Epilepsy in Children

What is epilepsy in children?

Epilepsy in children is a brain condition that causes seizures. The cells in your child’s brain create a sudden burst of irregular electrical activity and a seizure is the result. You may recognize a seizure when someone passes out and their body shakes uncontrollably. But not all seizures look the same. Some children may stare or experience confusion during a seizure.

While epilepsy causes seizures, not all seizures are the result of epilepsy in children. To receive an epilepsy diagnosis, a healthcare provider will examine whether your child has more than one seizure that isn’t caused by an underlying medical condition.

You might hear your child’s healthcare provider refer to their condition as pediatric epilepsy or seizure disorder.

What are the types of epilepsy in children?

There are several types of epilepsy in children. Some of the most commonly diagnosed include:

• Absence epilepsy: Absence epilepsy causes short moments when your child experiences confusion and stares off into the distance. During an absence epilepsy seizure, your child won’t be able to respond if you talk to them.
• Rolandic epilepsy (self-limited epilepsy with centrotemporal spikes): Affecting an estimated 15% of children diagnosed with epilepsy, Rolandic epilepsy seizures happen when falling asleep or waking up. Seizures cause uncontrolled movements, often to one side of your child’s body. They can also affect your child’s speech.
• Juvenile myoclonic epilepsy: Common during puberty, myoclonic epilepsy seizures cause uncontrolled muscle movements like twitching and jerking their arms around. These seizures are common when your child wakes up.
• Infantile spasms (West syndrome): Infantile spasms are a severe type of epilepsy that affects infants when they fall asleep or wake up. A seizure causes their body to twitch and jerk, as well as bend and stretch uncontrollably. An infantile spasm episode usually only lasts for a few seconds but your baby can experience many seizures back to back with very short breaks between each one.
• Lennox-Gastaut syndrome (LGS): LGS can cause seizures where your child’s muscles stiffen up and relax suddenly. Your child may also experience moments of nonawareness and confusion and be unable to respond when you talk to them during a seizure.

How common is epilepsy in children?

Over 3 million people in the United States have epilepsy, and over 450,000 are under 17 years old.

What are the first signs of epilepsy in a child?

Seizures are the main symptom of epilepsy in children. Some of the first signs of a seizure may include:

• Loss of awareness.
• Confusion.
• A blank stare (staring into space).
• Changes to your child’s hearing, vision, taste or smell.
• Feeling unwell, like an upset stomach or changes to their body temperature.

A seizure can happen quickly, sometimes, without any signs before it begins.

What are the symptoms of epilepsy in children?

Symptoms of epilepsy in children during a seizure only lasts for a few minutes and include:

• Loss of consciousness or passing out.
• Uncontrolled muscle movements, jerking or twitching or repetitive motions of a body part.
• Inability to talk, lip smacking or making a chewing motion with their mouth.
• A fast heart rate.
• Fast breathing.

Seizures can look different from person to person, and they don’t always involve uncontrolled muscle movements. Most people experience the same or similar symptoms with each seizure.

It can be difficult to recognize a seizure in infants compared to older children. As a child’s caregiver, note any unusual behaviors and how long they last and talk to your child’s healthcare provider.

After a seizure, your child may feel tired or confused about what just happened. They might not have any memory of the seizure happening until it stops. Headaches are common after seizures.

At what age do epilepsy symptoms start in children?

The age when epilepsy in children starts varies based on what type of epilepsy your child has. Some symptoms begin during infancy, while others begin during school-age or teenage years.

What causes epilepsy in children?

Uncontrolled electrical activity in your child’s brain causes epilepsy in children. Electricity passes between brain cells. It helps cells communicate. Sometimes, the electricity between cells becomes irregular and temporarily changes the messages sent between brain cells. This irregularity causes temporary symptoms of a seizure until your child’s brain is able to resend the correct messages to other cells in their brain.

Possible causes of epilepsy in children include:

• Head trauma or a brain injury.
• Complications from childbirth (birth injury).
• An infection (like meningitis or encephalitis).
• An abnormality in the way their brain formed before birth.
• An inborn change in their genetic makeup (genetic tendency).

Sometimes, there’s no clear cause of epilepsy and it can happen sporadically or randomly. Research is ongoing to learn more about what causes epilepsy in children.

What are the risk factors for epilepsy in children?

Your child may be more at risk of experiencing epilepsy if they had or have:

• A history of epilepsy in their biological family history (genetic predisposition).
• A history of a traumatic brain injury.
• A history of a brain infection.
• Other neurological issues or conditions.

What are the complications of epilepsy in children?

Epilepsy in children can affect their overall physical and mental health. Common complications of epilepsy in children may include:

• Physical injury.
• Fear of future seizures.
• Sleep disturbances.
• Low self-esteem.
• Lack of concentration.
• Depression and anxiety.

