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Pediatric Epilepsy

 

What is Epilepsy?

Epilepsy is a neurological condition involving the brain that makes people more susceptible to having seizures. It is one of the most common disorders of the nervous system and affects people of all ages, races and ethnic background. More than 2.7 million Americans live with epilepsy.

When a person has two or more seizures, he or she is considered to have epilepsy. There are many possible causes of epilepsy, including tumors, strokes and brain damage from illness or injury. In many cases, there may be no detectable cause for epilepsy.

What is a Seizure?

The brain is the center that controls and regulates all voluntary and involuntary responses in the body. It consists of nerve cells that normally communicate with each other through electrical activity.

A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function.

What are the Different Types of Seizures?

There are several different types of seizures in children, including the following:

Partial (Focal) seizures 

Partial seizures take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. In about one-third of children with partial seizures, the child may experience an aura before the seizure occurs. An aura is a strange feeling, either consisting of visual changes, hearing abnormalities or changes in the sense of smell. Two types of partial seizures include the following:

  • Simple partial seizures
    The seizures typically last less than one minute. The child may show different symptoms depending upon which area of the brain is involved. If the abnormal electrical brain function is in the occipital lobe (the back part of the brain that is involved with vision), the child's sight may be altered. The child's muscles are typically more commonly affected. The seizure activity is limited to an isolated muscle group, such as fingers, or to larger muscles in the arms and legs. Consciousness is not lost in this type of seizure. The child may also experience sweating, nausea, or become pale.

  • Complex partial seizures
    This type of seizure commonly occurs in the temporal lobe of the brain, the area of the brain that controls emotion and memory function. This seizure usually lasts between one to two minutes. Consciousness is usually lost during these seizures and a variety of behaviors can occur in the child. These behaviors may range from gagging, lip smacking, running, screaming, crying or laughing. When the child regains consciousness, the child may complain of being tired or sleepy after the seizure. This is called the postictal period.

Generalized seizures

Generalized seizures involve both sides of the brain. There is loss of consciousness and a postictal state after the seizure occurs. Types of generalized seizures include the following:

  • Absence seizures (also called petit mal seizures)
    These seizures are characterized by a brief altered state of consciousness and staring episodes. Typically the child's posture is maintained during the seizure. The mouth or face may move or the eyes may blink. The seizure usually lasts no longer than 30 seconds. When the seizure is over, the child may not recall what just occurred and may go on with his activities, acting as though nothing happened. These seizures may occur several times a day. This type of seizure is sometimes mistaken for a learning problem or behavioral problem. Absence seizures almost always start between ages 4 to 12.
  • Atonic (also called drop attacks)
    With atonic seizures, there is a sudden loss of muscle tone and the child may fall from a standing position or suddenly drop his head. During the seizure, the child is limp and unresponsive.
  • Generalized tonic-clonic seizures (also called grand mal seizures)
    This seizure is characterized by five distinct phases that occur in the child. The body, arms and legs will flex (contract), extend (straighten out), tremor (shake), a clonic period (contraction and relaxation of the muscles), followed by the postictal period. During the postictal period, the child may be sleepy, have problems with vision or speech and may have a bad headache, fatigue, or body aches.
  • Myoclonic seizures
    This type of seizure refers to quick movements or sudden jerking of a group of muscles. These seizures tend to occur in clusters, meaning that they may occur several times a day, or for several days in a row.
  • Infantile spasms
    This rare type of seizure disorder can occur in infants anytime within the first two years of age. There is a high occurrence rate of this seizure when the child is awakening, or when they are trying to go to sleep. The infant usually has brief periods of movement of the neck, trunk or legs that lasts for a few seconds. Infants may have hundreds of these seizures a day. This can be a serious problem, and can have long-term complications.
  • Febrile seizures
    This type of seizure is associated with fever. These seizures are more commonly seen in children between 6 months and 5 years of age and there may be a family history of this type of seizure. Febrile seizures that last less than 15 minutes are called "simple," and typically do not have long-term neurological effects. Seizures lasting more than 15 minutes are called "complex" and there may be long-term neurological changes in the child.

What Causes a Seizure?

A child may experience one or many seizures. While the exact cause of the seizure may not be known, the more common seizures are caused by the following:

In newborns and infants:

  • Birth trauma
  • Congenital (present at birth) problems
  • Fever
  • Metabolic or chemical imbalances in the body

In children, adolescents and young adults:

  • Alcohol or drugs
  • Trauma to the head
  • Infection
  • Unknown reasons

Other possible causes of seizures may include:

  • Brain tumor
  • Neurological problems
    • Drug withdrawal
    • Medications

What are the Symptoms of a Seizure?

