SUMMARY
Epilepsy is the tendency to have seizures that have no immediate cause. A seizure is uncontrolled, abnormal electrical activity of the brain that may cause changes in awareness, movement, or behavior.
A seizure can be provoked or unprovoked. A provoked seizure has an acute, known cause. Fever is the most common cause of provoked seizures in young children. Provoked seizures can also be caused by brain infection, stroke, and low blood sugar. Often, a clear cause of the seizure cannot be found. It is then called unprovoked seizure.
About 1% to 2% of children have epilepsy in the United States. An epilepsy diagnosis is made if:
- Two unprovoked seizures occur
- They occur at least 24 hours apart
Less commonly, epilepsy may be diagnosed after only one unprovoked seizure. This can happen if testing shows brain abnormalities that put the child at risk for more seizures.
Most children who have a single unprovoked seizure do not go on to develop epilepsy. About 30% to 40% of children who have one unprovoked seizure have a second seizure. Most recurrences take place in the first two years after a first seizure. Half of recurrences take place within six months.
Once a child has two unprovoked seizures, the risk of having a third seizure is around 70% to 80%. An anti-seizure medication is typically then recommended.
Epilepsy has a wide spectrum of severity. Some people may have only a few seizures in their lifetime. Others may have multiple seizures per day. Generally, children with epilepsy can still attend school and maintain daily life activities.
Seizures can often be successfully treated with anti-seizure medications. For some children, seizures can be controlled with one anti-seizure medication. Other children need more than one anti-seizure medication. It is difficult to know in advance exactly how a child will respond to an anti-seizure medication.
Epilepsy may not be a life-long condition. In children whose seizures can be controlled with one anti-seizure medication, there is a fairly good chance that the child will outgrow epilepsy.
LABORATORY INVESTIGATIONS
Patient History
Epilepsy is diagnosed through a careful patient history. A neurologist will try to get a detailed account of any seizures from primary eyewitnesses and from the child who experienced it. Videos of the event can also be helpful.
The neurologist may ask questions about:
- Warning symptoms
- Body movements during the event
- The level of awareness during the event
- What occurred after the event was finished
Lab Testing
EEG
An EEG, or electroencephalogram, measures electrical activity in the brain. It can help doctors learn more about a child’s brain wave activity. You can expect EEGs to:
- Be painless. EEGs are painless procedures.
- Use electrodes. During an EEG, stickers or electrodes are placed on the scalp.
- EEGs do not require cutting or shaving a child’s hair. The hair typically does not need to be modified. The scalp should be clean and accessible for electrodes.
- Vary in length. EEGs often last about 30 minutes. Sometimes a child is hooked up to EEG for multiple days. This depends on the information needed.
Sometimes, it is uncertain whether an event is a seizure. A longer EEG that can record the event can help determine if it is a seizure. EEGs are usually done in a hospital, but sometimes longer ones can be done at home. At times, in hospital long term continuous video EEG monitoring may be necessary. It is needed for seizure or spell classification and to capture the episode of concern on EEG.
An EEG can also provide useful information about the background electrical activity of the brain. One thing that the neurologist interpreting the EEG will look for are epileptiform discharges. These are abnormal electrical discharges in the brain. They show areas of “irritability” in the brain. These areas are more likely to produce seizures. These discharges are not themselves seizures.
An EEG is also useful for evaluating seizure type.
Note that a normal EEG does not rule out seizures. Nor does an abnormal EEG mean a child is having seizures. A neurologist must look at EEG results in the context of a child’s clinical history.
MRI
Once epilepsy is diagnosed, an MRI (magnetic resonance image) of the brain may be used to look for any structural causes of seizures. If a contributing structural cause is found, a child may be at higher risk for more seizures. A neurologist will decide if and when an MRI is needed.
Research
These are clinical trials that are recruiting or will be recruiting. Updates are made daily, so you are encouraged to check back frequently.
ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world. This is a resource provided by the U.S. National Library of Medicine (NLM), which is an institute within the National Institutes of Health (NIH). Listing a study does not mean it has been evaluated by the U.S. Federal Government. Please read the NLM disclaimer for details.
Before participating in a study, you are encouraged to talk to your health care provider and learn about the risks and potential benefits.
For more information about participation in clinical trials, check out our education hub on the topic here.
Information for research and clinical trials specific to Epilepsy can be found on the Pediatric Epilepsy Surgery Alliance website.
Research Spotlight
Stand Together Against pRolonged Seizures (STARS) Study
UCB is searching for people who experience prolonged epileptic seizures (i.e. lasting more than 3 minutes) to join this clinical research study. The STARS Study is testing an inhaler containing an investigational drug that has been designed to potentially stop a prolonged seizure once it has begun.
Who can join the STARS Study?
Up to 250 people in study sites across the United States, Europe, Asia and Australia are expected to take part in the STARS Study. You and your study partner may be able to take part if you:
- Are 12 years of age or older
- Have focal or generalized epilepsy, or a combination of the two
- Have experienced 2 prolonged seizures within the past 3 months
- Prolonged seizures last more than 3 minutes
- Have an adult who can act as a study partner to assist you throughout the study
Visit the website for more information or download the brochure.
CNF is pleased to share this information on behalf of UCB BioSciences.
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