Epilepsy is the most common childhood brain disorder, affecting around 450,000 kids under age 17 in the United States. Being faced with a diagnosis — or seeing your child have a seizure without knowing the cause — can be frightening. But with the right treatment and support, the condition can often be managed and children with epilepsy can thrive.
What is epilepsy?
Epilepsy is a brain disorder that causes recurrent seizures or periods of unusual behavior, loss of consciousness, muscle spasms or confusion. People have seizures when the electrical impulses in the brain get disrupted and misfire, sending out abnormal signals to nerve cells. Some children show signs of epilepsy at birth, but it can also develop later in childhood.
Epileptic seizures can last a few seconds to a few minutes and include different symptoms. Some seizures cause a person to lose consciousness or experience shakes or convulsions. Others are milder, causing a person to stare blankly, become confused, or feel fearful or panicked.
Seizures can be caused by conditions other than epilepsy. A pediatrician might diagnose a child with epilepsy if she experiences multiple seizures that don’t seem to have another underlying cause, like a brain injury, a high fever or diabetes.
What causes epilepsy in children?
Seizures, whether they’re caused by epilepsy or not, can happen in response to changes in the brain’s electrical or chemical activity.
In about half of all cases with epilepsy, doctors are able to pinpoint the cause of a child’s seizures.
Some types run in families, and genes can play a role in triggering the condition. Epilepsy can be triggered in utero because a baby suffers from a brain injury, or is deprived of oxygen during childbirth.
Brain tumors or other neurological disorders, as well as certain metabolic disorders, can also put a baby at greater risk of epilepsy. If baby suffers an accident that causes trauma to the brain, epileptic seizures may be a side effect. Childhood infections including meningitis or encephalitis can trigger epilepsy, too.
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Types of epilepsy in children
Epilepsy can take different forms, depending on the details of a child’s seizures and whether she experiences other symptoms. Here are some of the most common.
- Symptomatic generalized epilepsy. This is an umbrella term used to describe seizures that start at birth or during childhood, which is often accompanied by developmental delays. The seizures can cause convulsions or other, milder symptoms like muscle spasms or stiffening. Symptomatic generalized epilepsy is typically caused by an underlying brain disorder or genetic condition like cerebral palsy, or by a brain injury or infection.
- Progressive myoclonic epilepsy. This is a rare form of epilepsy that can also affect a child’s balance, muscle function or mental function. It’s usually caused by an inherited metabolic disorder.
- Reflex epilepsy. Reflex epilepsy occurs when a child has seizures in response to environmental triggers like flashing lights, repetitive sounds or activities like reading, writing or solving math problems. Most children outgrow reflex epilepsy by adulthood.
- Benign familial neonatal seizures. These epileptic seizures start when an infant is around three days old and continue for the first few months of life, stopping at around 4 months. The seizures can cause loss of consciousness and convulsions, but don’t typically have other symptoms.
- Infantile spasms or West syndrome. This rare type of epilepsy typically develops between 3 and 12 months, often in response to an injury that deprived the brain of oxygen (they can also be higher in certain medical or genetic conditions). The seizures usually cause jerking and stiffening motions.
- Dravet syndrome. Another rare type of epilepsy, Dravet syndrome causes hard-to-control seizures that can affect a child’s brain development. It usually occurs before a child’s first birthday and is often caused by a gene mutation.
- Ohtahara syndrome. This rare and serious form of epilepsy typically develops within a newborn’s first two weeks of life.
Other possible causes for seizures in babies and children
Seizures are actually more common than you might think — and not all are epileptic. In fact, convulsive seizures happen in about 5 out of every 100 people during childhood. They can affect kids in different ways, at different times in their lives and can even be outgrown.
Febrile seizures are one example: They aren’t caused by epilepsy but instead a high fever or infection — and half of all kids who suffer from a febrile seizure never have another. In some cases, head injuries or conditions like diabetes can also trigger a seizure.
Seizures can also be caused by other neurocognitive conditions including Rett syndrome, tuberous sclerosis or Angelman syndrome. Sturge-Weber syndrome, which can be marked by a port wine stain birthmark, can also trigger seizures.
Regardless of the suspected cause, seeing your child have a seizure is always frightening. Though most seizures stop on their own in a few minutes, you should always let your child’s pediatrician know about the seizure so they can try to determine the underlying cause. Always call 911 for seizures lasting longer than 5 minutes or for seizures that cause breathing trouble or choking.
Treatment for epilepsy in children
While there’s no cure for epilepsy, the goal of treatment is to try to prevent seizures from happening or at least reduce their frequency. Addressing epilepsy early can help prevent possible learning and developmental delays, so the sooner treatment starts, the better.
Your child’s pediatrician may refer you to a pediatric neurologist who specializes in treating conditions like epilepsy. They may recommend:
- Anticonvulsant medications. These drugs are typically the first line of treatment. In many cases, these drugs can reduce or stop epileptic seizures, and eventually, a child may be able to stop taking them.
- Surgery. If medication isn’t working (even after experimenting with different drugs and dosages), doctors may suggest other treatments like surgery.
- Vagus nerve stimulation (VNS). VNS involves using a battery-powered nerve stimulator that is implanted under the skin and wrapped around the vagus nerve in the neck. The stimulator delivers short bursts of electrical energy to the brain through the vagus nerve, and — for reasons that are still being studied — can lower the frequency of seizures. Your child may also continue to take medications along with these other types of therapies.
- Deep brain stimulation (DBS). Similar to VNS, DBS involves surgically implanting electrodes around an area of the brain called the thalamus. The electrodes are connected to a generator implanted in the chest which can help control seizures by sending out electrical pulses.
- Diet changes. Sometimes doctors put children on a ketogenic diet, which is high in fats and low in carbohydrates, since it’s been shown to reduce seizures in some people for reasons that aren’t entirely clear. Less restrictive low-carb diets like a low-glycemic index diet or the Atkins diet might also be beneficial.
- Seizure dogs. There’s evidence that therapy dogs can be trained to sense when a seizure is coming and alert children to get into a safe position so that they don’t injure themselves during a seizure. These specially trained dogs can also be a source of comfort and support for kids who often feel scared and different from their peers.
- Healthy habits. Sticking with a predictable daily routine (including taking medications at the same time each day) and making sure your little one gets enough sleep can help keep seizures at bay. You might also consider buying your child a medical-alert bracelet so that no matter where he is, people around him can easily identify his condition and respond quickly if a seizure happens.
Watching your child go through a seizure is upsetting, but knowing how to handle it safely and where to get help can go a long way. Most importantly, stay hopeful. Around two-thirds of children with epilepsy will outgrow their seizures by the time they become teenagers.
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