What is Epilepsy?
A seizure is a sudden, abnormal wave of electrical activity in the brain. A child who has had two or more seizures may be diagnosed with epilepsy.
About one in 26 people who have a seizure will develop epilepsy. Epilepsy affects people of all ages, races and ethnic backgrounds. Some people with epilepsy outgrow the tendency to have seizures. Others do not.
Types of Epilepsy in Children
There are many types of epilepsy in children. Some are more common than others. Rare epilepsy types can be difficult to recognize. Doctors play a critical role in diagnosing and treating all types of childhood epilepsy.
Localization-related epilepsy means that the seizure activity begins in one specific part of the brain. These are also called focal seizures.
The most common type of localization-related epilepsy is temporal lobe epilepsy. The brain has two temporal lobes. One temporal lobe is on each side of the brain, by each ear. They process emotions. They are important for short-term memory. When a child’s seizures start in a temporal lobe, it is called temporal lobe epilepsy.
The brain has three other lobes—the frontal, occipital and parietal lobes. Less commonly, seizures can start there.
If a child still has seizures after taking two seizure medications, the epilepsy is called “intractable.” Doctors sometimes call this condition “medication resistant” or “drug-resistant epilepsy.” Intractable epilepsy is still treatable. Some children can be seizure-free with expert care. The care team can offer more treatment options. These could include a specialized diet or a surgery evaluation.
Epilepsy Syndromes in Children
An epilepsy syndrome has features that usually occur together. These features may include:
- What the seizure types are like
- How old children are when seizures typically begin
- What brain scans and electroencephalography (EEG) tests show
- Genetic information
It is helpful when the medical team can classify a child’s epilepsy as being part of a syndrome. This can help decide what treatments will be most effective. It will also help see the child’s overall epilepsy outlook.
Below are the most common epilepsy syndromes affecting children.
- Absence (pronounced “ab-SONCE”) epilepsy involves brief interruptions of consciousness (awareness). A child may “space out,” staring into space for a few seconds. They may make involuntary movements, such as eye-rolling or eye fluttering. There are two types of absence epilepsy: childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE).
- Benign rolandic epilepsy (BRE) causes seizures that typically affect one half of the face, arm or leg. Patients may be aware during their seizures. The seizures may include twitching, numbness or tingling. During the seizure, the child may have a hard time talking or may drool a lot. About 95 percent of children with BRE outgrow it by age 15. The updated term for BRE is “benign childhood epilepsy with centrotemporal spikes” (BCECTS).
- Doose syndrome is characterized by frequent myoclonic seizures (which cause jerking or twitching in the limbs) and atonic seizures (which cause a sudden loss of muscle control followed by falling).
- Dravet syndrome is a rare, severe epilepsy disorder that can cause many different types of seizures. These can include atypical absence, atonic (drop seizures), myoclonic, generalized tonic-clonic and others.
- Lennox-Gastaut syndrome (LGS) is a rare form of epilepsy involving many types of seizures. Tonic (muscle stiffening) and atonic (drop) seizures are usually a part of LGS. Children have developmental delays or other neurological issues before they develop LGS.
- Infantile spasm (also called “West syndrome”) is a type of seizure that commonly occurs between two months and one year of life. These seizures are brief and subtle. They can happen hundreds of times a day.
- Landau-Kleffner syndrome involves a gradual loss of language abilities. Seizures are usually few in number. The EEG is abnormal during sleep. Symptoms typically appear between three and seven years of age. Landau-Kleffner may look like autism.
- Myoclonic epilepsy seizures involve sudden, shock-like muscle contractions affecting one or more limbs. These seizures may happen once or in clusters. More than one may happen in a short period of time.
Most of the time, a child’s seizures won’t be part of a syndrome. In this situation, the child may be diagnosed with “idiopathic” epilepsy. Another word for idiopathic is “unknown.” The old medical term for this is “cryptogenic.”
The main symptom of epilepsy is seizures that recur. Epilepsy always involves seizures. But not all seizures are caused by epilepsy.
