Epilepsy

Epileptic Conditions

There are many kinds of seizures and types of epilepsy. It’s important to find out what kind your child has, because we treat each one  differently. Controlling seizures is essential. Frequent seizures can harm your child’s development and learning. If seizures last longer than 30 minutes, they can permanently damage a child’s brain.

Epileptic encephalopathies
In epileptic encephalopathies (en-seff-uh-LAW-path-ees), children have repeated seizures that cause severe problems in thinking and behavior over time. For example, children with Landau-Kleffner syndrome lose the ability to speak. They often have seizures while they are sleeping. Rasmussen’s syndrome causes a slow loss of function on 1 side of the brain. The affected side of the brain can cause seizures and weakness on the opposite side of the body. Often the cause of these conditions is genetic.

Epilepsy in malformations of cortical development
Some children have epilepsy because tissue in part of their brain (cerebral cortex) did not form normally (malformations) during pregnancy. These malformations may involve the whole brain or small regions, which are called cortical dysplasias. Patches of this abnormal brain tissue cause seizures and developmental delays. Cortical dysplasia is a common cause of intractable epilepsy, meaning we cannot control it with medicine. We may recommend surgery in these cases.

Epilepsy in mitochondrial disorders
Mitochondria in cells help make almost all of the energy people need to live and grow. In children with mitochondrial disorders, these energy-making areas do not work as they should. This damages cells and causes different kinds of symptoms, depending on which cells are damaged. Children with some kinds of mitochondrial disorders have repeated seizures. We have a specialized team to care for children with mitochondrial disorders.

Genetic epilepsies
Changes (or mutations) in genes cause many epilepsy syndromes in children. For example, when there are problems with a gene that normally helps brain cells work correctly, it can cause Dravet syndrome (an epilepsy syndrome).

Genetic generalized epilepsies
This group of epilepsies used to be called idiopathic generalized epilepsies. Idiopathic means the cause is unknown. Many people with these epilepsies have generalized tonic clonic seizures (previously called grand mal seizures). The seizures include a tonic phase – muscle stiffening, crying or groaning and passing out (loss of consciousness). This is followed by the clonic phase – arms and legs jerking quickly and rhythmically. These seizures generally last from 1 to 3 minutes. If they last longer, they usually need emergency treatment. Medicine usually works to control generalized tonic-clonic seizures.

Infantile spasms
Infantile spasms are a type of seizure. They happen during infancy and childhood and are part of an epilepsy syndrome called West syndrome. The spasms often come in clusters of dozens to 100 or more. Children with infantile spasms may have several hundred spasms a day.

Intractable epilepsy
When medicine alone does not control seizures, we call the condition intractable (in-TRAK-tuh-bull) epilepsy.

Epilepsy is intractable when at least 1 of these statements is true.

1. If we try 2 medicines for some time and they don’t control the seizures.
2. If we try 1 medicine for some time and your child has an abnormal MRI (an imaging study that lets us look at their brain).

One in 3 people have epilepsy that medicine does not help. It can severely affect your child’s physical, social and emotional development. We may recommend that your child be referred to an epilepsy center, such as Seattle Children’s Epilepsy Program. We will evaluate surgery and other treatments if your child has intractable epilepsy. Surgery may offer a cure for epilepsy.

Juvenile myoclonic epilepsy
Children with juvenile myoclonic (my-uh-KLAHN-ik) epilepsy have mild seizures with quick jerks of the arms, shoulders or sometimes the legs. These may be followed by a tonic-clonic seizure. Children may also seem to stare for a few seconds to several minutes. Most people can control JME seizures with medicine. This is 1 of the more common genetic generalized epilepsy syndromes.

Pyridoxine-dependent epilepsy
An abnormal gene causes pyridoxine-dependent epilepsy. Children with this type of epilepsy have seizures that last several minutes. We can usually treat these with large doses of vitamin B6 (pyridoxine).

Self-limited focal epilepsies of childhood
Self-limited means the risk for having seizures happens over a limited time in a person’s life. Focal seizures begin in an area or network of cells on 1 side of the brain. There are several self-limited focal epilepsy syndromes, which usually begin in childhood. The most common is self-limited epilepsy with centrotemporal spikes. It affects 15% of children with epilepsy and is the most common cause of seizures in school-aged children. Children with this type of epilepsy have seizures that cause twitching, numbness or tingling in their face or tongue. The seizures usually last 2 minutes or less. They may cause drooling and problems with speech. They also can spread and become generalized seizures. Many children do not take medicines for the condition because they have few seizures, usually at night. It used to be called benign rolandic epilepsy (BRE).

Tuberous sclerosis complex (TSC)
Tuberous sclerosis (skleh-RO-sis) complex (TSC) is a rare genetic disease that causes tumors to grow in various parts of the body, including the brain and other vital organs. The tumors are benign (not cancer). They affect a child’s development in different ways, depending on where they grow and how big they get. Over 80% of people with TSC develop epilepsy. Read more about tuberous sclerosis complex (TSC).

How do we diagnose epilepsy?

