What is epilepsy and how does it affect children?
Epilepsy is a chronic medical condition marked by recurrent seizures (an event of altered brain function caused by abnormal or excessive electrical discharges from brain cells).
As one of the most common neurological disorders, epilepsy affects up to 1 percent of the population in the United States. More than 45,000 children ages 18 and younger are diagnosed with epilepsy every year.
Symptoms & First Aid for Seizures
To diagnose epilepsy, doctors work to determine the type of seizure a child is experiencing (epileptic or non-epileptic) and its cause because particular seizures respond best to certain medications.
Learn to recognize common symptoms of seizures:
- Staring and unresponsiveness
- Jerks and twitches
- Shaking or falling
- Picking or lip smacking
First Aid Steps
For non-convulsive seizures:
- Watch the person carefully to recognize the seizure
- Speak quietly and calmly to the person
- Explain to others what is happening
- Guide the person gently to a safe area away from any danger, such as water, machinery or fire
- Don't restrain the person or try to stop the movements
- Stay with the person until he or she regains complete consciousness
For convulsive (grand mal) seizures:
- Time the seizure
- Look for an "epilepsy" or "seizure disorders" bracelet
- Place the person on his or her side, away from hazardous objects
- Don't put anything in the person's mouth
- Remove eyeglasses and any tight objects around the person's neck
- Call 9-1-1 if the seizure lasts more than five minutes or results in injury
- Stay with the person until help arrives
Download a guide to first aid for seizures:
Symptoms Mistaken for Seizures
During childhood there are several other conditions that may be mistaken for seizures, both grand mal and petite. Some of the common entities that are misdiagnosed as seizures include:
Breath Holding Spells
Breath holding spells may occur in toddlers. They occur in response to a minor injury or as an emotional response if a toddler gets upset and cries. During an episode a child cries out and then seems to hold his breath. His lips and mucous membranes may appear bluish (cyanotic breath holding spell) or less commonly, a child may appear very pale (pallid breath holding spell) during an episode.
If the episode is prolonged, it may result in a generalized convulsion. It is important to distinguish such a convulsion from epileptic seizures. Consultation with the primary care provider is the first step and if necessary, further subspecialty consultation with a neurologist may be obtained for accurate diagnosis.
Syncope or fainting occurs when a patient falls down and has a brief loss of consciousness. Sudden emotional stress, severe pain, sudden standing up or prolonged standing are some of the common causes which may lead to syncope.
Misdiagnosis with epileptic seizures may occur if there is no clear history of a precipitating cause, while on the other hand, although infrequent, some epileptic seizures may have syncope as one of their manifestations. The primary care provider may refer such a patient to a neurology service for consultation and specialized testing, including a tilt table test and continuous video EEG monitoring to establish the correct diagnosis.
Seizure-like reactions can sometimes occur in response to stresses or unfavorable events in a patient’s past or present life. Such attacks are referred to as “non-epileptic behavioral events." Other less-preferred terms for this phenomenon are pseudo-seizures and psychogenic seizures. Non-epileptic behavioral events are often mistaken for epileptic seizures, but they are not due to epilepsy.
During an attack, the patient often exhibits shaking of the limbs and body as in seizures, and he or she may be unresponsive. A consultation with a neurologist is often necessary in order to determine whether a patient’s symptoms are due to epilepsy or to an underlying psychological disorder. Observation of the seizures in the inpatient video-EEG-monitoring unit may be necessary to make a definitive diagnosis.
Staring Spells Due to Inattention
Staring spells due to inattention are commonly misdiagnosed as “absence epilepsy." Absence seizures (the seizure type associated with absence epilepsy) and staring spells of non-epileptic origin may outwardly appear very similar. Both are associated with brief episodes of a blank stare and lack of awareness for the surroundings. In order to prevent a misdiagnosis of epilepsy and mistreatment with prolonged use of antiepileptic medications, the help of neurology consultation and EEG testing may be necessary.
How is epilepsy in children diagnosed?
A diagnosis is based on medical history, including family history of seizures, associated medical conditions and current medications.
The physician may ask the following questions:
- At what age did seizures begin?
- What circumstances surrounded the first seizure?
- What factors seem to bring on seizures?
- What is felt before, during and after seizures?
- How long do seizures last?
- Has there been previous treatment for epilepsy?
- Which medications have been prescribed and in what dosages?
- Was treatment effective?
- Are there eyewitness accounts from family or friends who can describe the seizures?
