain. Many of the children cared for with epilepsy in Africa had complications from these avoidable events,” says Prof Wilmshurst.
Symptoms of epilepsy in children
Epilepsy can manifest in different ways. The most common symptom is seizures, which can take many forms, including staring spells, confusion, muscle twitches, and loss of consciousness. Most epileptic seizures are short (under 2 minutes), but longer ones (30 minutes) can be dangerous for your health. Other associated symptoms may include memory problems and difficulty concentrating. These symptoms can have a significant impact on a child’s life, leading to social isolation.
Getting a diagnosis
Prof Wilmshurst emphasises the importance of not only early diagnoses and treatment but also the correct diagnosis and treatment methods. “Missing the diagnosis of epilepsy and the wrong diagnosis are huge problems. Getting a diagnosis early and correctly is very important to getting the best care, making the right decisions about tests and medications, and understanding how long the epilepsy might last. For some epilepsies, earlier treatment results in better long-term outcomes for remission (when the seizures resolve) and the occasional associated problems (e.g. concentration and learning difficulties),” she says.
Treatment options for epilepsy in children depend on the underlying cause and the severity of the symptoms. The most common form of treatment is medication, which can help control seizures and improve the quality of life for children with epilepsy. With the correct treatment 70-80% of people with epilepsy can have their seizures controlled.
Prof Wilmshurst stresses that it is very important for a doctor who has experience in epilepsy to take a good history, ideally check a video of the event, examine the patient, and undertake tests that he or she thinks are needed (e.g. EEG, ECG, brain scan). One of the most important causes to exclude from unexplained “collapse” or sudden “loss of consciousness” is a cardiac arrhythmia (irregular heartbeat).
For this reason, most newly presenting children with these signs will have an ECG as the first test. If the doctor finds that the patient meets the definition of epilepsy (as defined by the International League Against Epilepsy), he or she will talk to the family about the best medication choice, which should have the fewest side effects. Not all children with epilepsy need antiseizure medications.
Debunking the stigma
There are many stigmas associated with epilepsy. This comes from people’s misguided perceptions of what caused the person with epilepsy to be affected, e.g. possession and witchcraft. Prof Wilmshurst says it is essential that a person with epilepsy is allowed to live life to their full potential; this includes attending school, playing sports, having sleepovers, and so on. Their safety always comes first, but this can usually be adjusted for by understanding and planning around their needs.
She also says communication is critical, and people with epilepsy should discuss with their doctor whether they need a comprehensive care plan. “This engages all stakeholders in the life of the person with epilepsy, from family to teachers, community leaders, youth groups, primary health care, social workers, faith leaders, etc. Stigma is common, and open conversations about perceptions are important to debunk pre-conceived concepts, e.g. epilepsy is not infectious; this is often cited as a reason for children to be banned from school after having an epileptic seizure in the classroom,” says Prof Wilmshurst.
Epilepsy is a significant health issue affecting many children and adults around the world. Early diagnosis and treatment can help minimise the impact of the condition and improve the quality of life for affected people. Additionally, reducing the stigma surrounding epilepsy through education and awareness is crucial to ensuring that people with epilepsy receive the care they need.