Epilepsy in Children
What is epilepsy?
Epilepsy is a neurological condition involving the brain that makes people more susceptible to having seizures. When a person has two or more seizures on separate days, they are considered to have epilepsy.It is one of the most common disorders of the nervous system and affects people of all ages, ancestries and ethnic backgrounds. More than 2.7 million Americans live with epilepsy.
Pediatric epilepsy affects 1% to 2% of children worldwide. For many children, epilepsy is outgrown before or during adolescence, seizures go away, and treatments can be successfully reduced and stopped.
Symptoms of epilepsy
The hallmark of epilepsy is recurrent seizures (two or more on separate days) not caused by fever or by a transient medical illness. Diagnosis and classifying of epilepsy begins with understanding the type or types of seizures the child experiences.
Causes of epilepsy
There are many possible causes of epilepsy, including structural brain changes (from injury, infection or developmental brain differences), genetic differences, brain tumors (rarely), and immune problems (very rare). In many cases, however, there is no detectable cause for epilepsy. While not establishing a cause can be frustrating for families, prognosis is often favorable for children with no established cause. And finding an effective treatment does not depend on finding the underlying cause.
A child may experience one or many seizures. While the exact cause of the seizure is often not known, the more common seizures are caused by the following:
In newborns and infants:
- Genetic factors
- Brain infection
- Brain malformation or developmental difference
In children, adolescents and young adults:
- Genetic factors
- Brain malformation or developmental difference
- Trauma to the head
- Unknown reasons
Other possible causes of seizures may include:
- Brain tumor
- Brain blood vessel abnormalities
- Drug withdrawal
Testing and diagnosis of epilepsy
At the Pediatric Epilepsy Program, within Children's Hospital of Philadelphia's Neuroscience Center, your child’s care begins with a comprehensive, personalized assessment of their medical history, seizure types, and the cause of their epilepsy.
The diagnosis of a seizure is made with a physical examination and diagnostic tests. During the examination, your child's medical team obtains a complete medical history and asks when the seizures occurred.
Diagnostic tests may include:
- Electroencephalogram (EEG) to measure the electrical activity in the brain and identify the source of seizures
- Most children experiencing seizures will undergo a routine EEG that typically lasts 30 to 60 minutes.
- For some children, longer EEG recordings are required. Using continuous 24/7 EEG recording, our epilepsy specialists can help manage acute seizures and identify how many seizures a child is having. An EEG also helps us identify children who may be candidates for epilepsy surgery.
- Magnetic resonance imaging (MRI)
- Genetic tests may help us better understand each patient and their type of epilepsy
- Magnetoencephalography (MEG)
- Stereoelectroencephalography (sEEG or stereo-EEG), a minimally invasive procedure where electrodes are placed directly in the brain to identify where seizures start
- Lumbar puncture (spinal tap) to determine if there is an infection or other problems (this diagnostic test is rarely necessary)
Seizures are sometimes related to other neurological problems and require further medical follow-up.
At the Neuroscience Center, the goal of seizure management is to stop seizures without interfering with a child's normal growth and development, and with as few treatment-related side effects as possible.
The major goals of seizure management include:
- 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 optimal medication doses
Treatments for your child's seizures 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 ability to adhere to the medication.
- Ketogenic diet: Certain 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. This type of diet is low in carbohydrates and high in protein and fat.
- Surgery: Surgery for epilepsy is performed by a specialized surgical team. The operation may remove the part of the brain where the seizures are occurring, or, sometimes, the surgery helps stop the spread of seizures through the brain. If your child may benefit from epilepsy surgery, you will first have a detailed epilepsy surgery evaluation in order to determine if all the seizures are coming from a location that is safe to remove. We use modern minimally invasive technologies to develop a personalized epilepsy surgery plan for each child to optimize seizure control and minimize pain. Other types of surgery include neuromodulation devices (see VNS, RNS, DBS bullets below).
- 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 (VNS).
- Responsive NeuroStimulation (RNS): Some patients with focal seizures coming from an area that is not safe to remove undergo responsive neurostimulation (RNS), which can reduce seizures by stimulating the area where the seizure starts to prevent seizures.
- Deep Brain Stimulation (DBS): Some patients with focal or multifocal epilepsy will respond to stimulation of part of the thalamus, deep in the brain, which can reduce seizures.
After a comprehensive evaluation and careful diagnosis, we work closely with families to develop a personalized seizure management plan, using both anti-seizure medications and other therapies, which may include epilepsy surgery for some patients.
Specific treatment for seizures will be determined based on:
- A child's age, overall health and medical history
- Extent of the condition
- Type of seizure
- A child's tolerance for specific medications, procedures or therapies
- Expectations for the course of the condition
- The parents opinion or preference
If your child’s care is managed at a hospital or doctor’s office closer to your home, we will collaborate with local providers to ensure coordinated care and the best possible seizure management for your child.
The CHOP Neuroscience Center is actively engaged in epilepsy genetics and translational therapeutics research. New advances have led to the identification of specific genes that cause seizures, allowing us to more effectively target therapies and provide more personalized epilepsy care.
Reviewed by Dennis Dlugos, MD, MSCE