Injuries are common during a seizure, especially if your child loses consciousness and falls. If you notice signs of a seizure, make sure you get your child to a safe place, like lying them down away from hard surfaces, sharp or heavy objects or things that could fall, until the seizure is over. Place something soft, like a shirt or jacket, beneath their head during the seizure and don’t try to hold them or stop their body from moving. The seizure should only last for a few minutes. Ask your healthcare provider how to handle any seizure that lasts longer than five minutes.

Is epilepsy in children dangerous?

Some types of epilepsy are more severe, and symptoms can be life-threatening. Severe complications may include:

• Problems with cognitive development (intellectual disability).
• Status epilepticus (continuous or back-to-back seizures without enough time to recover between them).
• Brain injury or death.

Your healthcare provider will help your child manage their symptoms to prevent possible life-threatening complications with treatment. Research is ongoing and advances in treatment can decrease your child’s risk of complications.

How is epilepsy in children diagnosed?

A healthcare provider will diagnose epilepsy in children after examinations and testing that may include:

• A physical exam: During a physical exam, a healthcare provider will check your child’s vital signs along with learning more about their symptoms and taking a complete medical history and biological family history.
• A neurological exam: A healthcare provider will evaluate how your child’s brain and nervous system are functioning.
• Blood tests: A healthcare provider may order blood tests to check if an underlying condition caused your child’s symptoms.
• Imaging tests: Imaging tests, such as an MRI, can help your child’s care team learn more about their brain activity.
• Electroencephalogram: This painless test measures your child’s brain electrical activity.

Tests help your healthcare provider understand what caused your child’s seizures and rule out conditions that cause them. An epilepsy diagnosis may take time and it usually doesn’t happen overnight.

How is epilepsy in children treated?

Treatment for epilepsy in children may include:

• Medications to prevent seizures: Antiseizure medication only treats the symptoms of epilepsy and the frequency of seizures, not the cause. These medications help prevent the electrical irregularities that cause the seizures, but only while they’re in the bloodstream. So, it’s very important that your child takes their medication as prescribed.
• Surgery: If medications don’t work, your healthcare provider may recommend specialized brain surgery to target the cause of epilepsy in your child.
• Implanted medical devices: Medical devices use advanced technology to help your child manage symptoms of epilepsy if medications have proven ineffective. Common medical devices include a vagus nerve stimulator or a deep brain stimulator. Stimulators send electrical currents to specific parts of your child’s brain to regulate how brain cells function.
• Ketogenic diet: For some children with difficult-to-manage epilepsy, the ketogenic diet may be helpful. This high-fat, low-carbohydrate meal plan is best supervised by a medical care team.

Children may respond differently to treatment, so what works for one child may vary from the next. It may take trying a few different types of treatment before your child’s care team finds one that works best for them.

As a caregiver, what do I need to know about epilepsy medication for my child?

If your child is taking medicine for epilepsy, you can work with their healthcare provider to make sure they’re taking the medicine correctly. Some things to be attentive to include:

• Learn the schedule for the medicine (how many times a day to take it, whether it should be taken with food, etc.).
• Find out what to do if your child forgets to take a dose of medicine.
• Know if any of the medicines require blood tests.
• Be aware of the potential side effects of the medicines and what to do about them.
• Ask their healthcare provider what to do if your child is ill or has a fever. Fever sometimes brings on seizures.
• Make sure your child's school knows that they take epilepsy medicine and that arrangements are made for them to take it at school (if necessary).
• Make sure the school has a seizure rescue plan in place.

Are there side effects of the treatment?

Possible side effects vary from drug to drug, but some antiseizure medications may cause the following:

• Drowsiness.
• Changes to your child’s liver function or bone marrow function.
• Skin rashes.
• Upset stomach.
• Changes in appetite.

Ask your care provider which side effects are possible with the drug that your child is taking. Side effects may decrease after your child’s body adjusts to the medication over time. If your child experiences side effects, talk to their care team to make sure the medication is right for your child.

Can epilepsy in children be prevented?

There isn’t a way to prevent all causes of epilepsy. You can help your child reduce their risk of developing epilepsy by preventing head injuries. This may include having your child wear protective gear when they play sports or participate in certain activities. If you’re pregnant, you can make sure you have the care you need before your due date to prevent birth injuries. Even if you’re well protected, accidents that lead to head trauma can still happen.

What is the outlook for epilepsy in children?

Your child’s healthcare provider can help you learn more about your child’s prognosis, as they vary based on what type of epilepsy your child has and the frequency of their seizures. An early diagnosis and starting treatment quickly can lead to the best outcome. While rare, some seizures can be life-threatening and lead to unexpected death.

