Childhood Epilepsy & Seizures

What is a seizure?

A seizure can be caused when a group of neurons repeatedly misfires all at once. Seizures involve different involuntarily actions in the body such as:

Muscle spasms
Jerking limbs
Facial twitching
Sensations
Emotions
Behaviors
Loss of awareness
Loss of consciousness

What is epilepsy?

Epilepsy is a common condition with the highest incidence of diagnosis occurring in early childhood. More than 450,000 children and adolescents in the United States are living with epilepsy.

In nearly half of all people with epilepsy and seizures, the cause is unknown (idiopathic). In other cases, epilepsy and seizures can be linked to specific causes or other conditions, including:

Genetic factors
Brain tumors
Neurofibromatosis
Tuberous sclerosis
Developmental brain abnormalities
Chromosomal abnormalities
Arteriovenous malformations
Infections such as meningitis or encephalitis
Stroke
Traumatic head injury
Developmental neurological conditions
Autism spectrum disorder

While many children may experience one seizure during childhood, an epilepsy diagnosis requires two or more unprovoked seizures that occur at least 24 hours apart.

There are different types of seizures, which can be mild to severe and can happen frequently or infrequently.

Types of seizures

Focal or partial seizures

This type of seizure starts in a specific part of the brain. Children with focal seizures may experience sudden feelings of sadness or joy, or they may hear, taste, smell and see things that are not there. They may feel like they are in a dreamlike state and show repeated facial movements such as blinking. Focal seizures usually only affect one part of the brain, but they can become generalized, involving the entire brain.

Generalized seizures

These seizures impact the whole brain all at once. The abnormal nerve activity happens quickly, causing a variety of symptoms, from loss of consciousness to major muscle contractions. There are different kinds of generalized seizures:

Absence seizures. A child having an absence seizure seems to be staring into space and may show slight muscle twitching. These seizures are more common in girls and tend to last less than a minute.
Tonic seizures. A child having a tonic seizure will show muscle stiffening in the back, legs and arms.
Clonic seizures. A child having a clonic seizure will experience repeated jerking movements on both sides of the body.
Myoclonic seizures. Myoclonic seizures cause the upper body, arms and legs to jerk and twitch.
Atonic seizures. A child having an atonic seizure will lose normal muscle tone and may fall down.
Tonic-clonic seizures. A child having a tonic-clonic seizure shows a combination of symptoms, including stiff and jerking limbs and loss of consciousness.

Seizures can happen at any time, day or night. They can last for a few seconds or a few minutes. A child may recover quickly after a seizure, or it may take several hours for him or her to recover. Children may experience certain symptoms after a seizure, including:

Headache
Pain in the muscles that contracted during the seizure
Loss of function related to a focal seizure (such as weakness on one side of the body or language recovery)
Sleepiness
Confusion

Many forms of epilepsy require lifelong treatment to control the seizures, but some children do outgrow the seizures. For most children diagnosed with epilepsy, medicines and surgery control and reduce seizures.

Most children with epilepsy lead normal and productive lives. They can participate in the same activities as other children but may need closer supervision, such as not riding a bicycle or swimming without an adult nearby.

How is epilepsy diagnosed?

Doctors at Riley at IU Health perform the following exams and tests to diagnose epilepsy and seizures:

Electroencephalogram (EEG). This test records the brain’s electrical activity and looks for abnormalities in the brain waves. This is the most frequently used test to diagnose epilepsy.
Computed tomography (CT) scan. This X-ray scan combines cross-sectional images to create highly detailed pictures of nerves and other brain tissues.
Single photo emission computed tomography (SPECT). This imaging test can help locate the focal point of a seizure.
Magnetic resonance imaging (MRI). MRI combines radio waves and a magnetic field to create computer images of the brain.
Functional MRI (fMRI). This imaging test tracks normal brain activity and can spot abnormalities in brain function.
Positron emission tomography (PET). PET is a metabolic study which is performed between seizures and sometimes identifies the tissue causing seizures.
Blood tests. Blood samples can be studied to check for metabolic and genetic disorders and underlying health conditions that can cause seizures.
Developmental, neurological and behavioral tests. The neurologist may perform exams to check your child’s intellectual abilities, motor abilities and behavior, to see how epilepsy may be affecting him or her and to help determine the type of epilepsy.
Genetic tests. Chromosomal tests can sometimes diagnose genetic forms of epilepsy.

