Epilepsy - children
Seizure disorder - children; Convulsion - childhood epilepsy; Medically refractory childhood epilepsy; Anticonvulsant - childhood epilepsy; Antiepileptic drug - childhood epilepsy; AED - childhood epilepsy
Epilepsy is a brain disorder in which a person has repeated seizures over time.
A seizure is a sudden change in the electrical and chemical activity in the brain. A single seizure that does not happen again is NOT epilepsy.
Having a brain seizure can be a terrifying experience. If you have a seizure more than once, you may have epilepsy, a problem with electrical activity in your brain. So, what causes epilepsy? For most people, the brain sends electrical signals throughout the body efficiently, in a coordinated way. In epilepsy, however, the normal pattern of electrical activity becomes disturbed. This causes the brain to be too excitable, or jumpy, and it sends out abnormal signals. The result is repeated seizures that can happen at any time. Epilepsy seizures usually begin between ages 5 and 20, but they can happen at any age. Common causes include Stroke, or a mini-stroke called transient ischemic attack; Dementia, or loss of brain function, such as Alzheimer's disease; Traumatic brain injury; Infections in the brain; Brain problems you are born with; or perhaps, a Brain tumor. Some people with epilepsy may have simple staring spells, while others have violent, uncontrollable shaking and loss of consciousness. Before each seizure, some people may have strange sensations, such as tingling, smelling an odor that isn't really there, or emotional changes. This is called an aura. Your doctor will perform a number of tests to find out if epilepsy is causing your seizures. One test, an electroencephalogram or EEG, checks your brain's electrical activity. Other tests can take detailed pictures of the part of your brain that is causing your seizures. Your doctor will most likely start treating your epilepsy with medication. These medicines, called anticonvulsants, may reduce the number of seizures you have in the future. Sometimes, changing the diet of a child with epilepsy can help prevent seizures. Your doctor will probably talk to you about making some changes in your life, such as reducing your stress, getting more sleep, and avoiding alcohol and recreational drugs. Surgery to remove a brain tumor or abnormal blood vessels or brain cells may make the seizures stop. Another surgery can place a Vagus nerve stimulator in your brain. This device is like a pacemaker for your brain that limits the number of seizures you have. For many people, epilepsy is a lifelong problem, and they'll always need to take anti-seizure medicines. There is a very low risk of sudden death with epilepsy. However, you, or someone else, can be seriously injured if you have a seizure while driving or operating equipment. If your seizures are uncontrolled, you should not drive.
Causes
Epilepsy may be due to a medical condition or injury that affects the brain. Or the cause may be unknown.
Common causes of epilepsy include:
- Traumatic brain injury
- Damage or scarring after infections of the brain
- Birth defects that involve the brain
- Brain injury that occurs during or near birth
- Metabolic disorders present at birth (such as phenylketonuria)
- Benign or malignant brain tumor, often very small
- Abnormal blood vessels in the brain
- Stroke
- Other illnesses that damage or destroy brain tissue
Epileptic seizures usually start between ages 5 and 20. But they can happen at any age. There may be a family history of seizures or epilepsy.
A febrile seizure is a convulsion in a child triggered by a fever. Most of the time, a febrile seizure is not a sign that the child has epilepsy.
Symptoms
Symptoms vary from child to child. Some children may simply stare. Others may shake violently and lose alertness. The movements or symptoms of a seizure may depend on the part of the brain that is affected.
Your child's health care provider can tell you more about the specific type of seizure your child may have:
- Absence (petit mal) seizure: Staring spells
- Generalized tonic-clonic (grand mal) seizure: Involves the entire body, including aura, rigid muscles, and loss of alertness
- Partial (focal) seizure: Can involve any of the symptoms described above, depending on where in the brain the seizure starts
Most of the time, the seizure is similar to the one before it. Some children have a strange sensation before a seizure. Sensations may be tingling, smelling an odor that is not actually there, feeling fear or anxiety for no reason or having a sense of déjà vu (feeling that something has happened before). This is called an aura.
Exams and Tests
The provider will:
- Ask about your child's medical and family history in detail
- Ask about the seizure episode
- Do a physical exam of your child, including a detailed look at the brain and nervous system
The provider will order an EEG (electroencephalogram) to check the electrical activity in the brain. This test often shows any abnormal electrical activity in the brain. In some cases, the test shows the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures.