Does epilepsy in children go away?

Over 60% of children outgrow epilepsy before they reach adulthood. Others may have to manage the condition for their entire life. Certain types of epilepsy are more likely to be outgrown than others.

Can my child live a normal life with epilepsy?

Most children with epilepsy have a relatively unaffected or “normal” life in the same way that their peers do. About 70% of children diagnosed with epilepsy don’t experience any changes to their development or their day-to-day activities. The only difference they might experience is that they need to take medication regularly.

It’s common for children diagnosed with epilepsy to feel frustrated, embarrassed or like an outsider because they believe their condition makes them stand out in a negative way. Epilepsy often leads to low self-esteem, depression and anxiety. Many children find comfort in speaking with a mental health professional about their emotional well-being. They also benefit from the love and support of their caregivers and medical care team to combat possible complications of the condition.

Will the keto diet help my child diagnosed with epilepsy?

Some children benefit from changes to their diet as a way to manage their symptoms of epilepsy. The ketogenic diet (keto diet) is an eating pattern high in fats and low in carbohydrates. Your healthcare provider may recommend your child participate in this meal plan because it may change how your child’s brain gets and uses energy.

Your provider will let you know if you need to adjust what your child eats.

How do I keep my child with epilepsy safe?

As a caregiver of a child with epilepsy, you may have concerns regarding their safety in the event of an unexpected seizure. Many of the things you can do to keep your child safe are also things other children who don’t have epilepsy may benefit from as well. Your child’s healthcare provider will let you know if certain sports or activities are safe for your child to do. Most activities are safe if your child’s seizures are well-managed.

Keep in mind the following when caring for your child:

• Have your child wear safety equipment when playing or participating in sports. For example, have your child wear a helmet when riding a bicycle.
• Make sure your child has supervision during sports, playtime and activities. Their caregivers should be aware of their medical condition and know what to do in the event of a seizure.
• If your teenager has seizures, check with their healthcare provider before letting them drive. Diving recommendations vary from state to state.
• Your child shouldn’t sleep in the top bed on a bunk bed. Be aware of other risks related to heights, for example, rock climbing or tree climbing.

Water safety tips for children with epilepsy

Here are some water safety tips to keep in mind if you’re caring for a child with epilepsy:

• Keep bathroom doors unlocked for safety reasons. Teach the rest of your family about your child’s need for privacy in the bathroom.
• Monitor your child anytime they’re near water, whether at home or outside. This includes the bathtub and backyard pools. Don’t let a child with epilepsy swim alone.
• Check the bathtub drain to make sure it’s working properly.
• Keep the water in the tub at low levels.
• Keep the water temperature low to prevent scalding.
• Install a shower or tub seat for older children. A safety strap for the seat is helpful.
• Keep all electrical appliances away from the sink or bathtub.

If your child has a seizure while swimming, get them out of the water as soon as possible and check their breathing and pulse. If anything seems wrong, contact their healthcare provider or emergency services right away.

When should I see a healthcare provider?

Contact your child’s healthcare provider if they experience:

• More frequent seizures.
• Side effects from antiseizure medication.
• Depression or anxiety.
• A delay in reaching developmental milestones for their age.

When should I go to the ER?

Call 911 or local emergency services or go to the emergency room when your child:

• Has their first seizure.
• Injures themselves during a seizure.
• Has a seizure that lasts more than five minutes.
• Has another seizure before they recover from the first seizure.
• Is unresponsive for more than 10 to 15 minutes after seizure convulsions stop.
• Takes longer than 30 minutes to recover from a seizure.

Status epilepticus is a dangerous condition that happens when your child has seizures that last a long time or has multiple seizures without recovery time between each one. This is a life-threatening emergency and needs immediate medical attention.

For prolonged seizures, special “rescue medications” can be given by caregivers (like parents or teachers), either rectally or by nasal spray. Ask your child’s healthcare provider if having rescue medication on hand would be appropriate for your child.

What questions should I ask my child’s healthcare provider?

• What type of epilepsy does my child have?
• What signs should I watch for?
• What are the side effects of treatment?
• Does my child need surgery?
• How should I handle a seizure?
• How do I inform my child’s school about their condition?
• Can my child play sports?

A note from Cleveland Clinic

Caring for a child is challenging, but you may face more challenges caring for a child diagnosed with epilepsy. It’s normal to feel frustrated, confused and concerned about what your child is going through. Your child’s healthcare providers will work with you to help you understand the condition and how you can help your child as they grow. Contact your child’s care team if you have any questions about their diagnosis or if you see any side effects or new or worsening symptoms. Research is ongoing to help children manage epilepsy with few interruptions in their daily lives so they can have fulfilling childhoods.