Epilepsy

癫痫的症状是什么？

Epilepsy can have a profound effect on a child’s life. Some children may fall or get injured during a seizure, and the episode can leave your child exhausted. The abnormal brain activity that happens during a seizure can sometimes cause damage to the brain. This is a special concern in children because their brains are still growing and changing.

Because the brain controls all aspects of the body, seizures can have many different effects on a child depending on where in the brain the abnormal electrical activity occurs. Seizures can be subtle and barely noticeable or frightening to witness.

Symptoms can include:

• staring
• 手臂和腿部的震颤，抽搐或抽搐的动作
• stiffening of the body
• loss of consciousness
• breathing problems
• loss of bowel or bladder control
• falling suddenly for no apparent reason
• not responding to noise or words for short periods of time
• 出现困惑或阴霾
• extreme sleepiness and irritability when waking up in the morning
• 头点点头或掉落
• 快速眼睛的时期
• 视觉和言语的变化
• vomiting

是什么引起癫痫？

当大脑中的细胞发射或“说话”过多时，会发生癫痫发作，从而暂时破坏大脑的正常电信号。癫痫和癫痫发作有许多可能的原因，包括：

• 头部受伤
• birth trauma
• congenital conditions (conditions that your child is born with) such as brain development disorders
• 脑部肿瘤
• heredity
• degenerative brain disorders
• stroke
• metabolic problems

但是，在一半以上的儿童中，找不到原因。

如何诊断癫痫？

Many conditions other than epilepsy — such as stroke, fainting, problems with heartbeat or breath-holding spells — can cause症状that sometimes look like seizures. If you think your child has epilepsy, a neurologist will review your child’s medical history, perform a complete physical exam and may order some testing.

The main test used to diagnose epilepsy is anelectroencephalogram (EEG)，测量大脑中的电活动。高清脑电图使临床医生可以更详细地了解孩子的大脑活动。

Your child’s neurologist may also refer your child for other testing, which may include:

• imaging tests, such as aMRI，，，，PET，，，，or SPECT
• MEG (magnetoencephalography)
• TMS (transcranial magnetic stimulation)

这些测试有助于神经科医生诊断您的孩子的两种主要癫痫症中的哪种。患有局灶性发作（以前称为部分）癫痫的儿童的癫痫发作在大脑的一侧发作。癫痫病的儿童的癫痫发作似乎始于大脑的两侧。

While diagnosing the epilepsy itself, physicians will also watch for related problems, such as learning or behavior difficulties or depression. Neuropsychologists can conduct specialized testing to monitor your child’s cognitive abilities, learning, behavior, emotional well-being and social function. This will help in developing strategies so your child can function at the highest possible level.

How is epilepsy treated?

癫痫是一个复杂的条件影响child in a different way. This means there’s no one treatment that works for every child with epilepsy. Common therapeutic approaches include medication, surgery and dietary changes.

Epilepsy medications

Medication remains the first line of treatment for epilepsy. There are many types of medications to treat seizures, including newer medications that have been developed over the past few decades. This gives your child’s doctor many options for treating seizures when traditional first-line medications don’t work.

Findings from recent research can help doctors further individualize medical treatment to help control seizures. Possible options include:

• Chronotherapy：这种方法涉及对癫痫发作最常发生的时间的仔细计时处理。它通常可以帮助药物更有效地控制癫痫发作。
• 基因量身定制的治疗: The Boston Children’s Epilepsy Genetics Program uses DNA sequencing to discover previously unknown genetic causes of seizures. Some of these disrupt brain biochemistry in a way that can be targeted with drugs.
• 药物基因组学: Genetic differences in metabolism appear to affect children’s responses to medications. This information helps doctors choose the optimal treatment for each child.

Diet therapy

Diet therapy can sometimes be a good option for childhood epilepsy when medications don’t control seizures or cause intolerable side effects. It can be especially helpful for certain types of epilepsy, such as myoclonic astatic epilepsy (Doose syndrome).

A number of different diets can be used for epilepsy. These include the Classic Ketogenic Diet, the Modified Atkins Diet, the Medium Chain Triglyceride Diet and the Low Glycemic Index Treatment Diet. Which diet is best for your child will depend on the epilepsy diagnosis, your child’s age and eating habits, and family needs and preferences. It is possible and sometimes helpful to transition between the various diets.

Diet therapy takes a strong commitment, but it may offer children a better chance of seizure control than trying a new medication. Because there isn’t yet a good way to tell exactly how a child will respond to diet therapy, a trial of three to four months is usually recommended.