The child may have varying degrees of symptoms depending upon the type of seizure. The following are general symptoms of a seizure or warning signs that your child may be experiencing seizures. Symptoms or warning signs may include:

  • Staring
  • Jerking movements of the arms and legs
  • Stiffening of the body
  • Loss of consciousness
  • Breathing problems or breathing stops
  • Loss of bowel or bladder control
  • Falling suddenly for no apparent reason
  • Not responding to noise or words for brief periods
  • Appearing confused or in a haze
  • Sleepiness and irritable upon waking in the morning
  • Nodding the head
  • Periods of rapid eye blinking and staring

During the seizure, the child's lips may become bluish and breathing may not be normal. The movements are often followed by a period of sleep or disorientation.

The symptoms of a seizure may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

How are Seizures Diagnosed?

The seizure may not be completely understood right away, but tests may help find out more about what is causing the seizures. The diagnosis of a seizure is made with a physical examination and diagnostic tests. During the examination, the doctor takes a complete medical history of the child and family and asks when the seizures occurred. Seizures may be due to neurological problems and require further medical follow up.

Diagnostic tests may include:

  • Blood tests
  • Electroencephalogram (EEG) 
  • Magnetic resonance imaging (MRI) 
  • Computerized tomography (CT scan) 
  • Lumbar puncture (spinal tap) - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord.

Treatment of a Seizure:

Specific treatment for a seizure will be determined by your child's physician based on:

  • Your child's age, overall health and medical history
  • Extent of the condition
  • Type of seizure
  • Your child's tolerance for specific medications, procedures or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

The goal of seizure management is to control, stop or decrease the frequency of the seizures without interfering with the child's normal growth and development. 

The major goals of seizure management include the following:

  • Proper identification of the type of seizure
  • Using medication specific to the type of seizure
  • Using the least amount of medication to achieve adequate control
  • Maintaining good medicating levels

Treatment may include:

Medications 

There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, age of the child, side effects, the cost of the medication and the adherence with the use of the medication. 

Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles or syrup), but some can be given rectally. If the child is in the hospital with seizures, medication by injection or intravenous (IV) may be used. 

Make sure you and your child (if age appropriate) understand the type of seizure that is occurring and the type of medication(s) that are needed. It is important to give your child his medication on time and as prescribed by his doctor. Know the dose, time and side effects of all medications. Different people use up the medication in their body differently, so adjustments (schedule and dosage) may need to be made for good control of seizures. 

All medications can have side effects, although some children may not experience side effects. Talk to your child's doctor about any side effects that your child is experiencing. Talk your child's physician before giving your child other medications. Medications for seizures can interact with many other medications, causing the medications to work improperly and/or causing side effects. Young women of childbearing age who are on seizure medications need to know that seizure medications are harmful to an unborn child, and the medication may also decrease the effectiveness of oral contraceptives.

While your child is taking medications, different tests may be done to monitor the effectiveness of the medication. These tests may include the following:

  • Blood tests - frequent blood testing is usually required to check the level of the medication in the blood. Based on this level, the doctor may increase or decrease the dose of the medication to achieve the desired level. This level is called the "therapeutic level" and is where the medication works most efficiently. Blood tests may also be done to monitor the affects of medications on body organs.
  • Urine tests - these tests are performed to see how the child's body is responding to the medication.
  • Electroencephalogram (EEG)  - EEG tests are done to help monitor how the medication is helping electrical problems in the brain.

Your child's doctor will help determine a plan for follow-up visits and testing. Medications for seizures may not be needed for the entire life of the child. Some children may be taken off their medications if they have been seizure-free for one to two years. This will be determined by your child's doctor.

Ketogenic diet 
Some children who are having problems with medications, or whose seizures are not being well controlled, may be placed on a special diet called the ketogenic diet

Vagus nerve stimulation (VNS) 
Some children, whose seizures are not being well-controlled with seizure medications, may benefit from a procedure called vagus nerve stimulation

Surgery 
Surgery may be an option for some children with epilepsy.

 

     
 
SafetyInformation
    • Driving: Check with your state to understand any laws about people with epilepsy or seizures operating a motor vehicle.
    • Activities: If a child has good control over the seizures, only minimal restrictions need to be placed on the child's activities. The child should always wear a helmet with sports and bike riding (including in-line roller-skating, hockey and skateboards). The child should also always have a buddy or adult supervision while swimming.