Epilepsy is a chronic disease characterized by recurrent seizures caused by abnormal electrical activity in the brain. It is one of the most common neurological problems seen in children and can largely be controlled with proper treatment. The diagnosis and follow-up process requires great care.

Epilepsy in children may appear with different types of seizures; loss of consciousness, convulsions, staring spells, or involuntary movements may be observed. These symptoms vary depending on the type of the disease. Correct identification of seizures is critically important for determining the appropriate treatment.

Electroencephalography (EEG) and imaging methods are used in the diagnosis of epilepsy. Detecting the disease at an early stage is decisive in reducing the frequency and severity of seizures. Once the diagnosis is confirmed, appropriate precautions should be taken for the child’s lifestyle and safety.

Epilepsy treatment is carried out with medications, and in some special cases surgery or neurostimulation methods may come to the fore. With regular medication use, doctor follow-up, and lifestyle adjustments, the great majority of children can lead a healthy life.

What Is Epilepsy?

To understand epilepsy, let us first imagine how our brain works. Our brain, just like the processor of a computer, is a magnificent organ that controls everything in our body. While providing this control, there is a constant exchange of electrical signals between brain cells. Thanks to these signals, we think, move, feel, and remember. Epilepsy is a condition that manifests itself with seizures that occur as a result of this electrical activity in brain cells sometimes increasing abnormally, even if only for a short time.

We can compare this to a momentary short circuit in the electrical system of your home. Just as lights may flicker or devices may suddenly stop when a short circuit occurs, temporary changes may also occur in our body when abnormal electrical waves form in our brain, that is, seizures. These seizures may appear in different ways depending on which region of the brain these abnormal electrical waves start in and how far they spread.

What Causes Epilepsy in Children?

Epilepsy in children is seen about twice as often as in adults. There may be many different reasons for this. Sometimes, some structural differences that occur during brain development while the baby is in the womb may lead to epilepsy. Difficulties experienced during birth or brain infections such as meningitis after birth may also cause damage to brain cells and pave the way for epilepsy. Although rarely, brain tumors or head traumas may also cause epilepsy in children.

In the past, no clear cause could be found in approximately 65% of epilepsy patients, and this condition was called “epilepsy of unknown cause.” However, today, thanks to developments in medical technologies and especially genetic diagnostic methods, we can detect the underlying genetic causes of epilepsy in many children. This offers us the opportunity to better understand the disease and apply targeted treatments. Just like putting together the pieces of a puzzle, through genetic tests we can see the causes of some types of epilepsy more clearly.

How Is Epilepsy Diagnosed?

The most important step in diagnosing epilepsy is the detailed description of the seizure the child has experienced. The answers to questions such as what happened during the seizure, how long it lasted, whether your child was conscious, and whether there were contractions or jerks in the body are very valuable information for your doctor. If possible, recording the moment of the seizure with a video camera can also be very helpful in the diagnosis process. In this way, other conditions that may be confused with epilepsy, such as fainting, tics, or some behavioral conditions, can also be distinguished and it becomes easier to determine the type of epilepsy.

The most important laboratory test for diagnosis is electroencephalography, abbreviated as EEG. EEG is a painless and harmless method that measures the electrical activity of the brain. Brain waves are recorded through small electrodes placed on your child’s scalp. These recordings support the diagnosis by showing abnormal electrical activities specific to epilepsy.

According to the EEG results, your doctor may additionally request imaging methods such as brain MRI or tomography. These methods help us understand whether there is a structural abnormality in the brain. In addition, some blood tests, tests evaluating your child’s intellectual development, and metabolic and genetic tests to investigate some hereditary diseases may also be required. Just like a detective collecting clues at the scene, these different diagnostic methods provide us with various pieces of information to understand the cause and type of epilepsy.

How Is Epilepsy Treated?

Today, there are many different medications and treatment options in the treatment of epilepsy in children. The main goal of drug treatment is to reduce the number of seizures and ensure that your child can lead as normal a life as possible. The choice of medication is made carefully according to the type of seizure, your child’s age, and other health conditions. After drug treatment is started, it is generally important to continue the medication regularly for at least two years. While seizures can be controlled with a single medication in approximately 60-70% of patients, in some children it may be necessary to use more than one medication together. Although rare, in some patients seizures may be resistant to all medications.