Having a seizure does not mean your child has epilepsy. Your doctor will talk with you and your child and do tests to find out.

At our First Seizure Clinic, we evaluate children who have had a seizure for the first time to learn about the type of seizure and its cause. Up to half of the children we see at the First Seizure Clinic do not have epilepsy. Of those who do, we do the right testing to identify the seizure type and if they have an epilepsy syndrome. This is important, because each type of seizure may need a different treatment.

We use these ways to diagnose and plan the best treatment for your child:

• Ask questions to learn about your child’s and family’s health history, symptoms of your child’s seizures and what triggers them.
• Test your child’s blood to check for possible causes of seizures, including genetic changes, metabolic disorders, high sugar levels or exposure to toxic chemicals.
• Do genetic testing for most children younger than 5 years and those with specific types of seizures or epilepsy syndromes. Our ability to identify genetic forms of epilepsy means children get a specific diagnosis and start the right treatment sooner. Their treatment options may expand to include therapies that target a specific genetic pathway. Identifying a genetic cause also helps families connect with patient advocacy and support groups. An early diagnosis of genetic conditions like tuberous sclerosis complex (TSC) helps children get the monitoring or treatment they need to prevent problems.
• Check your child’s memory, attention, language and other skills. This is called neuropsychological (nur-oh- sy-kuh-LAH-juh-kul) testing. It is a way to look at your child’s brain development and behavior and help identify their strengths and weaknesses.
• Record electrical activity in your child’s brain using an EEG (electroencephalogram). Your child may have this done in the hospital as a day procedure or overnight stay. Some children use a backpack monitor at home.

Learn more about test we use to diagnose epilepsy.

Getting an EEG at Seattle Children’s (Video, 6:19)

Seattle Children’s EEG team shows patients and families what to expect when getting an outpatient EEG.

Treating Epilepsy

There are many effective treatments to prevent or reduce seizures. Finding the treatment that works best for your child will take time, and your child might need many tests.

We use video and EEG to learn more about your child’s seizures. To better understand the structure of your child’s brain and how it works, we use advanced neuroimaging such as MRI (magnetic resonance imaging), CT (computed tomography), PET (positron emission tomography) and functional MRI (fMRI).

Sometimes doctors stop seizures by treating an underlying problem, like diabetes, a brain tumor or concussion. For other types of epilepsy, options at Seattle Children’s include:

• Medicines, including clinical trials of new drugs. Medicine is the first and most effective treatment for most children with epilepsy.
• Nutrition therapy, using a ketogenic or modified Atkins diet.
• Implanted nerve stimulators, also called neuromodulation.
• Surgery to remove or disconnect part of the brain where seizures start. Our options include less invasive laser ablation surgery.

See our full range of Epilepsy Services and Treatments.

Surgery for Epilepsy

We consider surgery if medications do not control your child’s seizures or if they have a damaged part of their brain (a lesion). Your child’s healthcare team will do many tests before deciding if surgery is the best option. Our team will explain your child’s test results and next steps.

For some children, we use intracranial EEG and brain mapping to plan the safest, most effective procedure. With intracranial EEG, doctors place electrodes inside your child’s skull on many parts of their brain to help find where seizures start. We use the electrodes to map the brain. This helps us identify areas that control speech, memory and movement, so surgery does not harm them. In some cases, we do tests during surgery to ensure we don’t remove critical brain tissue.

Read more:

• Treatment planning for epilepsy
• Tests to See If Epilepsy Surgery Is Right for Your Child (PDF) (Spanish)

Surgery may be a good choice for your child in these cases:

• Medicine does not control your child’s seizures or causes bad side effects.
• Doctors can find a specific area in your child’s brain (a focus) that causes seizures.
• We can remove the part of the brain where seizures start without harming their speech, sight, memory or movement.
• A brain tumor or other growth is causing their seizures.
• Surgery can stop seizure activity in 1 half or region of the brain from spreading to the other side. This type of surgery is done for some severe cases of epilepsy.

Epilepsy surgery options

If surgery is the right choice for your child, research shows it’s better to have the operation sooner rather than waiting.

In most procedures, neurosurgeons remove the part of your child’s brain where seizures appear to start. Other procedures disconnect the seizure focus from the rest of their brain or stop the seizure pathway. As the neurosurgeons operate, the computerized guidance system shows the exact location in your child’s brain.

For some children, options include minimally invasive laser ablation or other procedures using ROSA, an advanced surgical tool that integrates brain imaging with a robotic arm. 

See the epilepsy surgery options we offer our patients.

Read how our Neurosciences team pinpointed and treated the cause of Giorgia’s seizures while preserving her ability to think, move, see and speak.

Recovery and rehabilitation after surgery

Recovery after surgery varies from person to person and by type of procedure. At first, children may have mood changes or problems with attention. Depending on how much brain tissue was removed, some children have problems with balance, language, memory, vision or weakness on 1 side.

Some problems go away as the brain heals. In other cases, children work with specialists in our Neuropsychology and Rehabilitation Medicine programs. Depending on your child, we may recommend physical therapy, occupational therapy, speech therapy, behavior management or education planning.