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Epilepsy (Pediatric)

What is epilepsy?

Epilepsy is a brain condition that results in ongoing seizures and is one of the most common neurological disorders. According to the Centers for Disease Control and Prevention, nearly 460,000 children are diagnosed with this condition.

Epilepsy appears to be caused by an imbalance of nerve-signaling chemicals called neurotransmitters. Epilepsy sometimes results from tumors, strokes, brain malformations, genetic disorders, high blood pressure, brain infection, and brain damage caused by illness or injury.

What is a seizure?

The brain controls the body’s movements and is made of nerve cells that communicate through electrical activity. A seizure occurs when some part of the brain receives a sudden burst of electrical signals that temporarily interrupt normal functions.

What are the symptoms of a seizure?

There are several types of seizures, each affecting a different portion of the brain and producing different symptoms.

Focal seizures (also known as partial seizures) involve only one part of the brain. Just before a focal seizure occurs, children may experience an aura, a feeling of unusual fear or elation accompanied by changes in vision, hearing, or sense of smell. Focal seizes are defined as simple or complex:

  • Simple focal seizures occur in the occipital lobe or back of the brain. They may produce vision changes and muscle contractions in the fingers, arms, and legs. When the seizure affects only one side of the brain, children will not lose consciousness but may grow pale and experience sweating and nausea.
  • Complex focal seizures are caused by interrupted signals in the temporal lobe, the part of the brain that controls emotion and memory function. This type of seizure does not usually result in a loss of consciousness. However, children may suddenly stop being aware of their surroundings and show signs of distress such as gagging, lip smacking, running, screaming, crying, or laughing. If the seizure spreads from one side of the brain to the other, children may pass out and complain of feeling tired or sleepy afterward.

Generalized seizures affect both sides of the brain at the same time, resulting in a loss of consciousness and an altered mental state following the episode.

Absence seizures (also called petit mal seizures) produce a brief altered state of consciousness and staring episodes of 30 seconds or less. These seizures can be so brief they go unnoticed. In children, they may be confused with daydreaming. Sometimes absence seizures result in blinking, chewing, or sudden hand gestures. Afterward, children may have no recollection of the event and simply continue playing. Absence seizures generally start between ages 4 to 12 and are sometimes misdiagnosed as learning disorders or behavioral problems.

Atonic seizures (also called drop attacks) produce a sudden loss of muscle tone and children may fall or suddenly drop their head. During an atonic seizure, children are limp and unresponsive.

Generalized tonic-clonic seizures (also called grand mal seizures) often occur in stages. First the arms and legs contract then they straighten out and begin to shake. Afterward, children may feel sleepy, have problems with vision or speech, or suffer from a headache and muscle soreness.

Myoclonic seizures involve the sudden jerking of one muscle group and may occur several times a day or for several days in a row.

Infantile spasms are seizures affecting infants in their first six months. They tend to occur when children wake up or just before they fall asleep, producing movements of the neck, trunk, or legs and lasting only a few seconds. Hundreds of these seizures may occur in a day and are usually caused by a serious underlying condition.

Febrile seizures are triggered by a fever and generally occur between 6 months and 5 years of age in children with genetic conditions. They are defined as simple or complex:

  • Simple febrile seizures last fewer than 15 minutes and do not have any long-term neurological effects.
  • Complex febrile seizures last more than 15 minutes and may produce long-term neurological changes.

How is epilepsy diagnosed?

We begin with a physical examination and medical history. Diagnostic tests may be ordered to identify the nature of the seizure and any neurological problems that require treatment:

  • Blood tests
  • Computed tomography (CT or CAT) scan shows “slices” of the brain, using a combination of X-rays and computer technology. CT scans provide more information than general X-rays.
  • Electroencephalogram (EEG) records the brain's electrical activity through electrodes (small patches) attached to your child’s scalp.
  • Lumbar puncture (spinal tap) uses a needle placed in the lower back to measure pressure in the spinal canal and brain. During this procedure, a small amount of cerebral spinal fluid (CSF) is removed and sent to a lab to test for an infection or other abnormalities.
  • Magnetic resonance imaging (MRI) scan produces a detailed image of the brain with a combination of large magnets, radio frequencies, and computer technology.

How is epilepsy treated?

We tailor treatment to the type of seizure and may use the following approaches:

  • Ketogenic diet may help some children who have difficulty with medication. A ketogenic diet is high in proteins and fats and low in carbohydrates.
  • Medication can be taken by mouth (as capsules, tablets, sprinkles, or syrup), rectally, or through the nostril. If hospitalized, children may receive an injection or intravenous (IV) medication. We carefully monitor and adjust dosages after frequent blood draws.
  • Monitoring electroencephalogram (EEG) is a technique to monitor the electrical activity of the brain and helps doctors track how well medication works. Experts at our Pediatric Epilepsy Center are experienced in this form of patient monitoring and know how to put children at ease. Typically, admissions for EEG monitoring are for a 24- to 72-hour period. The procedure is painless, and once the leads, or wires, are connected to the EEG, children are free to walk around the room.
  • Surgery entails removing or disconnecting the portion of the brain generating the seizure and is an option when other treatments fail. This operation must be performed by an experienced and specialized team. Children may be awake during the surgery because the brain does not feel pain. With children able to respond, the surgeon can pinpoint the affected area of the brain and ensure a better outcome.
  • Vagus nerve stimulation (VNS) is the most common treatment for children over 12 years old with partial seizures not easily controlled by other means. VNS sends small pulses of energy to the brain along the vagus nerve in the neck. A surgeon places an electronic pulse generator with a small battery into the chest wall and attaches small wires to the vagus nerve. When a seizure begins, children can activate that pulse to halt the event.