EPILEPSY IN CHILDREN: UNDERSTANDING AND SUPPORTING YOUNG MINDS

By Edwige Smague

INTRODUCTION

The challenges of paediatric epilepsy are many, given the lack of understanding of this neurological rather than psychiatric condition. Of course, the signs and symptoms can lead to a correct diagnosis in children, but misdiagnosis is common (1). This awareness helps to avoid misdiagnosis and ensures that children receive early intervention.

The difference between signs and symptoms

It is the most common chronic neurological disease in children and is associated with various symptoms and developments, such as jerky movements, brief absences, and gaze fixation.

It is essential to distinguish between signs and symptoms of epilepsy. A sign is a clinical manifestation the doctor can observe or measure, such as visible signs in a patient during a seizure (2). A symptom is something the patient feels, such as fatigue or pain, which cannot be observed directly but which the patient will then describe. Partial (or focal) seizures, in which the discharge affects only part of the brain, may manifest through visible signs such as involuntary movements, sensory disturbances or abnormal behaviour. However, some seizures may not have any visible signs, which complicates the diagnosis and means that it must be based solely on the symptoms reported by the patient. For example, some patients, particularly children, experience auras before seizures, a warning symptom such as a feeling of fear or nausea. The aura is, in fact, a simple partial seizure (3).

The specific symptoms of focal seizures depend on the area of the brain affected: 

If Broca's area (in the frontal lobe) is affected, this can lead to language disorders (aphasia). If Wernicke's area (in the temporal lobe) is affected, language comprehension may be impaired (4).

• Seizures in the frontal lobe, particularly the primary motor area, may cause involuntary muscle contractions or temporary post-critical paralysis.

• When the parietal lobe is affected, sensory disturbances may occur, such as tingling, numbness, or strange sensations on the skin.

• Seizures affecting the occipital lobe may result in visual hallucinations or blurred vision.

• Memory problems (temporary amnesia) may occur in the temporal lobe, where the hippocampus is located. These problems can affect both short-term and long-term memory.

Types of seizures

Generalised seizures include: Tonic-clonic seizures are the better known and the most impressive, but they are not frequent and manifest as loss of consciousness with a fall and jerky movements. Absences occur when there is a brief lapse in contact (a few seconds). They can be recognised by stillness and a fixed gaze. They tend to affect children and adolescents who are unaware of anything and have no memory (5).

Common diagnostic errors

Misdiagnosis can lead to inappropriate treatment, so careful differential diagnosis is essential, using tools such as the electroencephalogram (EEG), genetic tests and a full clinical assessment using imaging. Often, due to a lack of knowledge, and when the seizures are subtle or non-convulsive, the doctor or family may miss the signs and symptoms. Epilepsy can then be confused with other illnesses (1).

Why is confusion possible? 

According to the Epilepsy Foundation, epilepsy can be confused with other conditions due to overlapping symptoms such as staring, sleep problems, anxiety and depression. 

Attention deficit and behaviour disorders with or without hyperactivity (ADHD): The absence of seizures described above can confuse attention or inattention problems. Teachers and parents may think the child is daydreaming or not listening in class, mistaking these episodes for an attention disorder. Sure signs, such as non-convulsive seizures or focal seizures with altered consciousness, may present with behaviours similar to those of autism spectrum disorders, with communication difficulties or repetitive behaviours (6).

Sometimes, both syncope and seizure result in a sudden loss of consciousness. Sometimes, syncope may be accompanied by jerk movements, increasing the risk of diagnostic confusion.

Psychogenic non-epileptic seizures (PNES) are linked to somatoform disorders. These seizures often have psychological causes and can mimic the symptoms of epileptic seizures but without abnormal electrical activity in the brain (7).

Some migraines, particularly migraines with aura, which cause visual disturbances, tingling, numbness or dizziness, may resemble signs of a focal seizure (8).

Nocturnal epileptic seizures occur during sleep and may be confused with narcolepsy (episodes of excessive sleepiness) or parasomnias (sleepwalking, night terrors) (9).

Palpitations, feelings of strangulation, trembling, dizziness and panic attacks are typical symptoms of anxiety disorders or panic attacks. However, if the epileptic seizures are non-convulsive, they may be mistaken for manifestations of anxiety (10). More rarely, a transient ischaemic attack (TIA) may present symptoms similar to those of a focal seizure, such as muscle weakness or slurred speech, mainly if these symptoms occur over very short periods. Severe hypoglycaemia or endocrine disorders (hypocalcaemia, hypoparathyroidism) may be confused with epileptic seizures. In very young children, symptoms of gastro-oesophageal reflux may lead to spasms, crying or shaking, which may be confused with epileptic seizures (11).

Motor tics (rapid involuntary movements) or symptoms of Tourette's syndrome may be mistaken for focal motor seizures, as they involve sudden, involuntary movements just like epilepsy.

The doctor may try to eliminate these causes when assessing the child. It can be helpful to note when the seizures are observable, the signs and symptoms, the time when the seizure occurred, what the child was doing before the seizure, whether they were sick, tired or stressed, whether they were taking medication; how the seizure started; if they felt any warning signs; what movements (if any) the child made during the seizure; what if any, movements occurred on one side of the body; whether the child was able to speak and respond during the seizure; if the child made any sounds; how long the seizure lasted; whether the child was confused, tired or in pain after the seizure; whether the child was able to speak normally after the seizure.

Early intervention

Prompt action can distinguish epileptic seizures from the other disorders mentioned above. Untreated or misdiagnosed epilepsy is likely to get worse. Seizures may become more frequent or cause long-term brain damage; the child may experience delays in cognitive, motor and social development.

By identifying the signs and symptoms, doctors and families can rule out other illnesses and diagnose epilepsy quickly to minimise its impact. They can also treat seizures quickly and facilitate appropriate care, including educational and therapeutic measures. Treatment also makes it possible to reduce or eliminate epileptic seizures, which considerably improves the quality of life of the child and their family (12). 

CONCLUSION

Diagnostic errors often arise because we only find what we are looking for, just as we only look for what we know.

REFERENCES

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