Epilepsy - in children

Epilepsy is a condition with recurrent unprovoked epileptic seizures. It is the most common chronic neurological disease. Epilepsy affects approximately one in 26 individuals at some point in their lives. The greatest risk is during the first years of life and in old age, but individuals of all ages can be affected. Epilepsy that begins during childhood can have many different causes and different symptoms. The prognosis varies from epilepsy with easy-to-treat seizures that disappear as the child grows, to difficult-to-treat epilepsy with drug-resistant seizures, other neurological symptoms in addition to seizures, and an impact on the child's general development, cognition, language, and motor skills. 

What is an epileptic seizure?

An epileptic seizure is a sudden onset of symptoms caused by uncontrolled electrical discharges in the brain. Most epileptic seizures last no longer than one to a few minutes. There are also epileptic seizures lasting only a few seconds. In rare cases, epileptic seizures can be protracted – this is called status epilepticus and is a dangerous condition that requires immediate emergency care. Epileptic seizures can appear in many different forms and often, but not always, include muscle twitching. Sometimes consciousness is affected, making the patient confused, absent, or completely unconscious. Epileptic seizures can be provoked by certain acute factors such as, for example, low blood sugar, infection, or stroke. The most common type of provoked epileptic seizure is febrile convulsions in children. Provoked epileptic seizures are not a basis for an epilepsy diagnosis. 

Epilepsy can have many different causes. Sometimes the cause is visible on an MRI of the brain, what is referred to as structural causes. Examples of this are scarring after bleeding or encephalitis, a congenital malformation, or a tumor. More often, the cause is genetic in the form of an innate sensitivity of the brain. Sometimes this sensitivity disappears as the child grows and the brain matures, but sometimes the sensitivity remains throughout life. 

To establish that a child has epilepsy, a careful medical history is taken regarding the seizure symptoms the child has had. This is the most important information. To support the diagnosis of epilepsy, one or more EEG (electroencephalogram) examinations are performed. If it is suspected that the cause may be structural, an MRI is necessary. Small children need to be sedated for this. Sometimes a genetic or so-called neurometabolic examination is included to investigate the cause of epilepsy. Sometimes a video EEG is done in the ward for one or more days with the aim of recording when the child has a seizure. In drug-resistant epilepsy, a number of other, more advanced examination methods are used to map the disease and assess whether it is suitable for surgical or other non-pharmacological treatment. 

The basis of epilepsy treatment is medication. Today, we have access to around twenty different epilepsy drugs. Drug treatment of epilepsy is not curative but aims to prevent seizures without troublesome side effects. A third of all people with epilepsy do not become seizure-free with medication. These patients are offered other treatment methods: surgical treatment, vagus nerve stimulation, and dietary treatment with a ketogenic diet. A child with epilepsy sometimes, depending on the underlying cause, has other difficulties that may need to be treated. Examples of this are difficulty sleeping, anxiety, depression, and various degrees of learning difficulties. Both psychological treatment and medication may be relevant. Pedagogical assessment and adaptations during and outside school hours are often needed.