To diagnose epilepsy or plan for epilepsy surgery, your child may need to:
- Wear an EEG recorder for few days during day-to-day activities
- Stay in the hospital where brain activity can be watched on video cameras (video EEG)
The provider also may order other tests, including:
- Blood chemistry
- Blood sugar
- Complete blood count (CBC)
- Kidney function tests
- Liver function tests
- Lumbar puncture (spinal tap)
- Tests for infectious or metabolic diseases
Head CT or MRI scan are often done to find the cause and location of the problem in the brain. Much less often, PET scan of the brain is needed to help plan surgery.
Treatment
Treatment for epilepsy includes:
- Medicines
- Lifestyle changes
- Surgery
If your child's epilepsy is due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery may be needed.
Medicines to prevent seizures are called anticonvulsants or antiepileptic drugs. These may reduce the number of future seizures.
- These medicines are taken by mouth. The type of medicine prescribed depends on the type of seizure your child has.
- The dosage may need to be changed from time to time. The provider may order regular blood tests to check for side effects.
- Always make sure your child takes the medicine on time and as directed. Missing a dose can cause your child to have a seizure. DO NOT stop or change medicines on your own. Talk to the provider first.
Many epilepsy drugs may affect your child's bone health. Talk to your child's provider about whether your child needs vitamins and other supplements.
Epilepsy that is not well controlled after trying a number of antiseizure drugs is called "medically refractory epilepsy." In this case, the doctor may recommend surgery to:
- Remove the abnormal brain cells causing the seizures.
- Place a vagal nerve stimulator (VNS). This device is similar to a heart pacemaker. It can help reduce the number of seizures.
Some children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, also may be helpful. Be sure to discuss these options with your child's provider before trying them.
Epilepsy is often a lifelong or chronic illness. Important management issues include:
- Taking medicines
- Staying safe, such as never swimming alone, fall-proofing your home and avoiding activities that could lead to a fall
- Managing stress and sleep
- Avoiding alcohol and drug abuse
- Keeping up in school
- Managing other illnesses
Managing these lifestyle or medical issues at home can be a challenge. Be sure to talk with your child's provider if you have concerns.
Support Groups
The stress of being a caretaker of a child with epilepsy can often be helped by joining a support group. In these groups, members share common experiences and problems.
Outlook (Prognosis)
Most children with epilepsy live a normal life. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s. If your child does not have seizures for a few years, the provider may stop medicines.
For many children, epilepsy is a lifelong condition. In these cases, the medicines need to be continued.
Children who have developmental disorders in addition to epilepsy may face challenges throughout their life.
Knowing more about the condition will help you take better care of your child's epilepsy.
Possible Complications
Complications may include:
- Difficulty learning
- Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia
- Irregular heartbeat
- Injury from falls, bumps, or self-caused bites during a seizure
- Permanent brain damage (stroke or other damage)
- Side effects of medicines
When to Contact a Medical Professional
Call 911 or the local emergency number if:
- This is the first time your child has a seizure
- A seizure occurs in a child who is not wearing a medical ID bracelet (which has instructions explaining what to do)
If your child has had seizures before, call 911 or the local emergency number for any of these emergency situations:
- The seizure is longer than the child normally has or the child has an unusual number of seizures
- The child has repeated seizures over a few minutes
- The child has repeated seizures in which consciousness or normal behavior is not regained between them (status epilepticus)
- The child gets injured during the seizure
- The child has difficulty breathing
Contact the provider if your child has new symptoms:
- Nausea or vomiting
- Rash
- Side effects of medicines, such as drowsiness, restlessness, or confusion
- Tremors or abnormal movements, or problems with coordination
Contact the provider even if your child is normal after the seizure has stopped.
Prevention
There is no known way to prevent epilepsy. Proper diet and sleep may decrease the chances of seizures in children with epilepsy.
Reduce the risk of head injury during risky activities. This can decrease the likelihood of a brain injury that leads to seizures and epilepsy.
References
Dwivedi R, Ramanujam B, Chandra PS, et al. Surgery for drug-resistant epilepsy in children. N Engl J Med. 2017;377(17):1639-1647. PMID: 29069568
Ghatan S. Pediatric epilepsy surgery. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 267.
Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: efficacy and tolerability of the new antiepileptic drugs I: treatment of new-onset epilepsy: report of the American Epilepsy Society and the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Epilepsy Curr. 2018;18(4):260-268. PMID: 30254527
Mikati MA, Tchapyjnikov D. Seizures in childhood. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 611.
Pearl PL. Overview of seizures and epilepsy in children. In: Swaiman KF, Ashwal S, Ferriero DM, et al, eds. Swaiman's Pediatric Neurology: Principles and Practice. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 61.
Version Info
Last reviewed on: 5/2/2022
Reviewed by: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
