Pediatric absence epilepsy is a form of idiopathic generalized epilepsy, occurring in children of preschool and primary school age, with characteristic symptoms in the form of absences and pathognomonic signs on the electroencephalogram. It is manifested by sudden and short-term shutdowns of consciousness, more often in the daytime, without affecting the neurological status and intelligence of the child. Pediatric abscess epilepsy is diagnosed clinically according to a typical paroxysm picture with confirmation in an EEG study. Patients need specific anti-epileptic therapy.
Pediatric absence epilepsy (AED) accounts for about 20% of all epilepsy cases in children under 18 years of age. The debut of the disease occurs at the age of 3 to 8 years, the incidence of pathology is somewhat higher in girls. Even in 1789, Tissot described the absence as a symptom. A detailed description of the EEG-picture of the absans was presented in 1935.
This is what made it possible to reliably attribute this type of paroxysms to the group of epileptic syndromes, but in 1989 the children’s absence epilepsy was singled out as a separate nosological form. The disease remains relevant to pediatrics.because parents can often not notice the presence of absences in a child and for a long time write off such a state as carelessness. In this regard, the late treatment can lead to the development of resistant forms of AED.
Causes of childhood abscess epilepsy
The disease develops under the influence of a complex of causes and provoking factors. Initially, the brain substance is destroyed as a result of various factors in the period before birth, trauma and hypoxia during childbirth, as well as in the postnatal period. In 15-40% of cases there is a hereditary burden. The effect of hypoglycemia, mitochondrial disorders (including Alpers disease) and diseases of accumulation has also been proven. One way or another, the parameters of excitability of individual cortical neurons change, which leads to the formation of the primary focus of epileptic activity. Such cells are able to generate impulses that cause seizures with a characteristic clinical picture, depending on the localization of these cells.
Symptoms of childhood abscess epilepsy
Pediatric abscess epilepsy debuts at the age of 4-10 years (peak incidence – 3-8 years). Manifested in the form of paroxysms with a specific clinical picture. The attack (absans) always begins suddenly and ends unexpectedly. During an attack, the child seems to freeze. He does not react to the speech addressed to him, his gaze is fixed in one direction. Outwardly, it can often look as if the child was just thinking about something. The average duration of absence is approximately 10-15 seconds. The entire period of the attack is completely amnesized. The state of weakness, drowsiness after paroxysm is absent. This type of attack is called simple absans and is found in isolation in about a third of patients.
More often in the structure of absence there are additional elements. A tonic component may be added, usually in the form of tilting the head back or rolling the eyes. Atonic component in the clinic of the attack is manifested by the loss of objects from the hands and nods. Often, automatisms join, for example, stroking hands, licking, smacking, repeating individual sounds, less often words. This kind of paroxysm is called complex absans. Both simple and complex abscesses are typical in the clinic of childhood abscess epilepsy, however, atypical manifestations are rarely possible, when consciousness is gradually lost and not completely, the seizure is longer, and after it weakness and drowsiness are noted. These are signs of an adverse course of the disease.
DAE is characterized by a high frequency of paroxysms – several tens to hundreds of times a day, usually during the daytime. The attacks are often provoked by hyperventilation, sometimes photosensitization occurs. In about 30–40% of cases, generalized convulsive seizures with loss of consciousness and tonic-clonic convulsions also occur. Often this form of an attack may even precede the appearance of typical absences. Despite this, childhood abscess epilepsy is considered benign, since there are no neurological changes and any effect on the child’s intelligence. At the same time, about a quarter of children have attention deficit hyperactivity disorder.
Diagnosis of childhood abscess epilepsy
The diagnosis is based primarily on the clinical picture of the disease. The symptoms of childhood abscess epilepsy are quite specific, so the diagnosis, as a rule, does not cause difficulties. A pediatrician may suspect the disease if parents complain about inattention, frequent thoughtfulness of the child, or the child does not cope with the school program. Examination of a child neurologistallows you to collect a thorough history, including familial and early neonatal, when injuries or other factors in the development of childhood abscess epilepsy could have occurred. Also during examination, neurological symptoms are excluded and the approximate correspondence of the intellect to the age norm is revealed. For these purposes it is possible to conduct additional tests. Sometimes it is possible to visually register the attack itself.
Be sure to conduct electroencephalography . Not long ago, it was an EEG study that confirmed the diagnosis of childhood abscess epilepsy, but the accumulated experience showed that changes on the electroencephalogram may be absent, although in rare cases. At the same time, the presence of a lesion is possible in the complete absence of symptoms. However, EEG diagnostics is mandatory and performed in 100% of cases. Pathognomonic changes on the electroencephalogram are regular peak-wave complexes with a frequency of 2.5 to 4 Hz (usually 3 Hz), about a third of children have a bioccipital slowdown, and delta activity in the occipital lobes is less common when the eyes are closed.
Other studies (CT, MRI of the brain ) for making a diagnosis of childhood abscess epilepsy are not shown, but can be done to exclude symptomatic epilepsy, when the cause of the attack may be a tumor, cyst, encephalitis , tuberculosis of the brain, dyscirculatory disorders, etc.
Treatment of childhood abscess epilepsy
Drug therapy is indicated for the prevention of absences; it is usually about monotherapy. Preparations of choice for children are succinimides. In the presence of generalized tonic-clonic paroxysms, it is preferable to use valproic acid preparations. Treatment is prescribed strictly by a neurologist or an epileptologist, when the diagnosis of “childhood abscess epilepsy” is reliably confirmed. Removal of drugs is recommended after three years of stable remission, that is, the absence of clinical manifestations. If there are tonic-clonic seizures, it is recommended to withstand at least 4 years of remission to complete the treatment. The use of barbiturates and the group of carboxamide derivatives is contraindicated.
The prognosis of childhood abscess epilepsy is favorable. Full recovery occurs in 90-100% of cases. Rarely are atypical and resistant to treatment forms, as well as “transformation” of the disease into juvenile forms of idiopathic epilepsy. Prevention of hereditary cases of childhood abscess epilepsy is absent. General measures include the prevention of maternal complications of pregnancy, birth injuries of newborns and injuries in early childhood.