A complete physical and neurological examination of higher mental functions, muscle strength, reflexes, eyesight, hearing and ability to detect various sensations will be performed so physicians may better understand the cause of seizures. Electroencephalogram (EEG) is a test that records the electrical activity of the brain and gives useful information regarding the location and type of epileptic discharges.
A diagnosis is also based on additional testing, which often includes:
- Imaging studies of the brain, such as high-resolution magnetic resonance imaging (MRI)
- Other brain scans, including positron emission tomography (PET), single photon emission computed tomography (SPECT) and functional magnetic resonance imaging (fMRI)
- Neuropsychological testing to determine the impact of epilepsy on the child’s language function, memory, intelligence, attention span, organizational skills and mood
- Blood and urine tests to measure blood cell counts, blood sugar and electrolyte levels; liver and kidney function tests; and additional blood and urine tests to look for metabolic or genetic diseases
Can my child lead a normal life after being diagnosed with epilepsy?
Epilepsy is a treatable disorder with two-thirds of patients becoming seizure-free on medication. Even for those who may not respond to medication, epilepsy surgery and electrical brain stimulation may be options. Advancements in our understanding of the causes of epilepsy and new treatments continue to offer hope to ever more patients.
Depending upon the degree of seizure control, patients who have epilepsy can participate in many of the same activities that other people do. We recommend that patients engage in an active and healthy lifestyle, including outdoor and indoor sports.
Reasonable seizure precautions are advisable, however, to prevent injury due to falls, drowning or motor vehicle accidents. The treating physician can advise you to which activities are safe.
Some patients with epilepsy do have learning or memory difficulties and alterations in mood or behavior, which should be brought to the attention of the treating neurologist for appropriate diagnostic testing and treatment. Cleveland Clinic Epilepsy Center offers a comprehensive and multidisciplinary treatment approach for managing such issues. Specialists in Pediatric Neuropsychology and Child and Adolescent Psychiatry are an integral part of the treatment team.
How effective is medication in treating epilepsy?
Success, defined as seizure freedom, is achieved in about 50 percent of patients treated with the first antiepileptic medication.
After failure of the first drug, the patient is placed on another drug, or uses a combination of two drugs, and the seizure-free rate drops between 11 to 15 percent. After two or more antiepileptic medications fail, there is only a 5 to 10 percent chance that future medication trials will result in seizure freedom.
Overall, between two-thirds and three-quarters of all patients will become seizure-free. The remaining group of patients is much harder to control; the term for their condition is “medically refractory” or “intractable epilepsy.”
The reason why some patients will respond well to a given medication, and not so well to another is not fully understood. Precise identification of the exact seizure type with Video-EEG monitoring and determination of the underlying cause of epilepsy are important factors when considering the best form of treatment.
What kind of testing is done for children with epilepsy?
Other special services for children with epilepsy include sophisticated neuroimaging with advanced tests. These help doctors pinpoint the source of seizures and determine the best treatment options:
- High-resolution magnetic resonance imaging (MRI)
- Magnetic resonance spectroscopy (MRS)
- Ictal single-photon-emission computed tomography (SPECT)
- Positron emission tomography (PET)
- Magnetoencephalography (MEG)
If my child needs to have surgery, can he or she fully recover afterward?
Once considered a last resort, epilepsy surgery in the hands of experts has become a safe and highly effective method of treatment for selected patients whose epilepsy cannot be controlled with anticonvulsant medication. Our epilepsy surgery program identifies patients who are appropriate candidates for surgical intervention.
Testing is carried out to localize the seizure focus and determine whether it can be removed safely. Seizure-free rates after surgery can range from 50 to 90 percent, depending upon many factors. Pediatric patients are often best suited for epilepsy surgery due to the fact that their still-developing brains can better adjust after recovery. Each year, our neurosurgeons perform more than 80 pediatric surgical procedures.
Following epilepsy surgery at Cleveland Clinic, children are cared for by an expert team of physicians and nurses. Soon after recovering from anesthesia, children are observed in the Pediatric Intensive Care Unit for one or two days, followed by another three to five days in the hospital. Most children are able to go home, returning in about 10 days for removal of sutures. Some children may need rehabilitative therapy for one to two weeks at Cleveland Clinic Children’s Hospital for Rehabilitation. By two weeks after surgery, patients can stay awake most of the day. At six weeks, they usually are able to return to school or work a full day. Some patients may have mild cognitive difficulties, but these improve and stabilize three to six months after surgery. Patients should continue taking their seizure medications after surgery.