Does my child have epilepsy? Understanding the diagnosis and treatment options

Health & Wellness |


Peds Epilepsy1 Blog

It can be an unsettling and even scary experience if your child experiences a seizure. A seizure is a sudden increase in the brain’s electrical activity that causes involuntary movements or abnormal sensations.

“Seizures can appear as dramatic, full body shaking with stiffened muscles. But they can also take the form of subtle, abnormal sensations or a silent stare off into the distance. Your child may also experience confusion, memory and language problems,” said Dr. Makram Obeid, pediatric neurologist at Riley Children’s Health. “In the first month of life, more than 80% of newborn seizures can be silent and only detectable on electroencephalogram (EEG) tests.”

When children have the brain disorder epilepsy, they have a predisposition to recurrent seizures. Epilepsy is the most common neurological disorder in children in the United States, and it can have several causes.

“In children, about half of the epilepsy cases are genetic, and the other half are caused by brain lesions and acquired injuries, like a neonatal (newborn) stroke, traumatic brain injuries or infections that affect the brain. These can lead to epilepsy, sometimes months or years later,” Dr. Obeid said.

It is often difficult to predict when a seizure may occur in a child with epilepsy. What triggers seizures in patients with epilepsy can vary, and include things like emotional stress, physical exhaustion, poor sleep and fever. In some children with epilepsy, seizures can even be triggered by environmental factors like specific light patterns.

Diagnosing epilepsy in children begins with a visit to the neurologist to discuss your child’s history of seizures. The neurologist will order tests to identify where in your child’s brain the seizures are originating. Tests include an EEG to measure the brain’s electrical activity and magnetic resonance imaging (MRI) to look for a possible lesion or scaring from brain injuries, such as trauma or infection.

“In diagnosing epilepsy, a detailed medical history and physical exam will typically lead you to a clinical suspicion of epilepsy, and the imaging along with EEG helps you make the diagnosis,” said Dr. Saul Wilson, pediatric neurosurgeon at Riley Children’s Health.

“There is not one, single test for epilepsy,” Dr. Obeid said. “The diagnosis of epilepsy is based on a history of seizures, but the results of these tests support the diagnosis and help us figure out the underlying cause and where the seizures are coming from.”

Once a physician has established an epilepsy diagnosis with your child, the first step in treatment is usually controlling seizures through medication.

“We begin with anti-seizure medications that have the fewest side effects at the lowest dose possible,” Dr. Obeid said. “At times, the cause of the epilepsy calls for additional treatments or interventions. For example, this can be resecting a tumor or treating an underlying auto-immune disease.”

Doctors will work with you and your child to minimize anti-seizure medication side effects, like drowsiness, fatigue and changes in appetite and sleep patterns. If more than two medications fail to control the seizures, additional tests are usually performed to see if a child qualifies for more specific types of treatments and interventions, including epilepsy surgery.

“Before we go into surgery, we do detailed imaging on our patient to localize the source of seizures so we can improve or completely eliminate a patient’s seizure activity. Imaging may help us identify a brain tumor, a vascular lesion or a congenital malformation causing the seizures,” said Dr. Wilson.

There are several surgical options to treat epilepsy, depending on what is causing the seizures and where in the brain the seizures begin.

  • Ablation is a minimally invasive way to use a laser to treat lesions in the brain that are causing seizures.
  • Vagus nerve stimulation (VNS) involves implanting a device under the skin that delivers direct electrical pulses to the brain through electrodes in the vagus nerve in the neck.
  • Responsive neurostimulation (RNS) is a surgical treatment where an implanted device detects seizure onset and sends electrical stimulation to the brain to prevent seizures.
  • Resection surgery removes an area of the brain responsible for seizure activity.
  • In some cases, corpus callosotomy reduces seizures that begin on one side of the brain and spread to the other by cutting the band of nerves (corpus callosum) that connects the two hemispheres of the brain.

“Most often, the initial treatment for epileptic seizures will be medications, but occasionally imaging may help us localize a new brain tumor that must be treated surgically up front,” Dr. Wilson said.

If you think your child may be experiencing seizures, reach out to your child’s physician to discuss neurological care. When possible, document as much as you can about the seizures to help your child’s physicians understand what is causing the episodes and how best to treat them.

Related Doctor

Saul Wilson, MD

Saul Wilson, MD

Pediatric Neurosurgery

related doctor headshot photo

Makram M. Obeid, MD

Pediatric Neurology