Epilepsy

Epilepsy can affect children of all ages. It is common – affects 1% of the overall population. However it does not get discussed very much- has a lot of stigma. Hence there are a lot of myths around it. This can result in children not getting treated properly. Let’s learn a bit more about epilepsy in children.

Epilepsy in children tends to be most prominently seen in 1st year of life and in teenage. The type of seizures seen in childhood epilepsy are very many- they range from sinple absent like events to events with shaking / trembling of whole body. Just as there are many seizure types, the causes of epilepsy in childhood are also varied. The 2 commonest causes we see in India are a. brain injury – that has happened around the time of birth and b. genetic.

Majority of epilepsies- 70-80% - are fully treatable with anti epilepsy medications. The modern medicines available nowadays have fewer side effects. Most children can go to school, study, do extracurricular activities like annual function, go on picnics and participate in sports (with safety precautions) just like other kids. They are able to pursue most careers, attend college similar to their peers. In fact, in a majority of childhood epilepsies, doctors successfully stop the medications after few years as the epileptic tendencies are age limited.

It is not the end of the road in the small percentage of children whose epilepsy is not controlled by medications. Epilepsy surgery, neuromodulation surgery and ketogenic diet are various treatment options available. Epilepsy surgery is the most sought after option as it is curative. Next to natural remission, this is the treatment which can cure epilepsy completely.

Epilepsy surgery can be done at any age. Epilepsy surgery is offered as an option in a few very specialized epilepsy centers. The decisions regarding epilepsy surgery are very patient specific.

The first step is presurgical evaluation. Tests include video EEG and special MRI scans. Sometimes PET and SPECT scans are also done. These tests tell us extremely important information about that child’s epilepsy. Surgery is offered only if presurgical tests show that the child will benefit from surgery. Typically the chances of side effects from epilepsy surgery are rare.

The neuromodulation surgery typically entails a device insertion – either around the vagus nerve in the chest/ neck or rarely in the brain. These devices send electric signals which help to control seizures in addition to medications.

Even during the COVID 19 pandemic our epilepsy surgery program has continued. We have operated on 5 patients which included one patient from Africa and one from Gujarat. All of them have done exceedingly well. The pandemic shouldn’t stop patients from seeking medical help- needless to say with precautions. If your child’s epilepsy is stable then video consultations with your doctor might be appropriate.

The child can suffer serious consequences if timely help is not sought for epilepsy. Delay in seeking treatment and lack of appropriate treatment are common issues. Sadly, this happens commonly as there are lots of misunderstandings surrounding epilepsy.

India celebrates National Epilepsy day on 17th November. ‘Let’s talk about Epilepsy’ is a theme that is being endorsed this year. It is inspiring to hear Indian celebrities like Abhinav Bindra, Fatima Sana Shaikh talk about epilepsy. Let us pledge that we shall not discriminate against children with epilepsy. In fact, let us pledge to support families dealing with epilepsy. Let us be aware that there are very many treatment options for epilepsy and most children with epilepsy can lead a normal life.

- Dr Pradnya Gadgil

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