Medical Aspects
Clinical Assessment
The most important aspect of the evaluation of a child or adolescent with a suspected seizure disorder is the clinical assessment by a specialist paediatrician or child neurologist. This clinical assessment typically involves obtaining a detailed description of the child’s episodes, medical history, development, learning and behaviour. Crucial outcomes of the assessment are to determine:
- if a child’s episodes of altered behaviour, movement, consciousness etc. are epileptic or non-epileptic in origin
- the type of epileptic seizures that a child is having, most importantly whether the seizures are partial (focal) or generalised
- the type of epilepsy that a child with recurrent seizures has, most importantly whether the epilepsy is idiopathic (no known cause other than a genetic predisposition) or symptomatic (secondary to an underlying brain abnormality)
- any associated medical, physical, learning, behavioural and psychosocial problems that may accompany seizures in a child with epilepsy.
Paediatricians are often the most accessible and experienced child health specialists when it comes to assessing a child with a suspected seizure disorder. The Children’s Epilepsy Program provides a consultative service to general practitioners and paediatricians for children with uncertain, poorly characterised or uncontrolled epilepsy. These services are provided through consultation with paediatric neurologists in their private practices or through the specialist medical and allied health departments of the Royal Children’s Hospital, Austin Repatriation Medical Centre and Monash Medical Centre.
Diagnostic Tests
Special tests are performed in some children with epilepsy and related seizure disorders. The need for tests is determined by the detailed clinical assessment of a paediatric practitioner experienced in seizure disorders.
Tests are generally performed to:
- confirm a clinical suspicion,
- determine the type of seizure or epilepsy,
- determine the underlying cause of a child’s epilepsy,
- assess the severity or monitor treatment of a child’s epilepsy,
- assess associated medical or psychological problems,
- or determine the most appropriate treatment of a child’s condition.
Tests are not performed to determine if a child has epilepsy or not.
Children who present to their doctor or an emergency department with a major seizure episode will usually have a blood test to check the sugar, calcium, magnesium and salt levels, as abnormalities of body chemistry can lead to seizures. In a child with epileptic seizures, a recording of brainwave activity (EEG) and a picture of the brain (CT or MRI) may be obtained, where necessary. In special circumstances, some children with seizures may have an examination of the spinal fluid (lumbar puncture), metabolic testing of the blood or urine, or genetic tests such as an examination of the chromosomes. Children with uncontrolled epilepsy sometimes undergo detailed EEG (video EEG monitoring) and imaging studies as an inpatient and outpatient to accurately localise the source and determine the cause of their seizures, with a view to specialised treatments.
Treatments
Children with seizures do not always need treatment. In many instances, explanation and reassurance by the doctor and advice about safety precautions and first aid management for possible future seizures is suffice. Many children with epilepsy have only a single seizure and do not require medication. For children with recurrent seizures, the decision to prescribe antiepileptic medication depends on the type of seizure disorder, the age of the child, the presence of associated developmental and behavioural problems, and the attitudes and lifestyle of the child and family. Medical treatment usually means prescription of antiepileptic medication to prevent further seizures but occasionally, medication is prescribed to treat seizures when they manifest.