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: 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. 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: 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: 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, or magnetic resonance image, 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. Once epilepsy is diagnosed, it is usually treated with daily anti-seizure medication. These medications can prevent further seizures. There are many important reasons to treat seizures, including: Longer seizures especially can harm the brain. SUDEP stands for Sudden Unexpected Death in Epilepsy Patients. It is the most common epilepsy-related cause of death. It refers to a person with epilepsy who dies unexpectedly, and with no clear reason for the death. Scientists and researchers are still learning about its causes. There are over 30 different anti-seizure medications to choose from. Some work better for certain types of seizures. Often, in addition to daily anti-seizure treatment, children with epilepsy are prescribed a seizure rescue medication. This is a medication used only to stop a prolonged seizure or cluster of seizures as they are occurring. A clear plan should be outlined for use of these medicines. At minimum, a rescue medication is often used for motor seizures lasting more than five minutes. Many types of epilepsy are successfully treated with daily medications. Sometimes, more than one type of medication is needed to prevent seizures. In other cases, epilepsy does not respond well to medication. Sometimes, a child continues to have seizures after using two well-chosen medications. In these cases, the epilepsy is considered drug resistant, or “refractory” (meaning stubborn). Other treatments that should be explored include in these cases include: An evaluation for surgery is a very important step if a child does not respond to anti-seizure medication. This is not a last-resort measure. For the appropriately selected candidate, surgery may cure epilepsy. Undergoing evaluation for surgical candidacy does not commit the patient or families to surgery. Evaluation entails: Special diets can sometimes help epilepsy. These include the ketogenic diet or modified Atkins diet. Most children with epilepsy are able to live normal lives. Most children who have seizures easily controlled with medication do not require lifelong treatment. Many with well-controlled epilepsy can come off of seizure medication after a period of seizure freedom. Two years is a common yardstick for seizure freedom. Most children with epilepsy have normal development. They have a normal capacity for learning. However, some will experience delays in learning. Developmental delays can be observed prior to an actual diagnosis of epilepsy. These delays are often related to the underlying cause of the epilepsy rather than the seizures themselves. However, if a child is having very frequent seizures, this may impact their ability to learn. This is another important reason why seizures should be treated. Schools should be made aware of a child’s epilepsy diagnosis. This will help if the child has a seizure at school. If the child has a seizure rescue medication, it should be available anywhere the child spends a lot of time. This includes school. Children with epilepsy must take special precautions to assure they will be safe if they have a seizure. Common precautions relate to: The Epilepsy Leadership Council is made up of individuals representing organizations serving individuals with epilepsy and their families, as well as professionals, and governmental organizations. The mission is to develop and coordinate among its members shared projects that will have a positive impact on the lives of individuals with epilepsy, focusing on those areas where working together produces greater efficiency and impact than working independently. For a list of more than 40 professional societies, patient advocacy organizations, and governmental agencies, please click here. EpilepsyAdvocate is a community of people living with epilepsy, their family members, and their caregivers. The website includes information about epilepsy, stories from the community, a Facebook page, and other resources including the UCB Family Epilepsy Scholarship Program, which offers educational scholarships up to $10,000 to people living with epilepsy, family members and caregivers pursuing higher education. This website provides information to help you better understand epilepsy. Learn more about epilepsy, gain knowledge about epilepsy medications, and feel empowered to manage epilepsy. Pediatric Epilepsy Surgery Alliance In addition, PESA has resources for medical professionals to assist in helping clinicians help the parents of their patients find the resources they need after surgery. Educators and therapists will also find helpful resources and information, including videos, guides, and relevant research. Patients who have undergone surgery are encouraged to register with the Global Pediatric Epilepsy Surgery Registry to help set future research priorities. JCN Podcast September 2018 Pediatric Epilepsy JCN: NICU Series- Interview with a Parent and the Brain Recovery Project: Childhood Epilepsy Foundation JCN: What Your Pediatric Neurologist Wants You to Know – Epilepsy CNF’s Epilepsy Education Hub covers different topics to consider when managing seizures and navigating an epilepsy diagnosis. Each topic in the multi-part Health Epilepsy Management Video Series focuses on what we heard from partners and families in our community as a top priority. Some of the questions posed to our experts come directly from caregivers and parents who were given the chance to submit their questions prior to recording these videos. The Health Epilepsy Management Video Series includes: Child Neurology Foundation (CNF) solicits resources from the community to be included on this webpage through an application process. CNF reserves the right to remove entities at any time if information is deemed inappropriate or inconsistent with the mission, vision, and values of CNF. 
SUMMARY
INVESTIGATIONS
Patient History
Lab Testing
TREATMENT AND THERAPIES
Daily Medicine
Seizures can be harmful to the brain
Seizures are associated with SUDEP
Rescue Medicine
Other Treatments
Surgery
Diet
OUTLOOK
Developmental Delay
School Considerations
Special Precautions
Resources
The Pediatric Epilepsy Surgery Alliance (formerly known as The Brain Recovery Project) enhances the lives of children who need neurosurgery to treat medication-resistant epilepsy. They empower families with research, support services, and impactful programs before, during, and after surgery. PESA’s programs include research-based, reliable information to help parents and caregivers understand when a child’s seizures are drug-resistant; the risks and dangers of seizures; the pros and cons of the various neurosurgeries to treat epilepsy; the medical, cognitive, and behavioral challenges a child may have throughout life; school, financial aid, and life care issues. PESA’s resources include a comprehensive website with downloadable guides, pre-recorded webinars, and virtual workshops; an informative YouTube channel with comprehensive information about epilepsy surgery and its effects; a private Facebook group (Education After Pediatric Epilepsy Surgery) with over 300 members; Power Hour (bi-monthly open forums and live virtual workshops on various topics); and free school training to help your child’s education team understand the impact of their epilepsy surgery in school. Their Peer Support Program will connect you with a parent who has been there. The Pediatric Epilepsy Surgery Alliance also hosts biennial family conferences and regional events that allow families to learn from experts, connect with other families, and form lifelong friendships. They also provide a travel scholarship of up to $1,000 to families in need to fund travel to a level 4 epilepsy center for a surgical evaluation.PUBLICATIONS
Podcast from SAGE Neuroscience and Neurology/Journal of Child Neurology (JCN). In this podcast, Dr. Alison Christy interviews Nina Natarajan about Phenobarbitol use. She also talks with Sookyong Koh about her article, Role of Neuroinflammation in Evolution of Childhood Epilepsy. The podcast ends with an interview with Shlomo Shinnar, Pediatric Epileptologist.
Podcast from SAGE Neuroscience and Neurology/Journal of Child Neurology (JCN). Dr. Sonika Agarwal of Children’s Hospital of Philadelphia talks to Audrey Vernick about her experience with pediatric epilepsy, perinatal stroke, and infantile spasms from a parent’s perspective. Brain Recovery Project website.
Podcast from SAGE Neuroscience and Neurology/Journal of Child Neurology (JCN). JCN’s Residents and Fellows Board Director, Dr. Alison Christy, interviews Dr. Inna Hughes of the University of Rochester on epilepsy.CNF’S EPILEPSY EDUCATION HUB
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