My Child Has...

Epidemiological data indicate that approximately five percent of all children will experience at least a single seizure. Approximately one percent of children develop epilepsy. It is estimated that about 690,000 children and young adults in the United States have some type of epilepsy. About 55,000 new cases of epilepsy are diagnosed each year in children under age 18. In many cases (50-70%), there is no cause of epilepsy. Of the remaining cases of epilepsy, the cause can be traced to the following factors:

A physician who specializes in the treatment of childhood seizures is usually a pediatric neurologist or epileptologist, although pediatricians and family physicians can also treat a child with seizures. A complete medical examination that includes a series of blood work (blood sugar, complete blood count, electrolytes, and liver and kidney function tests) will be part of the initial evaluation for a child who has seizures.

The physician may also order an electroencephalogram (EEG). An EEG is a test that records brain waves picked up by tiny electrodes (wires) that are attached to the head. An EEG can show changes in the electrical activity of the brain in someone with epilepsy. At Children's Hospital Boston, we have pioneered the use of long-term EEG and video monitoring: a valuable technique in the evaluation and treatment of children with epilepsy. Long-term monitoring (LTM) consists of monitoring continuously the EEG and, using video techniques, the behavioral activity of the child. LTM helps us to answer two vital questions: "Is the episode epilepsy or some other disorder?" and "If the child is experiencing epilepsy, where in the brain is the source of the seizure activity?"

Other diagnostic tests that may be used to find a cause for seizures include CT scans (computerized tomography), MRI scans (magnetic resonance imaging), and PET scans (positron emission tomography). These imaging techniques can help in identifying tumors, scar tissue, or malformations that may be causing seizures, as well as their origin.

Diet therapy, specifically a ketogenic diet, may be used to treat seizures. A ketogenic diet changes the way the body derives energy and has been shown to have a seizure preventing effect in children. The introduction of a ketogenic diet must be closely supervised by a physician and often requires that a child be hospitalized initially. Although this diet was first introduced 80 years ago, before the advent of most anti-epileptic drugs, it has gained renewed popularity in recent years; particularly in children whose seizures do not respond to medication. In fact, approximately 30% of children may be controlled by the ketogenic diet. Unfortunately, as many as 30% of children who have epilepsy may have either an inadequate response to antiepileptic drugs or intolerable side effects to these drugs and fail the ketogenic diet. At least one-half of these children may be successfully treated through epilepsy surgery. If the seizures are confined to a small segment of the brain, sometimes by removing those pieces of brain tissue, seizure activity can be controlled.

Vagus nerve stimulation is a newer type of treatment for seizures that are hard to control. VNS involves surgically placing a small "pacemaker" (under the skin below the collarbone) that is attached to wires programmed to deliver small bursts of electrical energy to a nerve in the neck.

In addition to the above therapies, a child with epilepsy can often help to control his or her seizures by getting enough sleep, avoiding unwanted stress, and having regular medical check-ups by a physician. In some children, seizure disorders may resolve spontaneously. In spite of all the treatments now available to treat epilepsy, an estimated 20% of children with epilepsy are unable to gain complete control over their seizures.

Joseph R. Madsen, M.D.
Children's Hospital Boston
Department of Neurosurgery
300 Longwood Avenue
Boston, MA 02115
PHONE: 617-355-6005

joseph.madsen@childrens.harvard.edu

Further Information

Click here to read A former patient's story: Regaining independence after being paralyzed at 17.

Click here to read Brainpower: an article about Gwendolyn and her epilepsy treatment.

Click here to view videos of Dr. Madsen discussing epilepsy.