How is epilepsy treated?

The goal of epilepsy treatment is no seizures and no side effects. Medicines work to manage seizures in most children to reduce and control the number and frequency of seizures. However, about 25 percent of children have epilepsy that is resistant to medicine. These children often respond to surgery and implantable devices.

Treatments for epilepsy & seizures include:

Medicines

There are more than 20 antiepileptic medicines now available to control seizures. Some children require more than one medicine or a combination of medicine and other treatments.

Ketogenic diet/modified Atkins diet

When seizures do not respond to medicines or are difficult to control, a highly specialized type of diet may be used. The ketogenic diet is often initiated in the hospital by your child’s neurologist, pediatrician and dietician. The modified Atkins diet is similar to the ketogenic diet, but it can be started at home. Children following these diets are monitored every three months. Changes may be made to the diet in between visits in consultation with your child’s neurologist and dietician.

Riley at IU Health provides access to nutrition support services for all of our patients.

Surgery

Epilepsy surgery is a good option for children with medically refractory epilepsy, or epilepsy that's unable to be managed by medications. In some cases, a specific, localized group of abnormal brain cells that send abnormal signals and cause irregular brain activity can be identified. If the seizure focus can be safely removed, surgery may be the best treatment to stop your child’s seizures. If a specific area is not identifiable, alternative surgeries may still be more effective than continued medication management. These include neuromodulation with implantable devices or disconnection of different brain tissues that are causing seizures. The Riley at IU Health Epilepsy Program provides minimally invasive surgery using depth electrodes and lasers through very small incisions.

Vagal nerve stimulation therapy

Patients with frequent generalized seizures that are resistant to medicines may respond well to a surgically implanted device that helps control seizure activity. A vagal nerve stimulator uses a generator that is implanted in the fatty tissue under the skin in the left chest, as well as an electrode array (wire) that is wrapped around the left vagus nerve and connected to the generator. The stimulator controls seizure activity by sending electrical impulses to the brain from the vagus nerve in the neck.

Importance of treatments

It is important to find treatments that work to control the seizures to reduce the possible risk of more serious complications. In rare cases, some children with epilepsy may be at risk for sudden unexplained death in epilepsy (SUDEP). Researchers believe gene abnormalities that impact epilepsy and heart function may be the cause of SUDEP. Genes tied to specific types of epilepsy have been identified as well as biological links between epilepsy and heart dysfunction. This knowledge is aiding researchers as they look for potential risk factors and new treatments.

Key Points to Remember

Epilepsy is a condition in which nerve cells in the brain send abnormal electrical signals to other parts of the brain and body.
The abnormal electrical signals cause seizures that may cause a patient to convulse, lose consciousness or fall down.
There are different types of seizures, which can affect one part of the brain or all of the brain.
Medicine, surgery and implanted devices can help control seizures in children with epilepsy.
Some children stop having seizures as they get older while others may need lifelong treatment.
Riley Hospital for Children has the only Level 4 Epilepsy Program in Indiana as defined by the National Association of Epilepsy Centers (NAEC).

Support Services & Resources

View these links to discover support groups and more resources for epilepsy and seizures.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

Epilepsy Foundation

This organization advocates for families living with epilepsy, funds research for new treatments and provides resources and support to patients.

Citizens United for Research in Epilepsy (CURE)

This nonprofit organization raises funds for epilepsy research. The site includes educational information about epilepsy and research updates.

National Institute of Neurological Disorders and Stroke

This National Institutes of Health website provides an overview about the different types of epilepsy, treatments and research.

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