Pediatric Epilepsy

What is Pediatric Epilepsy?

Neurons in the brain send out electrical impulses to communicate with each other and with parts of the body. These electrical impulses control everything in your body, like movements and your senses. When too many neurons send out impulses simultaneously, the brain is overloaded and a seizure occurs. This can cause abnormal movements, change in behavior, or loss of consciousness. It is not uncommon for a child to have one or two seizures. Children with epilepsy, however, have repeated seizures.

Seizures are not a mental health disorder. Instead, epilepsy is a neurological condition that is still not completely understood. Having a single seizure does not mean that a child has epilepsy. A child has epilepsy when he or she has two or more seizures without a clear cause, such as fever, head injury, drug or alcohol use, or a virus (such as encephalitis or meningitis).

The Epilepsy Center at Children’s Health is a Level 4 Epilepsy Center, providing the highest level of treatment for children with epilepsy. We were the first such program in the country to be certified by the Joint Commission, the nation’s preeminent standard-setting accrediting and certifying regulatory body in healthcare. Our interdisciplinary medical team has the experience to not only comprehensively diagnose children with this condition, but we remain the area’s only center to perform the most advanced procedures and therapies for the treatment of epilepsy.

Because this condition affects your child and your family, you will be glad to know we provide care for the whole family, including education and support.

In addition, the Epilepsy Center works with referring doctors and area Emergency Departments to:

• Provide seizure safety education programs
• Expedite appointments in order to get your child evaluated quickly

What are the different types of Pediatric Epilepsy?

There are two major types of epilepsy:

Generalized epilepsy

With this condition, seizures affect the child’s whole brain. With generalized epilepsy, a child may experience sustained rhythmic jerking of various parts of the body, muscles that become weak, muscles that tense up rigidly, staring spells or other symptoms. Epilepsy with generalized seizure can disappear as a child grows older, or it can be severe and represent a life-long condition.

Partial (focal) epilepsy

With this condition, seizures begin in a specific portion of the brain. With partial epilepsy, the child can experience similar jerking or muscular reactions as with generalized epilepsy. A child with this condition can also experience repeated automatic movements, such as clapping or rubbing of hands, lip smacking or chewing. Partial epilepsy can also cause changes in emotions, cognition (thinking) or autonomic functions – including gastrointestinal sensations, waves of heat or cold or heart racing – depending on which part of the brain the epilepsy affects. Partial seizures may last from one to two minutes and can affect an isolated muscle group, such as fingers or legs. These seizures can happen at night and can be a benign occurrence in early childhood, which your child may outgrow.

What are the signs and symptoms of Pediatric Epilepsy?

The main symptom of epilepsy is repeated seizures. There are several types of seizures that a child with epilepsy can experience:

• Absence seizures (petit mal) – With this type of seizure, the child will have a brief lapse in awareness that lasts a few seconds and causes them to stare or have twitches in the eyelids or face muscles. Absence seizures can occur up to hundreds of times each day. They usually begin before age 2 and end by adolescence (age 10 to 19 years**).
• Tonic-clonic seizures (grand mal) – With this type of seizure, the child suddenly and completely loses consciousness and the arms and legs stiffen, usually causing them to fall to the ground (tonic phase). This is followed by a rhythmic jerking (clonic) phase. Anyone who experiences tonic-clonic seizures should be immediately evaluated by a healthcare professional to prevent brain damage or death.
• Tonic seizures – This is a seizure that includes only the tonic phase of a tonic-clonic seizure (described above).
• Myoclonic seizures – With this type of seizure, a child experiences very brief, lightning-quick jerks of any part of the body without losing consciousness.
• Atonic seizures – With this type of seizure, the child experiences a sudden loss of muscle tone, which causes them to collapse into the ground – sometimes head first.

*Age of young children as defined by the Centers for Disease Control (CDC).
**Age of adolescents as defined by the World Health Organization (WHO).

How is Pediatric Epilepsy diagnosed?

To diagnose epilepsy, your doctor will do a detailed physical exam of your child, ask you about your child’s past medical history and family history, and learn as much as possible from you about how a seizure started and what you observed.

Following the exam, simple tests may be done including blood tests, kidney and liver function tests, EEG and brain imaging. These tests are designed to determine the risk of seizure reoccurrence and to pinpoint any abnormalities that would help identify an underlying neurological disease, including epilepsy.

The diagnosis is based on several exams and tests, in addition to an interview about your child’s condition. The facts you provide the doctor are very important in diagnosing your child’s epilepsy and deciding on treatment.

What are the causes of Pediatric Epilepsy?

 For seven out of ten children with epilepsy, there is no known cause. These children are said to have idiopathic epilepsy. “Idiopathic” means “of unknown cause.” Epilepsy can be a congenital (present at birth) condition, or a child can have acquired epilepsy due to brain damage that occurred sometime after birth.

Although finding the cause can be difficult, there are several known causes of epilepsy such as:

• Problems with brain development before birth
• Lack of oxygen during or following birth
• A serious head injury that leaves a scar in the brain
• Unusual structures in the brain
• Stroke
• Tumors
• A prolonged seizure with fever
• The after-effects of severe brain infections, such as meningitis or encephalitis
• Genetic factors

Triggers

Some people report very specific triggers or immediate causes that can bring about a seizure. Children with epilepsy are more likely to have a seizure (have a lower seizure threshold) when they have a cold, the flu, or other common illnesses. Some common seizure triggers include the following:

• Forgetting/unable to take medication
• Not enough sleep
• Food allergies
• Stress
• Flashing lights (e.g., from video games, strobe lights)
• Alcohol
• Illicit drugs
• Dehydration
• Poor diet
• Inactivity

How is Pediatric Epilepsy treated?

Partial epilepsy can be benign and disappear, or it can be a life-long medical condition. The treatment for partial epilepsy depends on the underlying cause and if the seizures are deemed harmless and likely to be outgrown. Once tests are complete, your doctor may prescribe:

Medication

Anti-epileptic drugs work to control seizures. While these medications cause side effects (e.g., drowsiness, fatigue, rashes), they help someone with epilepsy lead a normal life.

Surgery

If seizures happen so often that they reduce a child’s quality of life, surgery may be necessary. Surgery can implant a small device in the brain to regulate electronic brain activity and reduce seizures. This device is called a vagus nerve stimulator, and is generally approved for patients older than 12 years of age. The Epilepsy Center at Children’s Health’s epilepsy surgery program has a high rate of success, with our patient outcomes often exceeding those of other centers.

There is no one treatment method for any child with a seizure disorder. Each treatment plan is tailored to the individual child based on their diagnosis and symptoms.