Pediatric Epilepsy

What Is It?

Pediatric epilepsy is epilepsy, a disorder characterized by recurrent seizures, which occurs in a young patient. There are several potential causes of seizures and epilepsy in children.

Seizures are abnormal, rhythmic brain activity which can occur due to several pathologies. The types of seizures and presentation of epilepsy varies depending on the cause and the locations in the brain which are affected by each seizure. While the typical convulsions that most people associate with seizures can occur with some forms of epilepsy, other types can present with very different types of seizures.

Some possible causes of pediatric epilepsy:

Fevers: Febrile seizures are one of the most common causes of seizures in pediatric patients. They typically occur during a high fever when the child is sick with a viral illness. However, this is generally not considered epilepsy as most of these seizures are benign and most of these patients do not go on to have a lasting epileptic disorder.

Brain Malformations: Some malformations of the brain which occur during brain development can lead to epileptic conditions that present in childhood. For example, cortical dysplasia or hemimegalencephaly can present with pediatric epilepsy.

Brain Tumors: Certain brain tumors which can occur in children, such as some low grade gliomas, ganglioglioma or ganglioneuroma, can be associated with pediatric epilepsy.

Infection: Certain infections in or around the brain can lead to seizures. Some will only cause seizures during the infection but occasionally can lead to long-standing epileptic conditions. Examples include meningitis, cerebral abscess and encephalitis.

Idiopathic: In idiopathic condition is one for which we do not know the cause. Some children who present with epilepsy do not have a known cause or the cause eludes detection until extensive work-up is performed.
Other Causes: Other potential causes of seizures and epilepsy in children include traumatic brain injury, brain hemorrhage, arteriovenous malformation, Moyamoya disease, cerebral palsy or cerebral infarction.

What Types of Symptoms Are Typical?

The symptoms of epilepsy vary depending on the type and cause of the seizures. Generally, epilepsy is characterized by the recurrent occurrence of seizures. The frequency of seizures can vary greatly from patient to patient. In mild cases, seizures may only occur rarely while in severe cases seizures may occur many times a day.

One of the most common forms of seizure and the one with which most people are familiar is called a generalized tonic-clonic seizure. These are the seizures that present with an increase in muscle tone followed by muscle convulsions and loss of consciousness. However, there are many other possible presentations of seizure. Absence seizures do not have motor convulsions and often present with staring spells with a dissociation of consciousness and automatic movements like smacking of the lips or others. Focal seizures may not lead to loss of consciousness and may only result in twitching or convulsions of one part of the body.

How Is The Diagnosis Typically Made?

The diagnosis of epilepsy can be complex as there are many causes and types of seizures. However, one of the most commonly employed tests is an electroencephalogram or EEG. This test allows physicians to non-invasively monitor the electrical activity at the surface of the brain. In many cases this can help confirm the presence of abnormal, seizure-like activity.

Additionally, many patients undergo imaging studies such as CT scan or MRI scan. These help to evaluate if there is any abnormality of the brain such as a brain tumor or brain malformations, for example. Finally, other more advanced tests may be required to help localize the source of the seizures in the brain. These can include PET scans or invasive monitoring (placing electrodes on or in the brain to monitor brain activity).

All of these aspects of diagnosis for pediatric epilepsy vary considerably depending on the type and cause of epilepsy in each patient.

What Are Some Common Treatments?

Treatment for epilepsy varies considerably from patient to patient.

Treatment generally consists of medical treatments or surgical treatments. In general, patients with forms of epilepsy that are not due to a tumor or other surgical condition are started with medical treatment with anti-epileptic drugs. There are many such drugs which help to suppress seizure activity in the brain. If a patient's seizures are well controlled only with these medications then this may be the only treatment that is needed.

However, in cases where the seizures are not controlled adequately with medication, surgical treatments may be necessary. These vary but can include surgical removal of the part of the brain responsible for the onset of seizures, the seizure "focus". Likewise, if there is a known lesion in the brain such as a tumor or malformation, surgical removal of the lesion may be necessary both to treat the lesion itself as well as preventing further seizures.

Some pediatric epilepsy is adequately treated with these various treatment options while other severe cases may be very difficult to control. Because there is such variability from patient to patient, each child with epilepsy or any history of seizures should be worked up fully by their own physician who can recommend the best diagnostic and treatment options for their specific condition.

For more information about epilepsy and seizures in general, see our Epilepsy section.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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