A seizure temporarily affects how a person acts, feels or appears. It may or may not have outward clinical manifestations (signs). Clinical manifestations may involve jerking movements or stiffening of the arms and legs. You may notice:
- Lip smacking
- Twitching of the face
- Drooping of one side of the face
- A blue color of the lips or face
The child may pick at their clothes, lose muscle control suddenly or stare into space. Their breathing pattern may change but rarely stops entirely. When the seizure is over the child may be extremely sleepy and need rest.
What Causes Epilepsy in Children?
There is no single cause for seizures. In many cases, the cause is unknown. Some identifiable causes (some of which can overlap) include:
- Differences in how the brain is shaped or formed
- An infection that affects the brain
- Loss of oxygen during birth
- A genetic disorder
Another cause for seizures relates to differences in how the brain is shaped or formed. Cortical dysplasia is one example of this. Cortical dysplasia occurs when the top layer of the brain does not form properly. A related condition is hemimegalencephaly, in which one side of the brain is much larger than the other. It causes frequent seizures. It typically involves mental retardation.
How is Epilepsy Diagnosed in Children?
Epilepsy is a complex condition. Some of its symptoms look like those of other diseases. Making an accurate diagnosis can be challenging. But it is an important step toward establishing an effective treatment plan.
It is important to know:
- What a child’s seizures look like
- How the child acts during the seizure
- How often seizures occur
Seizures rarely happen when a child’s doctor is present. So, the medical team relies on parents and caregivers to share a detailed description from people who were there. Cell phone videos of events are very helpful to show the doctor.
Medical tests also are important. These tests provide information about:
- The brain’s electrical activity
- What the brain looks like
- The possible causes of seizures
Medical tests to help with diagnosis of epilepsy include:
- Electroencephalogram (EEG)
- Magnetic resonance imaging (MRI) of the brain
- Genetic testing
Childhood Epilepsy Treatment
The goal of epilepsy treatment is to be free from seizures with minimal or zero side effects. Starting an anti-seizure medication is the first step. If a child’s seizures still happen after taking two carefully chosen seizure medications, the epilepsy is called “intractable.” Taking another medication will not help. The care team will talk to the family about other treatment options. These include a specialized diet and surgery. Learn more about intractable epilepsy.
Anti-seizure medication is effective for many children. This medicine helps control seizures. The doctor will choose the medicine based on the child’s:
- Seizure type
- Physical condition
Finding the right drug(s) can take time. The doctor might need to adjust dosages. Or they might change medications.
Specialized diets can help some children achieve seizure control. These diets include the ketogenic diet and the modified Atkins diet. Both have high fat, low or zero carbohydrates and moderate protein. These diets may help children who have not been helped by seizure medicines. They may also help children who aren’t surgical candidates. Talk to your doctor before you start a specialized diet for epilepsy.
When medication and/or a specialized diet doesn't work, surgery may be necessary. The goal of surgery is to dramatically reduce how severe and often seizures are happening. If possible, surgery may get rid of seizures. There are many surgeries for children with epilepsy. For example, some surgeries remove or destroy diseased tissue that is causing seizures. Others involve implanting devices that can send electrical signals to the brain to shorten or prevent seizures.
What Are the Long-Term Effects of Epilepsy in Children?
Many children with epilepsy outgrow their tendency to have seizures. Medication, diet or surgery can help many achieve seizure freedom.
However, children with epilepsy are at risk for:
- Learning difficulties
- Developmental delays
- Movement and balance issues
- Behavioral issues
Sometimes these difficulties are related to seizures. Sometimes there are medication side effects.
An experienced team of epilepsy specialists can help identify these concerns. They can also provide treatment so that the child can enjoy the best quality of life possible. We have a close network of epileptologists, psychologists, nurses, medical assistants, neuropsychologists and neurosurgeons who will support you and your family.
Most children with epilepsy who receive care at Cincinnati Children’s have healthy, normal lives and can enjoy school and sports.