In recent years, an approach we call “targeted treatment” has also gained importance. This is a treatment method applied especially in types of epilepsy whose genetic causes have been identified. For example, in children with certain genetic mutations, giving certain vitamins (such as vitamin B6 or folinic acid) or using special medications such as memantine can directly stop seizures. Sometimes genetic diagnosis also shows that some medications should not be used. For example, in children with mutations in the SCN1A gene, the use of some medications such as carbamazepine or phenytoin may increase seizures. In our clinic, such genetic diagnostic methods are successfully applied and pleasing results are obtained with targeted treatments. This is based on the principle of finding the right treatment with the right genetic diagnosis, just like fitting a key exactly into its lock.

In some children who do not respond to drug treatment or in whom adequate seizure control cannot be achieved, different treatment options may also be considered. One of these is the ketogenic diet, which is a special diet program. This diet consists of foods low in carbohydrates and high in fat and may be effective in reducing seizures in some types of epilepsy. Another option is epilepsy surgery. If it is determined that the seizures originate from a certain region of the brain and if this region can be surgically removed, this method may be successful in seizure control. In addition, there is also a pacemaker application called vagus nerve stimulation (VNS). In this method, a small device is placed under the collarbone and regular electrical impulses are sent to the vagus nerve through this device to reduce the frequency of seizures. These advanced treatment methods are also successfully applied in our clinic.

Different Types of Seizures in Children

Epileptic seizures in children may be seen in different types according to where the abnormal electrical activity in the brain starts and how it spreads. We can roughly divide these seizure types into two main groups: focal (partial) seizures and generalized seizures.

Focal (Partial) Seizures: These types of seizures start in a certain region of the brain. Sometimes, before the seizure begins, preliminary symptoms called “aura” may be seen in children. These symptoms may take the form of déjà vu (a feeling of having experienced it before), a sudden feeling of fear or pleasure, visual or auditory changes, or differences in the sense of smell or taste. Aura is actually the first sign of abnormal electrical activity in the region where the seizure starts.

Focal seizures are divided into two subgroups according to the state of consciousness:

• Simple Focal Seizures (Seizures with Preserved Consciousness): In these seizures, the child is conscious. The seizure symptoms vary depending on the brain region where the abnormal electrical activity starts. For example, while a seizure starting in the visual center may lead to visual disturbances, a seizure starting in the motor cortex may cause involuntary movements in the fingers or in the arms and legs. Sweating, nausea, or paleness may also be seen.
• Complex Focal Seizures (Seizures with Impaired Consciousness): These seizures usually start in the temporal lobe, which is the brain’s center of emotion and memory, and cause loss of consciousness or clouding of consciousness. The child may appear awake but is not aware of the surroundings. They may display automatic behaviors such as smacking the lips, chewing movements, walking aimlessly, shouting, crying, or laughing. After the seizure, fatigue or drowsiness is generally seen.
• Generalized Seizures: These types of seizures start in both hemispheres of the brain at the same time and generally cause loss of consciousness. Fatigue after the seizure is common. Different types of generalized seizures are as follows:
• Absence Seizures (Petit Mal Seizures): These are characterized by short-term (usually less than 30 seconds) staring, blank gaze, and loss of consciousness. Mild tremors around the mouth or face or rapid blinking may accompany them. The child does not remember the seizure and can usually return to normal activities immediately after the seizure. These seizures are especially common in school-age children and may sometimes be confused with attention deficit or behavioral problems.
• Atonic Seizures (Drop Attacks): These cause the child to fall to the ground or the head to drop suddenly as a result of sudden loss of muscle tone. During the seizure, the child is limp and unresponsive. These seizures increase the risk of falls and injury.
• Tonic Seizures: These are characterized by sudden and short-term stiffening of the body or a part of it. Short-term tonic seizures may also cause falls.
• Generalized Tonic-Clonic Seizures (Grand Mal Seizures): This is the most commonly known and dramatic seizure type. Typically, first there is stiffening in the body, arms, and legs (tonic phase), followed by rhythmic contraction and relaxation (clonic phase). There is loss of consciousness and difficulty in breathing may be experienced. After the seizure, the child may generally be tired and sleepy and may feel headache or body pain.
• Myoclonic Seizures: These are characterized by sudden, short-term, shock-like muscle jerks. They can usually recur in clusters, that is, during the day or over several consecutive days, and are seen more frequently at the time of waking.

