Angus Wilfong, MD
Neurologist and Chief, Division of Neurology at Barrow at Phoenix Children's
Understanding Epilepsy Treatment Options in Children
Epilepsy is one of the most common neurological conditions and may affect anyone in the general population and at any age. Overall, the likelihood of developing epilepsy is highest during childhood, particularly in infants and preschoolers, and then again as we approach age 70 years and beyond.
Epilepsy affects 1 in 26 Americans and is more common than Multiple Sclerosis, Muscular Dystrophy, Parkinson’s disease and ALS added together.
Epilepsy is a medical condition where people are prone to having recurrent seizures. However, not everyone who has a seizure will develop epilepsy. Seizures are due to abnormal electrical discharges in the brain and may result in a wide range of clinical signs and symptoms. There are over 30 different types of seizures with some causing altered awareness and others resulting in loss of consciousness. The vast majority of seizures last only a few seconds to a couple of minutes.
When a child has a seizure, it is important that the cause is searched for. The commonest cause of nonepileptic seizures is a sudden high fever resulting in a seizure, called a febrile convulsion. There are other reasons why a child may have a seizure that is not associated with epilepsy, including syncope (fainting) and head injuries (concussion). If the cause of the seizure is not immediately apparent, the child will require a medical evaluation including an EEG (electroencephalogram) that records the electric activity in the brain and an MRI (magnetic resonance imaging) scan to evaluation the brain anatomy and structure. These tests are performed routinely in the Pediatric Epilepsy Program at Barrow Neurological Institute at Phoenix Children’s Hospital. Having abnormalities on either of these tests makes the likelihood of more seizures much higher.
Most children with epilepsy should be seen by a child neurologist, a medical doctor specializing in the evaluation and treatment of neurological disorders.
It is important to identify the precise type of seizures and epilepsy that each child has, as well as the underlying cause, if medically possible. This may result in additional tests being ordered such as more prolonged EEG studies combined with video monitoring performed in the Pediatric Epilepsy Monitoring Unit (PEMU) at Phoenix Children’s Hospital and blood tests measuring the child’s metabolism and genetics. Some forms of childhood epilepsy are caused by abnormal genes, but these do not necessarily run in the family.
Once the diagnosis of epilepsy is made, treatment is started to lessen the likelihood of seizure recurrences. The first type of treatment for all forms of epilepsy is a medication taken by mouth or through a feeding tube called an antiepileptic drug (AED).
There are over 30 AEDs currently approved for treatment of epilepsy and some work better for certain types of epilepsy than others. Your child’s medical practitioner will work with you to decide which medication is most likely to be effective and best tolerated with the lowest risk of adverse effects. It is very important to understand what side effects are possible and be on the lookout for them, particularly over the first few weeks of therapy. Common AED adverse effects include drowsiness, slowed thinking, increased or decreased appetite, dizziness and rash.
The majority of children with epilepsy will have their seizures come under complete control with medication and many will outgrow the seizures over time. Unfortunately, medications do not always work to control the seizures.
If a child continues to have seizures after two to three AED trials, then she or he is considered to have treatment-resistant or medically intractable/refractory epilepsy. These children should be referred to a pediatric epileptologist, a child neurologist with specialized training and expertise in treating children with epilepsy of all types.
The epileptologist will work closely with the family to explain that there are three additional types of therapy at Barrow at Phoenix Children’s that may be very helpful in controlling, and in some cases, curing the epilepsy. These include epilepsy surgery, a brain operation that localizes and removes the cause of the epilepsy; ketogenic and other medical diet therapies, highly specialized medical diets supervised and managed by an epilepsy diet team; and Vagus Nerve Stimulation (VNS) therapy, a computer controlled implanted electrical pacemaker. Additional testing will help the epileptologist decide which therapy is best for each individual patient. Epilepsy surgery is always the first choice if possible, as it is the only one that offers the chance of cure.
If your child has had a seizure or you suspect he or she may have epilepsy, learn how you can make an appointment in our Pediatric Epilepsy Program.