|SSM Cardinal Glennon Children's Medical Center|
If you have a child with epilepsy, you're not alone — 2.5 million Americans have this disorder.
Anyone can get epilepsy at any age, but the majority of new diagnoses are in kids. About two-thirds of all kids with epilepsy outgrow the seizures that accompany it by the time they're teens.
Epilepsy is a disease of the central nervous system in which electrical signals of the brain to misfire. These disruptions cause temporary communication problems between nerve cells, leading to seizures. A seizure can be thought of as an "electrical storm" that causes the brain to do things that the person having the seizure doesn't intend.
Having a single or sometimes even several seizures is not necessarily considered epilepsy. Kids with epilepsy are prone to having multiple seizures over a fairly long period of time (months to years).
Causes of Epilepsy
In less than half the cases of epilepsy, there is a specific identifiable brain problem that causes the seizures. These include:
In kids, more than half of epilepsy cases are idiopathic (meaning there's no other identifiable cause or visible problem in the brain). In most of these, there's a family history of epilepsy or the condition is believed to be genetic (kids with a parent or other close family member with epilepsy are more likely to have it, too). Researchers are working to determine what specific genetic factors are responsible for these forms of epilepsy.
Seizures vary in severity, frequency, duration (from a few seconds to several minutes), and in their appearance. There are many different kinds of seizures, and what occurs during one depends on where in the brain the electrical signals are disrupted.
The two main categories of seizures are generalized seizures, which affect the whole brain all at once, and partial seizures, in which only part of the brain is mostly affected. Some people with epilepsy experience both kinds. Also, the electrical problem in a partial seizure can spread to cause a generalized seizure.
Seizures can be scary — a child may lose consciousness or jerk or thrash violently and may appear to stop breathing or have difficulty breathing. Milder seizures may leave a child momentarily confused or unaware of his or her surroundings. Some seizures are so brief and minor that only careful observation or an experienced eye will detect them — a child may simply blink or stare into space for a moment before resuming normal activity. Even in those cases, it is usually obvious to parents that a child is having episodes of concern.
After seizures that last more than 30 seconds, most kids are exhausted, tired, sleepy, disoriented, confused, or even combative and agitated for minutes to hours. This is known as the postictal phase.
During a seizure, it's very important to stay calm and keep your child safe. Be sure to:
Do your best to note how often the seizures take place, what happens during them, and how long they last and report this to your doctor. Once a seizure is over, watch your child for signs of confusion or the postictal phase. He or she may want to sleep and you should allow that. Do not give extra medication unless the doctor has prescribed it.
Kids who experience partial seizures may be frightened or confused during or after the seizure. Offer plenty of comfort and reassure your child that you're there and everything is OK.
Most seizures are not life threatening, but if one lasts longer than 5 minutes or your child seems to have trouble breathing afterward, call 911 for immediate medical attention.
Talk to your doctor if your child has seizures, staring spells, confusion spells, shaking spells, or unexplained deterioration in behavior or school performance. The doctor can refer you to a pediatric neurologist, who will take a patient medical history and examine your child, looking for findings that suggest problems with the brain or with the rest of the neurological system.
If the doctor suspects epilepsy, tests will be ordered, which may include:
Your doctor will use the test and exam results to determine the best form of treatment. Medication to prevent seizures is usually the first type of treatment prescribed for epilepsy management. Most kids are successfully treated with one medication — and if the first doesn't work, the doctor will usually try a second or even a third before resorting to combinations of medications.
No medication for epilepsy is perfect and side effects are possible. The most common include tiredness, decreased alertness, and mood or behavioral concerns, so parents should watch for these and discuss concerns with the doctor.
Nowadays, many choices are available and most kids treated with antiseizure medications do not experience worrisome side effects. Nevertheless, discuss any concerns you have with the doctor so that dose adjustments or appropriate changes can be made if appropriate.
Rarely, blood tests might be needed to monitor a medication's level in the bloodstream or to watch for side effects.
If your child still has seizures after the second or third medication tried, it's less likely that subsequent medications will be fully effective. In this case, more complicated treatments may be recommended or tried. These include:
Even people who respond successfully to medication sometimes have seizures (called "breakthrough seizures"). These don't mean the medication needs to be changed, although you should let the doctor know if they occur.
Living With Epilepsy
To help prevent seizures, make sure your child:
Keeping your child well fed and well rested and reducing unnecessary stress are all key factors that can help manage epilepsy. Common-sense precautions to take (based on how controlled the epilepsy is) include:
With these simple safety precautions, your child should be able to play, participate in sports or other activities, and generally do what other kids like to do. State driving laws vary, but teens with epilepsy will probably be able to drive with some restrictions, as long as the seizures are controlled.
It's important to make sure that other adults who care for your child — family members, babysitters, teachers, coaches, etc. — know that your child has epilepsy, understand the condition, and know what to do in the event of a seizure.
Offer your child plenty of support, discuss epilepsy openly, and answer questions honestly. Kids with epilepsy might be embarrassed about the seizures or worry about having one at school or with friends.
Unfortunately, many kids with epilepsy have other neurological problems. In particular, learning and behavioral problems are common and can create more hardship for a child than the epilepsy itself. In some cases, the medication's side effects can make these problems worse. Such difficulties might require the help of specialists, teachers, and social workers. Consider having your child talk with a mental health counselor or psychologist if he or she struggles with these feelings or problems.
Parents caring for a child with epilepsy also might benefit from advice from specialists such as psychologists, social workers, or specialized educators. For those whose kids have more severe epilepsy, this help is critical. Specialists can help parents plan for the future (transition services) by identifying social, financial, and other community resources that will improve the child's well-being.
Reviewed by: Harry S. Abram, MD