Pediatric Epilepsy

There are three main types of epilepsy:

Epilepsy of unknown cause

We don’t know what causes epilepsy in 50% of children.

Genetic epilepsy

Some epilepsies are genetic, which means that a child has one or more variants on their genes that predisposes them to having seizures. In some cases, a doctor may be able to identify the gene variant(s) through genetic testing, if they feel this information will be helpful in guiding treatment.

Structural epilepsy

This means something in the brain’s structure is causing seizures. This could be the result of a brain injury, including:

• Hypoxic injury (restricted oxygen to the brain)
• Tumor
• Dysplasia (part of the brain not developing correctly)
• Serious head injury

Repeated seizures are the symptom most closely associated with epilepsy. Seizures can cause abnormal movements, changes in behavior, loss of consciousness or loss of awareness. Most seizures stop within a minute or two. Some children might have only a few seizures in their whole lives, while other children could have hundreds of seizures a day.

It is not uncommon for children to have seizures due to a fever. This might not indicate that they have epilepsy. When a child has a seizure for the first time, they should either be taken to the emergency room or a pediatrician called if the seizure stops quickly.

Children with epilepsy may also have staring spells (where they don’t respond to their name) or episodes of confusion or unresponsiveness. If you see this in your child, take them to your pediatrician. They will decide if your child should see a neurologist.

If your child is having repeated seizures, your pediatrician or a doctor in the Emergency Department will refer you to a neurologist. A neurologist is a specialist who diagnoses and treats epilepsy and other issues that affect a child’s brain.

A neurologist will give your child a detailed physical and neurological exam and ask you about their past medical history, your family’s medical history, and about what you have noticed about your child’s behavior and their seizures.

They might recommend testing. The tests can include:

• Electroencephalogram (EEG), which can determine where in the brain the seizures are coming from. An EEG is performed by placing electrodes on the scalp and recording the brain’s electrical activity.
• MRI, which takes a detailed image that can detect changes in your child's brain and may identify the cause of the epilepsy.
• Genetic testing, to detect changes in your child's DNA, which may identify a specific type of epilepsy and help guide treatment and long-term prognosis.

Unfortunately, we don’t know what causes epilepsy in about half of children. In the other half of children with epilepsy, causes can include:

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

What can trigger a seizure?

Even when a child's epilepsy is under control, they might still experience a seizure triggered by:

• Missing medication doses
• Not enough sleep
• Stress
• Dehydration
• Fever
• Alcohol or illicit drugs
• Flashing lights from video games or strobe lights (this only affects patients with photosensitive epilepsy)

There are many ways to treat epilepsy. You and your doctor will talk about the best way to treat your child. Here are some of the treatment options:

• Anti-seizure medications are the most common way to treat epilepsy. These medications can come in a liquid that your child can drink or a pill that your child can swallow. These medications must be taken every day, as prescribed, to prevent seizures.
• Ketogenic diet may be prescribed for children who don’t respond well to medications. You and your child will work with one of our nutritionists to learn more about this high-fat, low-carb diet.
• Vagus nerve stimulator is a medical device placed under the skin on the left side of the chest with a wire connecting to their vagus nerve (a cranial nerve that runs from the brainstem to the chest and abdomen). This device sends tiny electrical impulses, going through the vagus nerve to the brain that can help control the epilepsy and decrease the number of seizures.
• Resective surgery is an option for seizures that start in a specific place in your child’s brain. During surgery, the part of the brain where the seizures begin is removed. The goal of this type of surgery (called a lesionectomy) is to reduce the number of seizures your child has. In some cases, this surgery may stop all your child’s seizures.
• Corpus callosotomy surgery may be used for children who are frequently injured from falling during their seizures. A doctor might recommend this surgery if anti-seizure medications haven’t worked. This surgery focuses on the corpus callosum, the big bundle of nerves that carries messages between the two halves of the brain (the brain’s left and right hemispheres). A surgeon removes some or all of this bundle of nerves to prevent the seizure from spreading from one hemisphere to the other. This surgery may help your child’s seizures be less severe.