Temporal Epilepsy in children

What is Temporal epilepsy in children?

Temporal epilepsy is one of the forms of epilepsy, refers to a heterogeneous group of diseases in which the first clinical and electrophysiological manifestations indicate the focal nature of epileptic seizures and localization of the epileptogenic focus in the temporal lobe due to its primary lesion.

Causes of Temporal Epilepsy in Children

The causes of temporal epilepsy are diverse and triggered by many factors: neuroinfections (brucellosis, neurosyphilis, meningitis, herpes, encephalitis, encephalomyelitis), traumatic brain injury, tumor of the temporal lobes of the brain (astrocytoma, angioma, glioma, etc., tumor of the temporal lobes of the brain (astrocytoma, angioma, glioma, etc.), tumor of the temporal lobes of the brain (astrocytoma, angioma, glioma, etc., tumor of the temporal lobes of the brain (astrocytoma, angioma, glioma, etc.), tumor of the temporal lobes of the brain (astrocytoma, angioma, glioma, etc., tumor of the temporal lobes of the brain (astrocytoma, angioma, glioma, etc.), tumor of the temporal lobes of the brain (astrocytoma, angioma, glioma etc. , tuberous sclerosis, asphyxia, abscess, intracerebral hematoma, cerebral aneurysm, birth injury, CNS damage in the perinatal period – intrauterine infections (rubella, measles, syphilis), etc.

Pathogenesis in Temporal Epilepsy in Children

The pathogenesis is manifested by local structural changes in the brain, which are characterized by pathological excitation of surrounding neurons, provoking convulsive symptoms. In children with temporal epilepsy, there are violations of the protein-nitrogen metabolism, water-salt, carbohydrate metabolism.

Symptoms of Temporal Epilepsy in Children

The main symptom of temporal epilepsy is an aura, which is most often manifested by a feeling of fear, tickling in the area of ​​epigastria, sensations of “already seen”, dreaming state, sometimes complex hallucinations and illusions. Following the aura, a disturbance of consciousness often occurs. Patients often exhibit normal alimentary disorders: smacking, chewing, lips licking, autonomic disorders manifest as increased heart rate and respiration. Clinical manifestations are polymorphic and diverse. Temporal epilepsy is classified according to the localization of epileptic foci and clinical symptoms, it is divided into 4 types: amygdalaar, opercular (insular), hippocampal, lateral posterior temporalis. Also adhere to another classification of temporal epilepsy, which consists of 2 types: amygdalogoppocampal and lateral.

Amygalogue and hippocampal epilepsy is considered a separate nosological form in the framework of temporal epilepsy. In this form, simple and complex partial as well as secondary generalized convulsive seizures are noted. The most characteristic are complex partial (psychomotor) seizures (PMS) with a disorder of consciousness, combined with intact, but automated motor activity. Temporal epilepsy is characterized by three criteria: deactivation with amnesia, lack of response to external stimuli, the presence of automatisms. The disorder of consciousness is the only constant criterion of all psychomotor attacks. The clinical picture of seizures with an isolated disorder of consciousness is characteristic: the patient can freeze with a mask-like face, wide-open eyes, his gaze is fixed in one direction, and various vegetative disorders can be observed: blanching of the face, tachycardia, dilated pupils, sweating.

The most important clinical manifestation are considered automatisms. They are expressed by swallowing, licking, chewing, sucking, facial expressions – grimaces, mimic fear, surprise, confusion, as well as smile, laughter, frowning. Gesture automatisms are accompanied by fast stereotypical one- or two-way traffic: clapping hands, hand friction; stroking, patting or scratching your body, sorting out clothes or anything else, shifting or viewing various objects, washing hands, etc. Speech automatisms in the form of various speech disorders: muffled muttering, pronouncing of separate words, sounds; sobbing or crying, hissing, etc. Outpatient automatisms are accompanied by long, seemingly targeted, expedient and coordinated movements, usually taking place with interaction. Patients can arrange various objects on the table, look around them, turn on the radio, pour water and perform other actions. Longer outpatient automatisms can turn into an epileptic trance. Children with this disease can walk aimlessly through the streets, go in an unknown direction. Attacks are forgotten after they end. Disorientation occurs in patients; they do not understand where they are and how they are syudopopals. The duration of transamozht be as several tens of minutes, so for several hours, very rarely – days.

Simple partial seizures often precede the occurrence of PPS or secondary generalized seizures. The main criterion of simple partial attacks – the safety of consciousness during an attack. They are manifested by motor, sensory, vegetative-visceral symptoms; marked attacks with impaired mental functions.

Simple partial motor seizures are expressed by local tonic or clonic-tonic convulsions, contralateral to the hearth; postural dystonic paroxysms most characteristic of temporal epilepsy. Dystonic seizures involve the distal limb (more often the hand than the foot) on the opposite side with a specific fixed athetoid setting. Attacks can be combined with turning the head opposite to the hearth and automatism in the hands.

Simple partial sensory seizures occur with varying frequency. For amygdalo-hippocampal temporal lobe epilepsy, olfactory and taste paroxysms are typical; visual, auditory hallucinations and bouts of dizziness.

