What is Temporal Epilepsy in Children?
Temporal epilepsy is a form of epilepsy that belongs to a heterogeneous group of diseases in which the first clinical and electrophysiological manifestations indicate the focal nature of epileptic seizures and the localization of epileptogenic focus in the temporal lobe due to its primary lesion.
Causes of Temporal Epilepsy in Children
The causes of temporal lobe epilepsy are varied and provoked by many factors: neuroinfections (brucellosis, neurosyphilis, meningitis, herpes, encephalitis, encephalomyelitis), traumatic brain injury, temporal lobe tumor (astrocytoma, angioma, glioma, and other vessels). tuberous sclerosis, asphyxia, abscess, intracerebral hematoma, cerebrovascular aneurysm, birth trauma, central nervous system damage in the perinatal period – intrauterine infections (rubella, measles, syphilis), etc.
Pathogenesis during Temporal Epilepsy in Children
Pathogenesis is manifested by local structural changes in the brain, which are characterized by pathological excitation of surrounding neurons, provoking convulsive symptoms. In sick children with temporal lobe epilepsy, disorders of protein-nitrogen metabolism, water-salt, carbohydrate metabolism are observed.
Symptoms of Temporal Epilepsy in Children
The main symptom of temporal lobe epilepsy is an aura, which is most often manifested by a sense of fear, tickling in the epigastric region, sensations of an “already seen”, dream state, sometimes complex hallucinations and illusions. Following the aura, a disturbance of consciousness often occurs. Patients often show anoalimentary disturbance: smacking, chewing, licking lips, autonomic disorders are manifested by an increase in 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: amygdala, opercular (insular), hippocampal, lateral posterior temporal. They also adhere to another classification of temporal lobe epilepsy, which consists of 2 types: amygdalohippocampal and lateral.
Amygdalohippocampal epilepsy is considered a separate nosological form in the framework of temporal lobe epilepsy. With this form, simple and complex partial, as well as secondary-generalized convulsive seizures are noted. The most characteristic are complex partial (psychomotor) seizures (SPP) with impaired consciousness, combined with intact, but automated motor activity. Temporal epilepsy is characterized by three criteria: turning off consciousness with amnesia, lack of response to external stimuli, and the presence of automatisms. A disorder of consciousness is the only constant criterion for all psychomotor attacks. The clinical picture of seizures with an isolated disorder of consciousness is characteristic: the patient may congeal with a mask-like face, eyes wide open, his gaze fixed in one direction, while various autonomic disorders can be observed: pale face, tachycardia, dilated pupils, sweating.
Automata are considered the most important clinical manifestation. They are expressed by swallowing, licking, chewing, sucking, facial expressions – grimaces, facial fear, surprise, confusion, as well as a smile, laughter, frowning. Automatism of gestures is accompanied by quick stereotyped one- or two-way movement: clapping, rubbing hands; stroking, patting or scratching his body, sorting through clothes or anything else, shifting or viewing various objects, washing hands, etc. Speech automatisms in the form of various speech disorders: slurred muttering, pronouncing individual words, sounds; sobbing or crying, hissing, etc. Outpatient automatisms are accompanied by lengthy, as if focused, expedient and coordinated movements, usually pass with interaction. Patients can place different objects on the table, look around them, turn on the radio, pour water and perform other actions. Longer outpatient automatisms can go into an epileptic trance. Children with this disease can aimlessly walk on 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 sadapopal. The duration of the trans can be several tens of minutes, or several hours, very rarely – days.
Simple partial seizures often precede the onset of DSS or secondary generalized seizures. The main criterion for simple partial seizures is the preservation of consciousness during an attack. They are manifested by motor, sensory, vegetative-visceral symptoms; attacks with violation of mental functions are noted.
Simple partial motor attacks are expressed by local tonic or clonic-tonic convulsions, contralateral to the outbreak; postural dystonic paroxysms, most characteristic of temporal lobe epilepsy. Dystonic seizures involve the distal extremities (most 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 outbreak and automatisms in the hands.
Simple partial sensory seizures occur at different frequencies. For amygdalo-hippocampal temporal lobe epilepsy, olfactory and gustatory paroxysms are considered typical; visual, auditory hallucinations and dizziness attacks.
