We do everything we can to protect our children, hoping we never have to make difficult decisions about their health. For the most part, we have been very lucky with the health of our kids which I am very grateful for. A couple of dashes to A&E with Croup but nothing that has had us overly concerned. This was until one day I noticed that my daughter was often not ‘listening’ when I was talking to her, zoning out and seeming distant. I didn’t think too much of it and brushed it away as just another child ignoring me, which was standard in our house. A week or so passed but they kept happening and as the time went on, they seemed to be getting more obvious, longer and had very similar characteristics each time. My ‘mumtuition’ knew that something just wasn’t right and after my husband and dad started noticing them too, and Dr google had pretty much confirmed to me that she might have Childhood Absence Epilepsy we decided to get an expert opinion.
I’m not against medicine, I vaccinate my children and give them the meds they need but, in my head, I really didn’t want to medicate unless it was really needed, which google seemed to think wasn’t the case so we waited until we saw our chosen doctor before making any rash decisions. It was going to be fine and he would say she will just grow out of it, right?
We saw Dr Arif Khan, who came very highly recommended and practices at King College Hospital Dubai to get his opinion. It was a matter of minutes of a short test, which was her blowing on a tissue to make her hyperventilate which brought on a seizure and what we had thought might be the case, was confirmed. Can’t deny that I had a small meltdown because although we knew this was coming it was very difficult to hear it confirmed.
So what next? “Medicine is the only option”…a sentence I didn’t think I would hear but that I was surprisingly okay with. It was explained that the medicine will stop her seizures, give her a better quality of life and after two years she would come off them and hopefully be symptom-free. This I could get on board with.
Here we are, three weeks into the medicine. Luckily, she hasn’t had any adverse reactions and the seizures seem to be lessening. So now we just wait to see if they stop and hope that in two years they are gone.
Any health issues are scary, especially in small children but knowledge is power. With that in mind, we asked Paediatric Neurologist, Dr Arif Khan to explain a little more about Childhood Absence Epilepsy (CAE) for anyone that might think their child might be showing any symptoms.
What are the most common signs that a child may have Childhood Absence Epilepsy?
Childhood absence epilepsy (CAE) is a common form of epilepsy that starts in early childhood between 4 and 7 years of age. CAE happens slightly more often in girls than boys. The hallmark of this syndrome is an absence seizure. During a typical absence seizure, there is a sudden loss of awareness, the child suddenly stops talking or what they are doing and stares blankly into space. They will not respond to people talking to them. Sometimes, one may notice some eye blinking, finger movements, mouth twitching, or lip-smacking along with the blank stare. These episodes usually lasted 5 to 15 seconds and stop suddenly, with the child getting back to his/her normal activity. The child will behave as if nothing has happened or may be briefly confused.
How common is this type of epilepsy?
Epilepsy in general occurs in nearly 1 out of 100 people. Childhood absence epilepsy accounts for 10% of all epilepsies.
What should a parent do if they suspect their child might have CAE?
Many a times these symptoms are overlooked or ignored as they are not very obvious, and parents tend to brush them aside until the frequency increases or the child’s academic poor performance is reported, or the school starts reporting these symptoms. The first thing a parent can do is to capture these events on their mobile phone and seek advice from a pediatric neurologist or your local community paediatrician.
How is this type of Epilepsy usually diagnosed?
The diagnosis is usually driven by the history. The doctor may carry out a hyperventilation test in their clinic to elicit an absence seizure. If the child does have an absence seizure, he will suddenly stop hyperventilating and starts to stare, and remains unresponsive for a brief period.
Your doctor will then recommend a test called electroencephalogram (EEG). This is done to reaffirm the diagnosis. Generally, no other investigations are required unless these absence seizures prove to be unresponsive to treatment or develop into atypical seizures.
Is it genetic?
Childhood absence epilepsy has a multifactorial genetic cause. Most children with CAE do not have abnormal results on testing for specific genes. However, about 1 out of 3 families of children with CAE will report a family history of absence seizures or some form of generalised seizures. Therefore, it can be safely concluded that although there is a familial predisposition, we have not been able to understand it fully.
How is Childhood Absence Epilepsy usually treated?
Following evaluation, appropriate anti-epileptic medication should be started under the supervision of a Paediatric neurologist or an experienced Paediatrician. There are few options when it comes to prescribing medications. Valproic acid, Ethosuximide, and Lamotrigine are some of the commonly used anti-epileptic medications used. Most of these children will respond to these medications, however, a small proportion will fail to respond and will require further evaluation, followed by an alternative treatment approach.
After remaining seizure free for two years, your doctor will recommend slowly withdrawing the anti-epileptic medication. This is because more than 80% of children go into remission (their epilepsy goes away with age). However, in some it may continue, requiring a longer treatment period.
Dr Arif Khan, Paediatric Neurologist, Founder of Nuropedia, a company that specializes in childhood neurological conditions such as epilepsy and seizure disorders, headaches and migraines, sleep disorders, neuromuscular conditions, movement disorders, neonatal neurology, cerebrovascular stroke, cerebral palsy, neurometabolic conditions, neurogenetic conditions, neurobehavioural conditions, autism and ADHD.