Epilepsy is the most common chronic neurologic condition in children where a child suffers from recurrent and unprovoked seizures.

It affects 0.5% to 1% of children aged 0-17 years. It means that 5 to 10 out of 1000 school students could have epilepsy. Epilepsy can begin at any age during childhood and often remains active for several years.

The most common known causes of epilepsy are:

• Problems with brain development before birth
• Lack of oxygen during or following birth
• Stroke and Brain Tumors; Serious head injury
• Infections of the brain such as meningitis or encephalitis
• Genetic factors and Metabolic diseases

Unfortunately, it is estimated that, for 7 out of 10 children with epilepsy, there is no known or detectable cause.

If a child had a seizure it does not necessarily mean that he or she has epilepsy. Many other conditions not related with brain dysfunction may mimic epilepsy.

In fact, to be diagnosed with epilepsy, a child must have had two or more unprovoked seizures that cannot be attributed to another cause (fever, head injury, encephalitis, meningitis, stereotyped movements….). On the other hand, sometimes a child can be diagnosed with epilepsy, even after only one unprovoked seizure; if there is a high probability of seizure recurrence.

There are different types of epileptic seizures and various types of epilepsy syndromes with different signs and symptoms.
Most common symptoms of epilepsy are impaired or loss of consciousness with sudden fall, muscle jerks or stiffness, rapid blinking or episodes of staring, clenched teeth or jaw, head and eye deviation….. But, signs and symptoms sometimes can be very subtle. This often makes the diagnostic process challenging, with a considerable risk of misdiagnosis.

If your child has suffered seizure you should visit your pediatrician. In case of suspicion for epilepsy your pediatrician may refer you to a pediatric neurologist who may recommend specific tests to obtain an accurate diagnosis. The two most important and most frequently used diagnostic tests in a child suspected to have an epilepsy are:

- Electroencephalography (EEG) or measuring electrical activity in brain and - Neuroimaging of the brain’s structure - computerized tomography (CT scan) and magnetic resonance imaging (MRi).

Additional tests also can be ordered based on medical history and clinical assessment of the patient. Tests often can show normal results, but this is common and does not necessarily rule out diagnose of epilepsy.

The good news is that epilepsy is manageable and many effective treatments do exist.

The key is to ensure the child is properly evaluated so that appropriate and individualized treatment strategy can be prescribed. If epilepsy is diagnosed, the usual first step in management is starting the antiepileptic drug (AED). Between 70 to 80 percent of children who have epilepsy, achieve seizure freedom with appropriate choice of AED. After medication is started, a child may need periodically to have blood checked and to repeat EEG recording during follow-up visits. If seizures are not controlled with medications (monotherapy or combined AEDs), then, other treatment options need to be considered – ketogenic diet, epilepsy surgery or vagus nerve stimulation.
The fact is that seizures are almost never life-threatening. Many last only a few minutes and stop on their own.

But in a case the child is having a prolonged seizure in outside of a hospital setting, the caregivers should be educated on how to provide first aid.

Here are some general rules how to help a child who is having seizure at home –

• place a child on their side to help keep their airway clear (this will help child breathe),
• ensure safe environment around the child to prevent injury,
• do not put anything in child’s mouth (child having a seizure cannot swallow his or her tongue),
• call emergency service number if seizure last longer than 5 minutes.

At the same time there are two emergency medications that can be given by parents in a case of seizure lasting for more than a 5 minutes in outside of the hospital setting.

These medications are: buccal (oromucosal) midazolam - is given into the buccal cavity (the side of the mouth between the cheek and the gum) and rectal diazepam – is given rectally (into the bottom). Education of caregivers is a role of pediatrician and / or pediatric neurologist.

Treating epilepsy is more than just controlling the seizures. Physician should be able to recognize different challenges that might affect quality of life not just of a child with epilepsy, but the whole family.

Most frequent areas of concern are if epilepsy will affect education, social interaction, sport activities and mental health of a child (particularly emotional and behavioral development).

With proper management and support children with epilepsy will have normal and active childhood which includes school, friends, sports, and other family and community activities.

If a child with epilepsy does not have a seizure for a few years while taking medication, it may be possible to decrease and maybe to discontinue antiepileptic drugs. This is different for every child and it depends on a type of epilepsy and some other factors. A child should never stop taking medication unless it is recommended and closely supervised by a pediatric neurologist.

According to the definition of International League Against Epilepsy – “Epilepsy is considered to be resolved for individuals who had an age-dependent epilepsy syndrome but are now past the applicable age or those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years.”

Child with epilepsy should receive all vaccines in accordance to national immunization program. Extensive and careful studies have not found any evidence that immunizations cause epilepsy.

Therefore, epilepsy is not contraindication for immunization. Only in cases of progressive neurologic disorder including infantile spasms, uncontrolled epilepsy, progressive encephalopathy…. some vaccines can be deferred until neurologic status stabilized and discussed with treating pediatrician or pediatric neurologist.

In American Mission Hospital, we recently started pediatric neurology service which currently includes – pediatric neurology specialist consultation (complete seizure history, comprehensive neurological examination), neuroimaging (CT and MRi of Brain), neuropsychological assessment, counseling and support services and treatment. Also, we are about to start with EEG service, so that comprehensive care can be provided for our patients.