Vegetative-visceral seizures are one of the manifestations of amygdalogippocampal temporal lobe epilepsy. Epigastric, cardiac, respiratory enhancements are distinguished. Epigastric paroxysms are manifested by abdominal discomfort, there is pain in the epigastric or navel areas, rumbling in the abdomen, urge to defecate, gas exhaustion, cardiac are accompanied by sudden specific sensations in the heart zone by type, compression, compression, bursting, etc. We note that patients are characterized by violations fluctuations in blood pressure, heart rate, autonomic disorders (hyperhidrosis, pallor of the skin, chills-like hyperkinesis); expressed a sense of fear. Respiratory attacks are typical: sudden asphyxiation, respiratory rhythm disorders with periods of apnea, compression in the neck area with tonic strains of the neck muscles. Attacks with mental disorders are observed, which are accompanied by states of vision, lack of reality and depersonalization. These conditions are not fully amnesized; patients retain separate memories of what happened.
Lateral temporal lobe epilepsy (neocortical) is less common than amydalogypyocampal. It is accompanied by seizures that occur in isolation or in combination, for example, auditory ones are accompanied by visual hallucinations, dizziness – speech impairment. Auditory hallucinations can be elementary (noise) and complex long-lasting (voices, etc.). Distinctive are heavy color visual hallucinations with the vision of people or animals, as well as various objects; their movements. Vestibular seizures are accompanied by an unexpected short stereotypical dizziness, most often of an unsystematic nature. During a seizure, illusions of changes in space may appear, children may think that the walls are falling, the ceiling is lowering, as well as vegetative symptoms.
When the focus is localized in the superior temporal gyrus of the dominant hemisphere (Wernicke speech center), sensory attacks are observed in the form of impossibility for patients to perceive oral speech.
With lateral temporal lobe epilepsy, peculiar seizures called “temporal syncope” or “fainting-like form of epilepsy” may occur. Attacks begin with an aura (often dizziness) or in isolation. A relatively slow turn-off of consciousness followed by “limp” and fall is characteristic. Light tonic tension of the muscles of the arms and legs, facial muscles, oromental or gesture automatisms are possible.
Diagnosis of Temporal Epilepsy in Children
Diagnosing temporal lobe epilepsy is quite difficult, since simple and partial seizures can be undetected in the early stages. But the chance to establish a timely diagnosis in childhood is higher than in adulthood, since children undergo a mandatory medical examination and consultation.
Routine interictal EEG (electroencephalogram) with temporal lobe epilepsy is of low importance, 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 peak wave activity regional, usually in the anterior temporal leads or bitemporal, a slowdown in the main activity of the background recording, generalized wave activity with a frequency of 2.5-3 Hz. During an attack on the EEG, low-amplitude fast (3) activity or continued slowdown in the temporal leads is noted. In the latter case, only a higher amplitude of slow waves on the source side can have lateralization value. A test with sleep deprivation may be essential for determining pathological activity, this is done during polysomnography. Other provocative tests are less significant.
MRI and CT are mandatory research methods for first-time attacks of temporal lobe epilepsy. The diagnostic significance of MRI to exclude organic damage to the brain is high, and therefore should be carried out for each patient with suspected attacks of temporal lobe epilepsy. MRI helps diagnose the presence of medial temporal sclerosis, cortical dysplasias, tumors, vascular malformations, cysts, atrophic changes in the temporal lobe, which cause the occurrence of temporal lobe epilepsy.
Treatment of Temporal Epilepsy in Children
In the treatment of temporal lobe epilepsy, the main tasks are to reduce the frequency of seizures, to achieve remission of the disease, the so-called complete cessation of seizures.
Treatment begins with monotherapy. The drugs that are used include carbamazepine, in case of its inefficiency, valproates (depakine), hydantoins (diphenin), barbiturates, benzodiazepines, lamotrigine are prescribed.
If treatment with one drug was unsuccessful, then polytherapy is prescribed from several of the above funds.
If temporal lobe epilepsy is not amenable to drug therapy, surgery is considered. Most often, temporal resection is performed, less often – focal, selective hippocampotomy or amygdalotomy.
According to forecasts, remission is achieved in 35%. Most often, treatment leads to the fact that seizures 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, complications such as hemiparesis, mnestic disorders, and speech disorders can be observed.
Prevention of Temporal Epilepsy in Children
Prevention of temporal lobe epilepsy is divided into primary and secondary. The primary one is the prevention of epilepsy, early diagnosis, monitoring the state of the mother during pregnancy, monitoring a child who was born in a family with hereditary factors.
Children with potential heredity are at risk of temporal lobe epilepsy. The secondary prevention of epilepsy is stabilization of achieved therapeutic remission.
Parents need to monitor the regimen of the child’s day: a full sleep, a balanced menu, light physical activity.