ailments

Epilepsy

By Dr Evelyn Lewin

Epilepsy involves having more than one unprovoked seizure of any type. There are a number of different epilepsy syndromes, primarily defined by age of onset, seizure types, developmental course and other features.

 

symptoms

Seizures are caused by abnormal activity in the brain that produces an outward change in the body. Depending on what part (and how much) of the brain is involved, a person having a seizure may experience tingling feelings on their skin, abnormal movements, unusual smells, nausea, visual hallucinations, sensations of fear or other emotions.

Epilepsy can start at any age and may be a consequence of a number of different factors. When unprovoked seizures begin in childhood, genetic reasons are often suspected; however strokes, trauma, infection, brain malformations and autoimmune disorders can all also result in epilepsy.

These are some of the seizure types that may be seen in children:

  1. Generalized tonic-clonic: Formerly known as “grand mal,” this type of seizure involves the entire body becoming stiff with rhythmic jerking. Stiffness is often the first stage of the seizure, with rhythmic jerking starting later. Eyes are usually open but the child is completely unresponsive. Generalized tonic-clonic seizures usually last less than a minute but can continue much longer. After the seizure, the child is tired and sleepy but will usually be close to their normal self within 30 minutes.
  2.  Absence: These seizures involve brief periods of blank staring and unresponsiveness, usually lasting just a few seconds (30 seconds is typically the maximum). Afterwards, the child goes back to what they were doing and is usually unaware that anything has happened. Children may have hundreds of these seizures per day, but the events are so brief that they often go unrecognized by parents and teachers.
  3.  Myoclonic: These seizures are brief, quick jerks lasting less than a second. They can involve the entire body or just one body segment (for example, the hand). In teenagers, this seizure type often occurs predominantly in the morning.
  4.  Focal Seizures: This type of seizure involves abnormal electrical activity in only one part of the brain. There are great number of focal seizure types, usually divided into those that are associated with impaired consciousness and those that are not. What happens during the seizure depends on what part of the brain is affected. Rhythmic jerking of one side of the body, abnormal feelings on the skin, strange smells, and unusual emotions are just some of the possible focal seizure types. If the abnormal brain activity spreads, a focal seizure may evolve into a generalized tonic-clonic seizure.
  5.  Epileptic Spasms: This seizure type involves brief stiffening of the body (1-2 seconds) and is most commonly seen in infants.  Epileptic spasms are often associated with developmental impairment.
  6.  Atonic: In this type of seizure, the child will suddenly go limp and collapse to the ground. Although the events are brief (< 2 seconds), children can easily injure themselves during the fall. This seizure type is usually associated with syndromes involving intellectual disability.
  7.  Tonic: These seizures are similar to epileptic spasms, except that the stiffening lasts longer than 2 seconds, often up to a minute. The child has no recollection of the event afterwards. This is another seizure type often associated with intellectual disability.

treatment

Children with epilepsy should be managed by a paediatrician or paediatric neurologist. The key elements of management include the following.

  1. Safety Precautions: Children with epilepsy are at increased risk of hurting themselves if they have a seizure at an inopportune time. Caregivers should first review with their doctor the steps to take to make their child safe in the event of a seizure. Along with this training, precautionary safety measures must also be taken. Due to the potential for drowning, children with seizures should always have an adult in the room when they are having a bath. If going swimming, they must be supervised by someone who understands the risks of a seizure and is capable of helping them if one were to occur. In general, children with epilepsy can safely engage in most activities, but must be careful to avoid situations in which they could injure themselves if they were to fit. Teenagers wishing to drive should discuss the safety of this with their neurologist.
  2. Medications: There is a long list of medications that can be used to treat seizures, and the best medication for a given situation depends on a number of factors including seizure type, age of the child and other medical issues that may be present. Though any drug has a potential to produce side effects, the majority of children with epilepsy can have their seizures controlled on a medication they tolerate well.
  3. Other Options: For the rare cases of epilepsy in which seizures cannot be controlled with medication alone, there are a number of other options. Certain diets, vagal nerve stimulator insertion and surgical resection may all be considered for the especially difficult to treat cases.
Reviewed by Dr Evelyn Lewin 14 March 2016 references
  • current version

    Dr Ken Myers PhD - Paediatric Neurologist
  • PEER REVIEWER

  • document id

    10103016
  • next review

    29.03.2018

This document has been developed and peer reviewed by a KIDS HEALTH Advisory Board Representative and is based on expert opinion and the available published literature at the time of review. Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner.

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