Vegeto-visceral seizures – this is one of the manifestations of amygdalogo-pocampal temporal epilepsy. Allocate epigastric, cardiac, respiratory gain. Epigastric paroxysms manifest abdominal discomfort, there is pain in the epigastric region or navel, rumbling in the abdomen, urge to stool, discharge of gas, cardiac accompanied by sudden specific sensations in the area of ​​the heart according to the type of compression, compression, distention, etc. fluctuations in blood pressure, heart rhythm, autonomic disorders (hyperhidrosis, pallor of the skin, chill-like hyperkinesis); a feeling of fear. Respiratory attacks are characteristic: sudden suffocation, respiratory rhythm disorders with periods of apnea, compression in the neck area with tonic tension of the neck muscles. Seizures with mental function disorders are observed, which are accompanied by sleep states, lack of reality and depersonalization. These conditions are not fully amnesized, patients have separate memories of what happened.

Lateral temporal epilepsy (neocortical) is observed less frequently amygdalogipocampal. It is accompanied by seizures that occur in isolation or in combination, for example, the auditory ones are accompanied by visual hallucinations, dizziness – speech disorders. Auditory hallucinations can be elementary (noise) and difficult long (voices, etc.). Distinctive are heavy colored visual hallucinations with the vision of people or animals, as well as of various objects; their movements. Vestibular seizures are accompanied by an unexpected short stereotypical dizziness, most often of a non-systemic nature. During a seizure, there may be illusions of space changes, children may think that walls are falling, the ceiling is falling, as well as vegetative symptoms.

With localization of the lesion in the upper temporal gyrus of the dominant hemisphere (Wernicke speech center), sensory episodes are observed in the form of the inability of patients to perceive oral speech.

In lateral temporal epilepsy, a kind of seizure called “temporal syncope” or “faint-like form of epilepsy” can occur. Attacks begin with auras (often dizziness) or in isolation. A relatively slow deactivation of consciousness followed by “limping” and falling is characteristic. Mild tonic tension of the muscles of the arms and legs, facial muscles, or alimentary or gestural automatisms are possible.

Diagnosis of Temporal Epilepsy in Children

It is rather difficult to diagnose temporal epilepsy, since simple and partial seizures can be undetected in the early period. But the chance to establish a timely diagnosis in childhood is higher than in an adult, since children undergo compulsory medical examination and consultation.

Routine interictal EEG (electroencephalogram) with temporal epilepsy is of low significance, since in many patients (up to 40%) it may not differ from the norm. The following pathological changes are described on the EEG in the interictal period: peaks, sharp waves, or picwave regional activity, more often in frontal-lead or bitemporal, slowing down the main activity of the background recording, generalized peakwave activity with a frequency of 2.5-3 Hz. During an attack on the EEG, a low-amplitude rapid (3) activity or a continued slowdown in the temporal leads is noted. In the latter case, the lateralization value can have only a higher amplitude of slow waves on the side of the source. A sample with sleep deprivation may be essential for determining the pathological activity; this is done during polysomnography. Other provocative tests are less significant.

MRI and CT are mandatory research methods for the first-time bouts of temporal epilepsy. The diagnostic value of MRI for the exclusion of organic brain damage is high, and therefore each patient should be conducted with suspected episodes of temporal epilepsy. MRI helps diagnose the presence of medial temporal sclerosis, cortical dysplasia, tumors, vascular malformations, cysts, atrophic changes in the temporal lobe, which cause the appearance of temporal epilepsy.

Treatment of Temporal Epilepsy in Children

In the treatment of temporal epilepsy, the main objectives are to reduce the frequency of attacks, to achieve remission of the disease, the so-called complete cessation of attacks.

Treatment begins with monotherapy. The drugs that are used include carbamazepine, in the event of its inefficiency, valproates (depakine), hydantoins (diphenin), barbiturates, benzodiazepines, lamotrigine are prescribed.

If the treatment with one drug was unsuccessful, then a polytherapy of several of the above remedies is prescribed.

If temporal epilepsy does not respond to drug therapy, surgery is considered. The most common is a temporal resection, less often – a focal, selective hippocampotomy or amygdalotomy.

According to forecasts, remission is reached in 35%. Most often, treatment leads to the fact that the attacks become rare. Surgical treatment helps in 30-50%, and in 60-70% of cases, seizures become rare. But It is worth noting that after the operation there may be complications, such as hemiparesis, mnestic disorders, speech disorders.

Prevention of Temporal Epilepsy in Children

Prevention of temporal epilepsy divided into primary and secondary. The primary concern is the prevention of epilepsy, early diagnosis, monitoring of the state of the mother during pregnancy, observation of the child who was born in a family with hereditary factors.

Children with potential heredity are at risk of temporal lobe epilepsy. Stabilization of the achieved therapeutic remission belongs to the secondary prevention of epilepsy.

Parents need to follow the regime of the child’s day: a full sleep, a balanced menu, light physical exertion.

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