What is occipital epilepsy in children?
Occipital epilepsy belongs to a heterogeneous group of diseases, the initial clinical and electrophysiological manifestations of which indicate the focal nature of epileptic seizures. Localization of epileptogenic foci is located in the occipital lobe due to primary lesion. The disease can debut at any age.
Occipital epilepsy can develop with constitutional episodiculation or can occur as a hereditary disease.
Causes of Occipital Epilepsy in Children
The causes of symptomatic occipital epilepsy are brain dysgenesis (focal cortical dysplasia, microgyria, etc.), tumors, neurofibromatosis, a cyst of the occipital lobe, congenital malformations of the brain, MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis, torn red fibers, broken MELAS syndrome (lactic acidosis, ruptured red fibers, fractured red fibers, broken red fibers, broken red fibers), in broken red fibers, broken red fibers, in broken red fibers, broken red fibers;
Pathogenesis during occipital epilepsy in children
In occipital epilepsy, changes in the neuronal activity of the brain occur. At the same time, there is an unexpected pronounced depolarization of neurons in the brain, which leads to significant disturbances in the processes of thalamocortical interaction and an increase in the sensitivity of cortical neurons. The onset of seizures is affected by the excessive release of excitatory neurotransmitters – aspartate and glutamate, as well as a lack of inhibitory neurotransmitters, primarily GABA.
Symptoms of Occipital Epilepsy in Children
Occipital epilepsy, like parietal, is characterized mainly by simple partial paroxysms without disturbing consciousness. Its clinical manifestations are divided into initial and subsequent symptoms. The initial clinical symptoms are due to epileptic activity directly in the occipital lobe, whereas the subsequent symptoms are the result of the spread of epileptic activity to other areas of the brain. The initial clinical symptoms of occipital paroxysms include simple visual hallucinations, paroxysmal amaurosis, paroxysmal visual field disturbances, subjective sensations in the area of the eyeballs, blinking, deviation of the head and eyes. Simple visual hallucinations are bright flashes of light before your eyes, luminous spots, circles, stars, squares, straight or zigzag lines. They can be either one color or multi-color, fixed or moving horizontally, rotationally, or moving in and out of the field of view. Simple visual hallucinations, as an isolated symptom or as part of a more complex attack, always indicate the localization of the epileptogenic focus in the occipital lobe.
Paroxysmal Maurosis is manifested in the form of vagueness or temporary loss of vision. Patients usually describe their feelings as “blackness before eyes”, less often – as “white veil before eyes”. Paroxysmal amaurosis is often combined with simple visual hallucinations, and sometimes with migraine headache. Paroxysmal disturbances of visual fields are relatively rare in the form of paroxysmal hemianopia or quadrant hemianopia within a few seconds or a few minutes. Subjective sensations in the area of the eyeballs are mainly expressed by the feeling of eye movement in the absence of objective symptoms. This symptom is typical for occipital epilepsy. Blinking in epilepsy is noted at the very beginning of the attack, has a violent nature and resembles the fluttering of butterfly wings. Head and eye deviation is characteristic of epileptic paroxysms of various localization. In occipital epilepsy, deviation of the head and eyes is often one of the initial symptoms of an attack, with the head and eyes turning in the opposite direction. Epileptic activity often spreads to other areas of the brain, resulting in various clinical symptoms.
Diagnosis of Occipital Epilepsy in Children
In the diagnosis, an interictal EEG (electroencephalogram) using surface electrodes is used, this study is quite informative. However, in some cases, focal epileptic samples are recorded, mainly in the occipital or posterior temporal area. The presence of epileptic specimens in the posterior temporal areas may indicate a possible occipital nature of epileptic paroxysms.
An MPT study is conducted to rule out local brain pathology. MRI is necessary for the first episodes of occipital epilepsy, it has a high diagnostic value and allows, in most cases, to identify pathological changes in the occipital lobe.
Neuroimaging is aimed at identifying non-epileptogenic organic defects such as ventriculomegaly, arachnoid cysts.
Neuropsychological research is conducted to determine speech and behavioral disorders, visual abnormalities, reduce attention and memory disorders.
The diagnosis is made after the above-mentioned studies and differential diagnosis, which is carried out in early form on the basis of circulatory disorders of the brain.
Treatment of Occipital Epilepsy in Children
Drug treatment for occipital epilepsy is indicated when observing frequent attacks or impairment of the patient’s quality of life. Attacks often affect a child’s psychosocial behavior.
The drugs of choice for partial seizures (without secondary generalization or secondary-generalized) are carbamazepines and valproats. In general, with partial seizures, a number of drugs (carbamazepines, valproates, phenytoin, phenobarbital) are quite effective, however, phenobarbital and phenytoin are not drugs of choice due to side effects. with partial forms of epilepsy, topiramate (topamax). Topamax is prescribed to children older than 2 years with monotherapy in the first week of treatment at a dose of 0.5-1 mg / kg per day (the daily dose is divided into 2 doses). Children older than 2 years with monotherapy with topamax are recommended doses of 3-6 mg / kg per day. Older children and adolescents at the beginning of monotherapy with Topamax should take 25 mg 1 time per day before going to bed for 1 week. Then the dose is increased at intervals of 1-2 weeks. on 25-50 mg / day. The recommended dose is 100 mg / day, the maximum daily – 500 mg. With polytherapy in children older than 2 years, the recommended total daily dose of topamax is from 5 to 9 mg / kg in 2 doses. The selection of the dose begins with 25 mg / day (or less – 1-3 mg / kg per day), the drug is taken overnight for 1 week. In the future, with a 1-2-week interval, the dose can be increased by 1-3 mg / kg in 2 doses. In adolescents, the initial dose of topamax in polytherapy 50 mg 1 time per day for the night for 1 week. Next, you should increase the dose of 50-100 mg every week until the selection of an effective dose. The average daily dose is 200-600 mg, the multiplicity of reception – 2 times a day.
In the treatment of occipital epilepsy there is no need for long-term medical treatment. The child needs a course of treatment from a psychotherapist, because the clinical symptoms of the disease without timely treatment can make the child socially unsuitable. The prognosis for treatment of this form of epilepsy is favorable.
Prevention of Occipital Epilepsy in Children
As a preventive measure, doctors recommend parents to ensure that the child does not overeat, that they follow the milk-vegetable diet and the daily regimen. Children with occipital epilepsy are prohibited from being at high altitude and engaging in tourism, climbing mountains, staying by the fire or in stuffy rooms, near moving mechanisms. At the same time, children are shown walks in the fresh air and light feasible physical exertion, children must observe the regime of work and rest.
Parents should worry about a relaxed family atmosphere, children with occipital epilepsy should avoid stressful situations (in kindergarten, school, at home).