Cerebral Palsy and Epilepsy

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Around half of all children with cerebral palsy also have epilepsy. Epilepsy is a seizure disorder that varies in severity. Medication is the most common treatment, but children might benefit from dietary changes or surgery.

What Is Epilepsy?

Epilepsy is a chronic brain disorder or group of disorders. Epilepsy is characterized by seizures when nerve cells in the brain send faster, stronger signals than normal.[1]

During these episodes, some children will experience loss of consciousness. As the fourth most common neurological disorder globally, epilepsy can affect anyone at any age. Around 1 out of every 100,000 people develop epilepsy each year.

There are several different types of seizures, and people with epilepsy may experience one or several of the various types. It’s important to note that there is a difference between epilepsy and seizures. Someone who has only one seizure generally does not have epilepsy.

Epilepsy is marked by recurrent seizures. If someone has at least two but usually more episodes as an ongoing condition, they are more likely to be diagnosed with a seizure disorder, otherwise known as epilepsy.

Types of Seizures

Seizures come in many different varieties that can be categorized as either focal or generalized.

Focal Seizures

Focal seizures occur in just one part of the brain. They are named for the area of the brain in which they occur. Focal seizures can be simple or complex.

In a simple seizure, a person remains conscious but experiences sudden emotions and sensations. These might include happiness, anger, sadness, nausea, or tastes and smells.

During a complex seizure, a person loses consciousness to some degree. They exhibit repetitive motions like twitching or blinking.

Generalized Seizures

Generalized seizures occur in both sides of the brain and usually cause a person to lose consciousness. Subtypes of generalized seizures include:

• Absence seizures. During an absence seizure, a person stares off into space and might jerk or twitch.
• Tonic seizures. This type of seizure stiffens the back and limb muscles.
• Clonic seizures. Clonic seizures cause jerking in the body.
• Tonic-clonic seizures. This is a combination includes symptoms of both tonic and clonic seizures.
• Atonic seizures. During this kind of seizure, a person loses muscle tone. They might flop over or fall down.

What Causes Epilepsy?

For about half of epilepsy cases, there’s no known cause. Among the known causes of epilepsy, the most common include:

Prenatal Injuries

During intrauterine life, the developing brain of a fetus is highly susceptible to damage. This can occur from prenatal infections, maternal alcohol and drug use when the oxygen or blood supply is low, and poor nutrition or vitamin deficiencies.

Developmental and Genetic Disorders

As mentioned earlier, cerebral palsy and epilepsy often co-occur. Other neurodevelopmental and genetic disorders associated with epilepsy include conditions like autism, neurofibromatosis, Angelman syndrome, and many others.

Sometimes, a mutation in one or more genes can cause abnormalities in the brain that can be passed down and make a whole family more susceptible to epilepsy or other brain disorders.

Brain Injury

Brain injuries, such as those caused by birth injuries, motor vehicle collisions, or any accident in which the head undergoes traumatic damage, can lead to epilepsy.[2]

Diseases

Several infectious diseases can cause direct damage to brain tissue, such as viral encephalitis and meningitis, which can result in epilepsy.

Oxygen Loss

Any significant lack of oxygen to the brain before, during, or after birth can cause seizures in babies. This can also occur with people of any age with a stroke, which is a bleed or obstruction to the blood flow in the brain. The brain damage that occurs is often permanent and may leave the child with a seizure disorder.

What Are the Symptoms of Epilepsy?

The main symptom of epilepsy is recurrent seizures, which are marked by any of the following:

• Uncontrollable, jerking body movements, usually in the arms and legs
• Repetitive movements of the face, including lip-smacking or chewing
• Loss of awareness
• Drooling
• Difficulty talking
• Rigid, tense muscles
• The skin may look pale or flushed
• Racing heart
• Dilated pupils or staring
• Sweating
• Tongue biting
• Tremors

Keep in mind that not every child will experience all of these symptoms.

Epilepsy Treatment

Several different treatments and therapies are available to manage epilepsy and seizures:

Medication

Physicians often treat epilepsy with medication.[3] The type of medicine prescribed is based on the particular seizure type experienced by the child. However, since each child is different, finding the correct medication and dosage can be arduous.

Most epilepsy medications have significant side effects, especially when first used, including dizziness, weight gain, fatigue, nausea, skin rashes, and more, depending on the medication. Doctors usually prescribe the first medication at a low dosage to see how effective it is and how many side effects the child will experience.

Over half of the people who begin medication find success with this treatment method. With continued use, they may even eventually become seizure-free. There are some for whom the medication works well to control the seizures, but they will have to continue on medicine for life to remain seizure-free.

Vagus Nerve Stimulation

If medications fail to work, physicians may recommend a treatment called vagus nerve stimulation. This involves the placement of a small device into the patient’s chest. This device sends low levels of electrical energy to stimulate the vagus nerve, which may reduce seizure activity between 20% and 40%.

Dietary Changes

The ketogenic diet is another treatment option for epilepsy that fails to respond to medication. However, a strict diet entails substantially lowering carbohydrates while increasing fats. The body will then use fat for energy, as opposed to carbohydrates.

It is a difficult diet for families to follow because of the severe limitations in what the child may eat, as well as the continuous need to monitor for ketones.

You’ll need to work closely with your physician and a dietitian or nutritional counselor if you decide to have your child try the ketogenic diet, as some children may experience adverse side effects, including dehydration and nutritional deficiencies.

However, the side effects are not too common with proper medical supervision. Around 10% to 15% of children who go on the ketogenic diet are seizure-free within a year. The problem is that most people cannot stay on a strict diet for long periods.

Surgery

Surgery may be considered the next option if all other treatments have been exhausted. Surgical procedures are generally only performed as a last resort. During the operation, the part of the brain that’s causing seizures is removed.

Studies on Cerebral Palsy and Epilepsy

According to studies, spastic quadriplegia and spastic diplegia are the most common types of cerebral palsy associated with epilepsy.[4] Symptoms of epilepsy generally start for children with cerebral palsy during the first year of life, some within the first month after birth.

Nighttime Safety with Seizures

Seizures don’t stop at night. Nighttime seizures occur most commonly just after falling asleep and just before and after waking up. Seizures at night present some safety issues parents need to consider: 

• Suffocation
• Vomit or fluid in the lungs
• Injury from striking nearby objects
• Prolonged seizures that go unnoticed

Controlling seizures with the right treatment plan is the first and most important step to keeping your child safe at night. Talk to your pediatrician about nighttime management and follow these safety guidelines:[5]

• Remove any sharp or hard objects from the area around the bed.
• Use a low bed or mattress on the floor to reduce the risk of injury resulting from a fall.
• Encourage your child to sleep on their side. Stomach sleeping is the most dangerous, as it can lead to suffocation.
• Use a pillow designed to reduce the risk of suffocation.
• Use a monitor to listen for sounds of a seizure.
• Try a seizure alert device, which can detect seizure-like movements and send an alert. You can find wearable monitors and those that cover the mattress like a sheet.

Epilepsy Prognosis

If children respond well to medication, there’s a good chance they’ll be seizure-free one day and may even be able to discontinue epilepsy medication use. However, it is important to note that many children with cerebral palsy will need to remain on medication to control their seizures for life.

The University of Maryland Medical Center (UMM) states that long-term survival rates are lower when traditional treatment options like medications and surgery fail to work. Accidents from uncontrollable seizures also play into the lower survival rate.

These are cases in which the severity of the seizure disorder is part of an overall more severe form of cerebral palsy, and many other organ systems are affected, leading to a shortened life span.