生酮饮食

生酮饮食已被证明在药物失败时对许多患有癫痫病的儿童有效。它可以为大约30％的患有癫痫病的儿童提供癫痫发作的控制。

生酮饮食以最严格的形式通过脂肪提供超过90％的卡路里（相比之下，通常建议使用25％至40％）。当人体燃烧脂肪以获得能量，而不是碳水化合物中的葡萄糖时，它会产生称为酮体的化合物。酮的增加称为酮症。专家认为，酮症会减少大脑的癫痫发作活性，尽管确切的工作原理仍然未知。

Though the diet is challenging, it’s easier than it used to be. As interest in the diet has increased, “keto-friendly” products have become more widely available. These include coconut oil, low-carbohydrate noodles, sugar-free syrups and flavorings, and nut flours.

生酮饮食is highly precise and restrictive. Because it can cause side effects, it should only be started under medical supervision. Before starting on the ketogenic diet, clinicians will assess your child’s nutritional status, diet preferences and calorie needs. If the diet seems like it will be feasible for your family, they will customize it to your child to achieve the best seizure control while meeting daily energy and nutrient needs. In some cases your child may start the diet while in the hospital. Special ketogenic formulas are available for infants or children who need to be fed though a tube.

Because ketogenic diets are not nutritionally balanced, children will need to take vitamin and mineral supplements. Clinicians will also need to check your child’s ketone levels periodically and may need to change the diet to maintain ketosis.

Children usually stay on the diet for about two years. At that point, your child will slowly transition back to a regular diet, and some children are able to remain seizure-free.

无创脑刺激

This approach, also known as neuromodulation, is beginning to be tested as a treatment for drug-resistant epilepsy that cannot be effectively or safely treated with surgery. It applies a magnet or small electrical currents to the scalp, changing brain excitability. There are two main types of brain stimulation:

• Transcranial magnetic stimulation (TMS)涉及将磁铁放在孩子的头皮上。磁铁会产生强大的波动磁场，从而诱导大脑中的小电流，从而降低大脑的兴奋性。两种TMS设备针对大抑郁症的成年人进行了FDA批准，另一个用于治疗偏头痛的设备。尽管没有FDA批准的TMS治疗儿童，但在所有年龄段批准脑部手术之前，有助于识别运动和语音皮质区域的TMS设备。此外，现在正在波士顿儿童医院研究TMS，以治疗某些类型的癫痫病。欧宝彩票平台
• Transcranial direct-current stimulation (tDCS)applies a weak, direct current to the brain via scalp electrodes to decrease firing in selected areas. Though tDCS is currently not FDA-approved, a growing number of studies support its use in pain suppression, certain psychiatric disorders, and stroke.

Surgery

When seizures don’t respond to medication or other treatments, your child’s doctor may recommend an evaluation to see if surgery is an option. Surgical evaluations are done in the hospital over five to seven days. During this time, clinicians will study your child’s seizures and learn exactly what area of the brain they are coming from. If surgery is an option for your child, the care team will discuss what type of surgery they recommend. These may include:

• Focal resection: If the care team can pinpoint the “focal point” — the specific area of your child's brain that is over-firing and causing the seizures — your child may be able to have surgery to remove the abnormal brain tissue without harming neighboring brain areas. This procedure, called “resective” surgery, can often stop the seizures entirely, and most children function normally afterward.
• call骨切开术:这个过程包括削减主要的纤维that connect the two halves (hemispheres) of the brain. This cuts off communication between the two hemispheres and can prevent seizures from spreading from one side of your child's brain to the other. Corpus callosotomy is particularly effective for children who experience severe “drop attacks” in which they lose consciousness. The seizures won’t usually go away, but in most cases they become milder and less disabling. Corpus callosotomy occasionally produces problems with behavior, cognition or motor function.
• Hemispherectomy: A hemispherectomy involves removing or disabling one half (hemisphere) of the brain. This procedure may be used if seizures are coming from a broad area of a single hemisphere. It is only recommended for very severe epilepsy that has not responded to medications and other less aggressive surgeries. It can cause serious side effects, including motor and language skill loss, which must be weighed against the severity of the epilepsy symptoms themselves. When used appropriately, hemispherectomy can be extremely rewarding.
• Vagus nerve stimulation: If your child’s seizures are not controlled by medication or diet, and if brain surgery cannot be done safely, vagus nerve stimulation (VNS) may be an option. For VNS, the surgeon implants a small stimulator (much like a heart pacemaker) under the skin below the left collarbone or into the armpit area. Small wires attached to the stimulator deliver small pulses of electricity to the vagus nerve, one of the major nerves running along the neck to the brain. The device is then set to stimulate the nerve at regular intervals, such as 30 seconds every five minutes; a neurologist will fine-tune the settings during follow-up visits. Seizures usually don’t go away completely with VNS, but most children see a reduction in their number and severity. Many are able to reduce their medications, giving them greater flexibility and confidence.

实验治疗

If your child's seizures are not well managed by existing therapies, your care team may recommend enrolling in a clinical trial of a new drug or other experimental treatment. Being in a study sometimes means that your child has a 50-50 chance of receiving the new treatment, at least in the beginning. Each study has different ground rules, so it’s worth inquiring.