Neurology

Pediatric Epilepsy

Epilepsy occurs in less than 1 percent of children. Fortunately, most kids who have a single seizure will not go on to develop epilepsy. Even when they do, the majority will have a relatively benign disorder that we can control with a single anti-seizure medication, and over time, the disorder often resolves itself, so we can stop treatment.

Children with epilepsy are at risk for associated problems like learning disabilities, attention deficit disorder, and depression. Mount Sinai’s caring team of specialists works with parents to accurately diagnose and carefully manage each child’s condition.

Epilepsy Syndromes in Childhood

An epilepsy syndrome is identified based on a child’s development, the diagnostic findings, the child’s age at the onset of seizures, and the type of seizures. Some syndromes are fairly benign, while others are progressive and more difficult to control. The following is a sampling of some of the syndromes.

  • Absence Epilepsies: This condition features normal development and brief episodes of staring and “zoning out.” Most children outgrow this type of epilepsy but are treated with medication to prevent injuries and academic issues.
  • Benign Rolandic Epilepsy: Typically starting between ages 3 and 10, this type of epilepsy involves simple partial seizures that occur during sleep and affect the face and/or one side of the body, involving drooling and difficulty speaking.
  • Panayiotopoulos Syndrome: This disorder begins in early childhood and features seizures with vomiting and eye and head deviation.
  • Doose Syndrome: This condition—occurring in developmentally normal children and beginning between seven months and eight years of age—typically involves seizures that may happen several times each day.
  • Dravet Syndrome: Associated with movement disorders and intellectual disabilities, this syndrome may begin with febrile seizures or seizures that occur when the child experiences a change in temperature.
  • Landau Kleffner Syndrome: This rare form of epilepsy causes children to lose their understanding of language.
  • Infantile Spasms: This severe form of epilepsy begins in infancy, and is characterized by head drops with associated outstretched arms.
  • Lennox-Gastaut Syndrome: Beginning in childhood and continuing into adulthood, this condition is associated with an abnormal EEG, different types of seizures, and intellectual disabilities.
  • Febrile Seizures: These are not a form of epilepsy as they only occur with fever. Most children outgrow these around the age of five, although some persist longer.

Diagnosis of Pediatric Epilepsy

We diagnose epilepsy when a child has two or more unprovoked seizures that occur without illness or fever. It can also be diagnosed after one seizure when the child has an abnormal electroencephalogram (EEG). Other testing usually includes a magnetic resonance imaging (MRI) scan.

Some patients require careful in-hospital monitoring and recording of seizure activity to guide diagnosis and treatment decisions. Mount Sinai’s pediatric epilepsy monitoring unit (EMU) is a state-of-the-art facility located in Mount Sinai Kravis Children’s Hospital. Our team of physicians, nurses, nurse practitioners, residents, and EEG technicians carefully monitors each child for seizure activity and provides critical information to your family.

Treatment of Pediatric Epilepsy

After Mount Sinai’s epilepsy specialists determine the type of seizures a child is experiencing, we work with your family to customize the right plan of treatment.

We carefully select any medications we prescribe, taking side effects into consideration. Our goal is to control the seizures with one medication, but some patients may need more than one prescription. Some patients may also respond to dietary treatment, in the form of a ketogenic diet, modified Atkins diet, or low-glycemic diet. The Mount Sinai team will work closely with parents to both recommend and carefully monitor these diets.

If your child tries two or more medications that don’t adequately help, we may consider surgery. Possible procedures include cortical resections, responsive neurostimulation, vagus nerve stimulation, corpus callosotomy, hemispherotomy, and multiple subpial transections. The Mount Sinai pediatric epilepsy team collaborates with the Mount Sinai neurosurgery team to carefully determine the best approach.