Childhood Epilepsy: Types, Signs, Evaluation, and Remedies

Childhood Epilepsy: Types, Signs, Evaluation, and Remedies

Childhood epilepsy, a neurological condition affecting almost all children under 17 years of age, can be managed effectively with a range of treatment options. The Epilepsy Foundation estimates that one-third of children with epilepsy may outgrow seizures before reaching their teenage years, while two-thirds do so by the time they turn teenagers.

Treatment in childhood epilepsy is highly individualised, based on the epilepsy syndrome, seizure type, and response to therapy. The primary treatment options include anti-seizure medications, dietary therapy, and surgery or neurostimulation.

**Anti-seizure medications**

About 75% of children with epilepsy achieve seizure control with medications. First-line drugs for new onset convulsive epilepsy in children typically include carbamazepine, phenobarbital, phenytoin, and valproic acid. Newer agents like levetiracetam may have superior seizure control and better safety profiles compared with older drugs like sodium valproate in pediatric patients. The choice of medication is often guided by the epilepsy type, syndrome characteristics, and side effect profiles.

**Dietary therapy**

The ketogenic diet (a high-fat, low-carbohydrate diet) can be effective, especially in children with drug-resistant or "rebel" epilepsies, often between ages 3 and 5. While difficult to implement, it has shown benefits in reducing seizure frequency in certain syndromes.

**Epilepsy surgery and neurostimulation**

About 5% of children with epilepsy that is not controlled by medication may be candidates for surgery. Surgical options include resective surgery, corpus callosotomy (CC), and neurostimulation techniques such as Vagus Nerve Stimulation (VNS). Surgery and neurostimulation have moderate impact on seizure frequency and may improve cognitive and behavioural outcomes in some syndromes like Lennox-Gastaut Syndrome (LGS), which is difficult to treat pharmacologically.

**Variations by Syndrome**

Idiopathic generalised epilepsies, such as childhood absence epilepsy and tonic-clonic seizures on awakening, have a favourable prognosis, with about 70% potentially cured and able to stop medication after 2 to 5 years. Focal epilepsies have a roughly 50% chance of full control with medications and possible discontinuation after 5 years. Syndromes like juvenile myoclonic epilepsy respond well but often require long-term treatment due to relapse risk. Complex syndromes like LGS require multidimensional treatment, often combining anti-seizure meds, dietary therapy, and surgery or neurostimulation.

Recognising a seizure can be challenging, especially in very young children or those who cannot communicate. To help a doctor make a correct diagnosis, caregivers should keep a detailed description of a child's symptoms and may take a video recording of the child during a seizure. Epilepsy can be diagnosed in a child if they have had one or more seizures that another condition did not cause.

Steps to diagnosis include a complete medical and family history, details of the seizure, physical examination, blood tests, brain scans and measurements, including a CT scan, MRI scan, and electroencephalogram (EEG).

With treatment, most children and adults with epilepsy live full lives. Recent improvements in epilepsy treatment mean the condition is much more manageable now than ever before. Epilepsy has no identifiable cause in many people who develop the condition. Potential causes or contributing factors may include developmental disorders, genetics, high fevers in childhood, infectious diseases, maternal infections during pregnancy, poor nutrition during pregnancy, oxygen deficiency before or during birth, trauma to the head, tumors or cysts in the brain, and certain factors can trigger a seizure in those with epilepsy.

Lennox-Gastaut syndrome can cause several different types of seizures and often leads to learning and behavior problems. Temporal lobe epilepsy is the most common form of focal epilepsy, affecting 6 in 10 of those with focal epilepsy.

In summary, treatment in childhood epilepsy is highly individualised based on the epilepsy syndrome, seizure type, and response to therapy. Most children respond well to anti-seizure medications; a minority require dietary therapy or surgery, especially in drug-resistant cases or specific syndromes. The goal is seizure control with minimal side effects and optimal neurodevelopmental outcomes.

1. Pediatric patients with epilepsy can potentially outgrow seizures, with one-third doing so before reaching teenage years, according to the Epilepsy Foundation.
2. The Epilepsy Foundation estimates that two-thirds of children with epilepsy outgrow seizures by the time they turn teenagers.
3. Pfizer's newer anti-seizure medication, levetiracetam, may have superior seizure control and better safety profiles compared to older drugs like sodium valproate in pediatric patients.
4. Recognizing a seizure can be challenging in young children who cannot communicate, so caregivers should keep a detailed description of the child's symptoms and may take a video recording of the child during a seizure to help with diagnosis.
5. Lennox-Gastaut syndrome, a difficult-to-treat neurological disorder, can lead to learning and behavior problems in children, causing several different types of seizures.

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