On the Day of the Patient with Epilepsy, March 26, aif.ru learned from experts how widespread this disease is today, and what kind of help is provided to children with epilepsy today.
Purple Day has been celebrated since 2008. It was initiated by a nine-year-old Cassidy Megan from Scotland, who suffers from epilepsy. The girl dreamed of dispelling the myths around this disease, and telling the public that this diagnosis is not a sentence, and people with epilepsy are no different from the rest.
Every fourth patient is a child
Epilepsy can develop at any age. But most often it occurs in childhood. Worldwide, about 70 million people are diagnosed with epilepsy, a quarter of them under the age of 15. Such data are provided by the International League against epilepsy.
The disease is not a psychiatric pathology, it is treated by neurologists. Its mechanism is to change the activity of neurons in the cerebral cortex. However, depending on the type and cause of the development of the disease, the form and frequency of seizures in epilepsy, mental disorders are also possible (but not necessary).
The Russian Children’s Clinical Hospital carries out a full cycle of diagnosis and treatment of this disease, which makes it possible to establish an accurate diagnosis even in the most difficult cases. “About 1,000 patients with epilepsy receive specialized medical care at the RCCH every year,” said aif.ru Head of the Psychoneurological Department for Young Children, Russian Children’s Clinical Hospital, Russian National Research Medical University named after N.I. N.I. Pirogova of the Ministry of Health of Russia, Candidate of Medical Sciences Elena Ilyina – This disease has become one of the priorities in the work of neurologists since the opening of the hospital. Currently, patients aged from 1 month to 18 years old with paroxysmal conditions, primarily with a diagnosis of epilepsy, are hospitalized in the clinic.
Not only seizures
Although epilepsy is sometimes called the disease of geniuses, because it suffered Van Gogh, Dostoyevsky, Alexander the Great, Leonardo da Vinci, Socrates and other great people, parents perceive such a diagnosis, especially if it is given to a child, as a tragedy. After all, epilepsy is a chronic disease, that is, currently incurable, although there are cases when it goes away by itself (this sometimes happens in adolescents) or seizures can stop as a result of surgical treatment.
Many people are sure that the danger of the disease lies only in sudden convulsive seizures (which, by the way, do not occur with all forms of epilepsy). In fact, delayed negative consequences are also possible: the disease leads to developmental delay in children and other serious problems that significantly reduce the quality of life. Nevertheless, the possibilities of helping children with such a diagnosis today have increased significantly, and treatment (both medical and surgical) has become more effective.
What research is needed
But first you need to make sure that the child has this diagnosis, since many conditions (fainting, migraines, paroxysmal conditions, etc.) can disguise themselves as epilepsy. Therefore, only on the basis of the clinic, the diagnosis is not made. Often, epilepsy manifests itself in a non-convulsive form, and then it is even more difficult to suspect it.
Video-EEG monitoring is one of the key methods for diagnosing epilepsy. One of the first video-EEG monitoring laboratories in the country was opened in 1996 in the RCCH, in the psycho-neurological department for young children. This allowed to significantly improve the diagnosis of various paroxysmal conditions in patients.
During this study, which can last from one hour to a day, the child, who is put on a special cap with 2 dozen electrodes, and several additional electrodes are glued to the body, spends in a special room. If the study is daily, then in the same room the patient plays, reads, watches movies, eats and even sleeps. It is important that all the time his face is turned to the video camera.
After all, when an attack occurs, the most important thing for a correct interpretation is the movement of the eyeballs and eyelids (sometimes attacks only manifest themselves in this way, but there is no “falling”). Also, during the study, parents should press the button when they see (or suspect) that the child has an epileptic seizure, this time should be noted on a special sheet. First, active wakefulness is recorded, the child is invited to sit quietly with his eyes open (you can watch cartoons at this time). Further, passive wakefulness is recorded – you need to sit (or lie down) with your eyes closed. Half an hour after the start of the study (and 30 minutes before its end), functional tests are carried out – “provocations” of epileptic activity. For example, asking the child to open and close their eyes, take a deep breath, or direct flashes of bright light at the patient’s eyes.
Diagnosis of the disease also includes neuroimaging methods: computed and magnetic resonance imaging. As told aif.ru Head of the Department of Radiation Diagnostics of the Russian Children’s Clinical Hospital of the Russian National Research Medical University named after N.I. N.I. Pirogov of the Ministry of Health of Russia, Doctor of Medical Sciences, Professor Alikhan Alikhanov, the first high-resolution MRI protocol for focal epilepsy in children based on the functionality of a 1.5-slot scanner was first developed in this hospital. “Now the technique has undergone multiple modifications and is being successfully implemented on 3 Tesla superconductive magnetic resonance systems, and is also used in medical institutions throughout the country. It was developed by us in 2006 and preceded all foreign analogues, which began to be introduced only in 2015-2017,” the doctor noted.
Everything’s under control
In recent years, several new antiepileptic drugs have appeared. Their competent appointment and use allows achieving control of the disease in 65-70% of patients. Together with the Department of Neurology, Neurosurgery and Medical Genetics of the Pediatric Faculty of the Russian National Research Medical University. N.I. Pirogov in the clinic, algorithms for prescribing and monitoring anticonvulsant therapy in children were developed. Proper treatment helps keep the disease under control and patients can lead normal lives.
In addition, together with the Medical Genetic Research Center, the RCCH was the first to develop and start selective screening of patients with developmental delays and epilepsy. Thanks to him, it was possible to identify groups of patients who suffer from congenital hereditary metabolic diseases, and to clarify the cause of the pathology. This, in turn, makes it possible to provide complex treatment: to carry out not only anticonvulsant therapy, but also pathogenetic therapy – to deal with the cause, and not with the symptom.
Surgery stops seizures in 70%
And today, after a comprehensive comprehensive examination, neurosurgical intervention is performed for patients with forms of the disease that are resistant to drug therapy.
For more than ten years, the RCCH has been performing surgical treatment of epilepsy – resection of focal lesions. This is the most complicated surgical intervention, which is available in the clinic due to complex multimodal preoperative diagnostics. With its help, it is possible not only to resect focal lesions with high accuracy, but also to minimize damage to “healthy” brain tissue. This significantly reduces the degree of disability of patients, and increases their rehabilitation potential.
“Every year we perform about 50 operations on patients with epilepsy as part of the provision of high-tech medical care,” said aif.ru doctor of the neurosurgical department of the Russian Children’s Clinical Hospital of the Russian National Research Medical University named after N.I. N.I. Pirogov of the Ministry of Health of Russia Igor Vasiliev. “More than 70% of cases of surgical treatment lead to a complete recovery of the patient: when the seizures completely stop and the need to use anticonvulsants disappears.”
Children with epilepsy often have associated movement disorders and require rehabilitation therapy. The Russian Children’s Clinical Hospital was one of the first in the country where the rehabilitation of patients with epilepsy under EEG control became possible. Thanks to close cooperation with the Department of Rehabilitation, Sports Medicine and Physical Education of the Pediatric Faculty of the Russian National Research Medical University. N.I. Pirogov developed rehabilitation techniques that can be used in patients with epilepsy.