Kids Health Info

Epilepsy - an overview

  • What is epilepsy?

    Epilepsy is a brain disorder which leads to a person having repeated epileptic seizures or fits.  During seizures, there is uncontrollable electrical activity in nerve cells in the brain  The electrical activity causes the person to convulse, fall, stare or behave strangely.

    One child in 20 (or 5 per cent) will have at least one seizure during their childhood, often associated with a high temperature (a febrile convulsion).  Single seizures, febrile convulsions and seizures during acute illnesses are not considered epilepsy.  Less than five per cent of children who have febrile convulsions go on to develop epilepsy.  Epilepsy with repeated, unprovoked seizures occurs in about one in 200 children (or 0.5 per cent).

    Epileptic seizures are not usually dangerous.  However, a person is at risk if they are in a dangerous environment when a seizure occurs, e.g. swimming in a pool, driving a car, climbing a ladder, handling hot liquids, and they lose consciousness or convulse.  Children with epilepsy can usually lead a normal and active life, but need to take care with certain activities such as swimming and bathing.

    Signs and symptoms

    The symptoms of seizures depend on what parts of the brain are affected. What happens during a seizure lets doctors know about what parts of the brain are involved.

    Signs and symptoms of seizures include:

    • Sensory disturbances - tingling; numbness; changes to what your child sees, hears or smells; or unusual feelings that may be hard for your child to describe.
    • Abnormal movements - limp, stiff or jerking movements or postures that that may occur with loss of consciousness and shallow or noisy breathing.
    • Abnormal behaviour - confused or automatic movements such as picking at clothing, chewing and swallowing, or appearing afraid.

    Causes

    • For most children with epilepsy no definite cause is found.  However, is is assumed that the epilepsy is due to genetic or brain maturity factors.
    • Epilepsy sometimes runs in families, an indication that genetics play a part.
    • Sometimes children may develop epilepsy after a head injury, stroke or infection in the brain.
    • Sometimes epilepsy is due to a malformation, benign (i.e. non-cancerous) tumour, scar or cyst on the brain, present at birth.

    Types of seizures

    There are many different types of seizures and they can be generally classified into two groups:

    Focal seizures

    Focal seizures happen when the seizure activity begins in one part of the brain.  If there is convulsing, it usually affects one side of the body.  Focal seizures may also appear as your child just staring and being unresponsive.  Focal seizures can spread in the brain and become "secondarily generalised".  Focal seizures with any loss of consciousness are often referred to by doctors as "complex partial" or "focal dyscognitive" seizures, not absence seizures. 

    Generalised seizures

    Generalised seizures happen when the seizure activity begins all over the brain at once. The person's conscious state and movement are always affected.  There are different types of generalised seizures, including tonic-clonic, absence, myoclonic, atonic and tonic seizures.

    Infantile spasms are a special type of seizure with both focal and generalised features.

    Diagnosis of epilepsy

    It is important that your child's epilepsy is correctly diagnosed and treated by a children's doctor (paediatrician) or a doctor who specialises in childhood disorders of the brain (paediatric neurologist). To make a correct diagnosis, the doctor will need a detailed description of your child's seizures, medical history, development, learning and behaviour. A home video recording of your child's seizures is very helpful if seizures happen often or are predictable.

    Tests

    Special tests are needed in some children with epilepsy. Your child's doctor will talk to you about the following tests if they are needed.

    • Blood tests: to check your child's blood sugar, calcium, magnesium and salt levels.
    • EEG: to record electrical brainwave activity. For more information read the Kids Health Info fact sheet:  EEG.
    • MRI: to provide pictures of the brain. For more information read the Kids Health Info fact sheet: MRI.
    • Video EEG monitoring: prolonged EEG done in hospital to capture attacks.  For more information read the Kids Health Info fact sheet: Video EEG monitoring VEM.

    Treatment

    Most children who have only one seizure are not diagnosed with epilepsy and are not treated with antiepileptic medication.

    Medication

    If your child has repeated seizures, your doctor may prescribe antiepileptic medication to help prevent further seizures. There are many different medications used for epilepsy. The medication prescribed will depend on:

    • the type of seizure your child has
    • the pattern on the EEG
    • how often the seizures are happening
    • your child's age
    • whether or not your child has any other medical, developmental or behavioural problems.

    It is important that you do not suddenly stop any medication your child is taking for epilepsy. Doing so may cause a severe or prolonged seizure to occur.

    Medication is usually taken one to three times daily to prevent further seizures, but occasionally medication is prescribed to treat seizures as they happen. These include giving medications in the nose (intranasal midazolam), in the mouth (buccal midazolam), or up the bottom (rectal valium). 

    Other treatments

    In about one in five children (or 20 per cent) with epilepsy, seizures are not controlled with medication and other treatments may be considered.  These treatment options include a ketogenic diet, epilepsy surgery or vagus nerve stimulation.

    Care at home

    Children with epilepsy that is controlled (i.e. not having seizures while on medication) should be encouraged to live a normal and active life.

    You should know what to do and how to help when your child has a seizure. Any adult looking after your child should be aware of their seizures and what to do.

    • For information about first aid management of a seizure, please read the Kids Health Info fact sheet: Seizures - how to help

    If your child has been diagnosed with epilepsy some precautions will need to be taken to ensure your child is safe. They include the following:

    • Don't let your child swim or bathe alone. Always make sure your child swims with an adult or that there is an adult watching your child closely. The supervising adult needs to be able to recognise your child's seizures and be able to retrieve your child from the water if they have a seizure. 
    • Have your child take showers instead of baths, and always turn on the cold tap before the hot tap.
    • Lower the temperature of the hot water service at home.
    • Special care should be taken when using hot water or appliances that can cause burns (e.g. irons, stoves, kettles).
    • Activities involving heights are best avoided, unless appropriate supervision and protection are provided.
    • Make sure adults who look after your child know what to do if your child has a seizure.
    • Make sure your home and car have a first aid kit.
    • Sleep in a room close to your child with doors left open.  Consider an audio monitor or commercially available seizure detector.

    Occasionally, seizures can be prolonged or complicated by serious breathing difficulties or aspiration (breathing vomit or other fluids into the lungs).  Rarely, children can die unexpectedly from a seizure during sleep.  This is called SUDEP, or sudden unexpected death in epilepsy.  SUDEP is rare in most forms of epilepsy that affect children, especially if the child is taking regular antiepileptic medication and their seizures are controlled.  There are some types of seizures and some associated neurological conditions where the risk is greater.  Your child's doctor will discuss these risks with you, and further information can be found from the Epilepsy Foundation of Victoria or SUDEP Aware.

    Your child's doctor will give you advice about any other activities your child should not do, and for how long.

    Key points to remember about epilepsy

    • Most children who have febrile convulsions do not go on to develop epilepsy.
    • It is important that your child's epilepsy is correctly diagnosed by a paediatrician or paediatric neurologist with expertise in epilepsy.
    • Do not suddenly stop any medication your child is taking for epilepsy.  If medication is not effective or is causing side effects, it needs to be withdrawn slowly.
    • Children with epilepsy that is controlled should be encouraged to live a normal and active life, with appropriate safety precautions.
    • Any adult looking after your child, e.g. carer or teacher, should be aware of your child's seizures and what to do if a seizure occurs.  Consider making an epilepsy management plan.

    For more information

    Other factsheets and RCH information:

    Produced in consultation with the Royal Children's Hospital (RCH) Neuroscience Centre. Many thanks to the parents who helped with this fact sheet. First published January 2006. Updated May 2015.


Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.