Focal Epilepsy in Children

Focal epilepsy refers to a type of seizures that are caused by abnormal electrical brain functions in one region of the brain.

Focal seizures may be caused by an underlying structural abnormality in the brain, or they can be brought on by head trauma, stroke, infection or tumors. Most commonly, seizures have a genetic cause that is either new in the child or that is inherited from a parent with seizures.

Focal seizures can cause changes in behavior, thinking or movement. In some cases, children don’t fully lose consciousness during focal seizures. They know what is happening and are somewhat aware of their surroundings, even if that awareness is incomplete. This type of focal seizure often affects an isolated muscle group, such as the fingers or muscles in the arms and legs.

Symptoms of this type of focal seizure may include:

• Jerking of the arms or legs on one side of the body
• Muscles becoming limp or weak
• Brief muscle twitching

In other types of focal seizures, a child doesn’t know what is happening, is not aware of their surroundings, and doesn’t remember what happened when the seizure is over.

Children may experience the following behaviors:

• Staring into space
• Chewing motions or lip smacking
• Aimless wandering or running
• Screaming, crying or laughing
• Muscle stiffening or shaking

Before a focal seizure, a child may have a sense or feeling that something is about to happen. This is called an “aura.” The most common aura involves feelings such as deja vu, impending doom, fear or euphoria. Auras can also cause visual changes, hearing abnormalities, headaches and dizziness, or changes in the sense of smell and taste.

After a focal seizure, a child may become limp or may have weakness in one part of their body.

At Children’s Hospital of Philadelphia’s Neuroscience Center, a child’s care begins with a comprehensive, personalized assessment of their medical history, a physical examination and diagnostic tests to determine where in the brain the seizures are coming from and whether the seizures represent epilepsy or some other disorder.

Tests and imaging that may be done include:

• Brain imaging tests, including computed tomography (CT or CAT) scan, magnetic resonance imaging (MRI), and PET scans, to look for abnormalities in the brain’s structure or evidence of prior brain injury.
• Electroencephalography (EEG), a test that records electrical activity in your child’s brain using tiny wires attached to the head (EEG is highly sensitive and can pick up even small seizures that don’t lead to physical symptoms.)
• Blood tests, such as blood sugar, complete blood count, electrolytes, and liver and kidney function tests to detect the presence of a metabolic condition.
• Lumbar puncture (spinal tap), to see if an infection is causing the seizures.
• Genetic testing, including epilepsy panel testing or whole exome sequencing, to look for specific genetic causes of seizures.

Identifying a genetic cause can provide families with an explanation for why their child has developed seizures, may inform prognosis, can guide treatment choices, and can provide information regarding recurrence risks for future siblings or other family members.

The primary goal of treatment for focal epilepsy is to eliminate seizures. Early and effective treatment of seizures may improve the child’s long-term outlook.

Treatments for focal epilepsy may include:

• Medications: Seizures may be controlled with medications such as corticosteroids and anti-seizure medication.
• Surgery: If the seizures are found to be the result of a brain lesion, surgical removal of the lesion may bring improvement.
• Metabolic treatment: If the seizures are found to be caused by an underlying metabolic condition, treating the cause of the metabolic problem can help to reduce the seizures.
• Ketogenic diet: For children who are having problems with medications, or whose seizures are not being well controlled, the ketogenic diet may be helpful. This type of diet is low in carbohydrates and high in protein and fat.

The Neuroscience Center at Children’s Hospital of Philadelphia combines cutting-edge clinical care and advanced genetic testing with innovative research to identify the underlying cause of a child’s epilepsy and develop an individualized approach to treatment and management.

We provide:

• Expedited evaluation
• Comprehensive diagnostic testing including electroencephalography, neuroimaging, metabolic testing and genetic testing
• Access to the most effective treatments including medications, the ketogenic diet and epilepsy surgery

Our team collaborates with specialists throughout our hospital to provide comprehensive care to lessen seizures and their impact, address any underlying disease or injury causing the seizures, and develop strategies that will help children function at their highest possible level.

Children’s Hospital of Philadelphia’s Pediatric Epilepsy Program accept referrals from primary care providers and specialists from across the U.S. and internationally.

• If you are a pediatrician and are concerned that your patient has focal epilepsy, please contact our physician referral line to request an expedited evaluation: 1-800-879-2467 (1-800-TRY-CHOP).
• If you are a pediatrician or neurologist and want to refer your patient to CHOP for additional diagnostic evaluation or treatment of focal epilepsy, please contact the Epilepsy Neurogenetics Initiative for an appointment with one of our epilepsy specialists.