Epilepsy in Children and Teens
For some children, epilepsy is a temporary problem that can be easily controlled with medication. Many kids outgrow this neurological disorder, which is characterized by two or more seizures that are separated from each other by more than 24 hours. For other children, epilepsy may be a lifelong challenge.
It's important to first get an accurate diagnosis if you suspect your child might have epilepsy. “Sometimes babies and kids make funny movements, and these are misinterpreted as being seizures,” says Nigel Bamford, MD, a Yale Medicine pediatric neurologist and an associate professor of pediatrics and of neurology at Yale School of Medicine. “Older children often have ‘staring spells,’ but these are not seizures—they are often just daydreaming.”
The Yale Medicine Pediatric Epilepsy Program is internationally known for clinical excellence and innovative research and was one of the nation's first such programs. Our pediatric neurologists are here to help diagnose and treat children with this condition—and support their families.
What are the symptoms of pediatric epilepsy?
Seizures often involve behavioral arrest (wherein a child stops moving), which is sometimes followed by abnormal movements of the face, arms and legs. Seizures can be as short as a few seconds and as long as several hours. When a child has more than one seizure without any identifiable reason, he or she may be diagnosed with epilepsy.
“Most people who have epilepsy develop the symptoms early in life,” says Dr. Bamford. There is a great range in the frequency of seizures, with some only having a few throughout their lives, and others having several each day.”
The age at which a child has his or her first seizure is related to the type of epilepsy. Some epileptic syndromes begin early whereas others present later in childhood or adolescence.
"Because seizures can be very brief, parents don’t always recognize them,” Dr. Bamford says. “We don’t think there is a danger in these short seizures, per se, but they do need to be treated.”
There is research going on at Yale Medicine to find out how seizures impact brain function.
“We know that longer seizures are not good for children, because when they are in turmoil for such a long time, their brains can’t learn and mature,” he says. “That could lead to cognitive issues, though some children with cognitive difficulties develop seizures. The challenge is to identify the underlying problem that results in both seizures and developmental issues or cognitive delays.”
How is pediatric epilepsy diagnosed?
The first task for a physician is to determine whether or not the child has actually had one or multiple seizures. (Any physician can make the diagnosis but a neurological consultation is recommended.)
Pediatric neurologists must determine if children are having seizures. This requires that they interview parents in order to get specific information and a clearer picture of the situation. (Video of the concerning event is often very useful, says Dr. Bamford.) Doctors must consider causes of similar symptoms, such as acid reflux or movement disorders in small children. If a child is daydreaming, for example, the child will respond immediately to touch, whereas a child having a seizure probably won’t.
Another part of the evaluation may include an electroencephalogram (EEG), a device that measures electrical activity in the brain. An EEG can provide valuable clues to guide a diagnosis and the best treatment for a child.
If it’s determined that a child has had more than one unprovoked seizure separated by more than 24 hours without an identifiable cause, he or she will be diagnosed with epilepsy. Each year, more than 45,000 children receive the diagnosis.
“Epilepsy is like the fever that occurs with a viral illness,” Dr. Bamford says. “It is a symptom of an underlying disorder. Sometimes seizures occur in an otherwise normal child. Sometimes the seizures are part of a specific disease that may cause other brain problems.”
Possible underlying disorders of epilepsy include genetic disorders, metabolic disease, brain tumor or prior brain trauma. In a chicken-or-egg dilemma, a physician must figure out whether seizures are causing all of the child’s additional problems or whether a poor outcome after a long seizure is due to another, underlying issue.
What are the risk factors for pediatric epilepsy?
About 0.6% of children between ages 0-17 have active epilepsy. If you consider a group of 1,000 students at school, about 6 of them could have the condition.
“Seizures and underlying neurological problems can run in families, but the research on the genetic component of the disorder is in its infancy,” Dr. Bamford says.
Other risk factors include premature birth, brain injuries, brain abnormalities, and developmental disorders such as autism and cerebral palsy.
How is pediatric epilepsy treated?
If there is an underlying disorder that can be treated, a doctor will try to do so first. “Otherwise, controlling seizures is similar to giving a child Tylenol for a fever without getting rid of his or her virus,” Dr. Bamford says.
“With careful observation, a seizure can sometimes be localized to a certain part of the brain. For example, the right arm starts shaking first so the seizure may begin on the left side of the brain. However, this is often difficult as the seizure spreads quickly across the brain and involves all of the extremities. In those cases, an EEG is needed to help determine which area of the brain is responsible,” Dr. Bamford says.
If a doctor identifies a particular pattern, he or she can prescribe the medication best suited to preventing seizures for that patient.
“There are many anticonvulsant medications available,” Dr. Bamford says of the medicines, which are through to prevent the spreading of the abnormal brain activity that leads to seizures. “Most children tolerate these medicines well, without side effects. If side effects occur, other medications can be tried, as there are many available options to choose from.”
About 70 percent of children who have epilepsy will respond to the first medication and first dosing regimen they are given, Dr. Bamford says. A further 20 percent of kids will respond to a second medication or a change in dose, he adds.
The remaining 10 percent of children, who have seizures that are difficult to control, will require several medications and/or will be evaluated for other types of treatment, Dr. Bamford says. Options for additional treatment can include a ketogenic diet, a vagal nerve stimulator or epilepsy surgery.
A ketogenic diet is a high-fat diet that provides some relief from seizures in almost all patients who adhere to it. “There is a lot of research going on about why this diet helps prevent seizures, but so far no one has been able to determine the precise mechanism,” Dr. Bamford says. The diet is better tolerated in younger children. It requires close surveillance by a clinical nutritionist to make sure children don’t gain weight.
One surgical option for some patients is the implantation of a vagal nerve stimulator, which can offset seizures. “It’s almost like a brain pacer that sends a signal to the brain that can disrupt seizures,” says Dr. Bamford. While it generally requires a one-time procedure, it also needs some monitoring and maintenance.
Another option for patients is brain surgery. “Surgery can be very successful,” Dr. Bamford says. “But whether or not it will work, or is an appropriate treatment, depends on the child and his or her underlying problem or problems. If there is an area of the brain that is causing the seizures that can be identified and safely removed, then the chances of success are very high.”
The risk of seizures declines over time, says Dr. Bamford, adding that half of kids with epilepsy go on to become adults who don’t have epilepsy.
“So, after one or two years, the pediatric neurologist will try to determine if the child can safely stop taking his or her medication,” he says. This recovery “is most likely related to brain development during childhood and is unrelated to treatment, as the anti-seizure medications do not cure epilepsy.”
What makes Yale Medicine’s approach to pediatric epilepsy unique?
At Yale Medicine, researchers are trying to understand how seizures occur and what role genetics play in their onset. Those investigations allow Yale Medicine doctors to improve treatment based on the latest and most comprehensive understanding of disease during the diagnosis and treatment of epilepsy.
“Our team meets weekly to discuss which tests should be performed on patients, expected outcomes and plans for treatment, including surgery if appropriate,” Dr. Bamford says.