Other Types of Seizures:

• Infantile Spasms (West Syndrome): This is a rare and serious type of epilepsy generally seen in the first year of life, especially between 2-12 months. It manifests itself as sudden, short-term contractions in the neck, trunk, or legs and generally occurs at the time of waking or falling asleep. It may recur hundreds of times a day and if left untreated may lead to serious developmental problems.
• Febrile Convulsions (Febrile Seizures): These are seizures triggered by high fever and are generally seen in children between 6 months and 5 years of age. They may occur in different forms, from mild contractions to severe convulsions. Most febrile seizures are simple and short-term and generally do not mean epilepsy. However, in some cases they may be more complex or prolonged.
• Status Epilepticus: This is a condition in which a seizure lasts longer than five minutes or intermittent seizures recur without recovery of consciousness in between. This is a dangerous condition requiring urgent medical intervention.

Common Epilepsy Syndromes in Childhood

Epilepsy can be classified not only by different seizure types but also as “epilepsy syndromes” that begin at certain ages, have characteristic EEG findings, and generally follow a predictable course. Recognizing these syndromes is important for making the correct diagnosis, predicting the possible course of the disease, and determining the most appropriate treatment strategies. Some epilepsy syndromes frequently seen in childhood are:

• Benign Rolandic Epilepsy (BRE) / Self-Limited Epilepsy with Centrotemporal Spikes (SeLECTS): This is one of the most common epilepsy syndromes seen in childhood. It usually begins between the ages of 3-10. Focal motor seizures characterized by symptoms such as twitching, numbness, or tingling in the face or tongue, difficulty speaking, and drooling are typical. These seizures generally occur during night sleep. Most children become seizure-free by adolescence, around the age of 16.
• Childhood Absence Epilepsy (CAE): This usually begins between the ages of 4-10 and is characterized by frequent and short-term absence seizures that may recur up to 100 times a day. During these seizures, the child stares blankly, becomes unresponsive, and eyelid fluttering or other repetitive movements may be seen. It generally responds well to drug treatment and up to 90% of children outgrow these seizures by adulthood.
• Dravet Syndrome: This is a rare and complex type of epilepsy. Seizures generally begin in the first year of life and may be prolonged and resistant to treatment. It is often associated with high fever or hot environments. Intellectual and behavioral problems frequently accompany it and it may last lifelong, although its symptoms may change over time.
• Juvenile Myoclonic Epilepsy (JME): This usually begins between the ages of 12-18. Myoclonic seizures (especially sudden muscle jerks in the upper body), tonic-clonic seizures, and sometimes absence seizures may be seen. Seizures usually occur at the time of waking or shortly after. Drug treatment may be effective in controlling seizures, but it may generally be necessary to use medication lifelong. Sleep deprivation, stress, fatigue, and in some people flashing lights may trigger seizures.
• Infantile Spasms (West Syndrome): As mentioned earlier as a seizure type, this is also a serious epilepsy syndrome beginning in the first year of life.
• Lennox-Gastaut Syndrome (LGS): This usually begins between the ages of 3-5 and is characterized by multiple seizure types such as tonic, atonic, and atypical absence seizures. Many children also develop learning difficulties and behavioral problems. Its treatment can be quite difficult.

In addition to these syndromes, there are many different epilepsy syndromes in childhood such as Benign Occipital Epilepsy, Juvenile Absence Epilepsy, and Doose Syndrome (Myoclonic Atonic Epilepsy). Each syndrome has its own unique characteristics and course.

Living with Epilepsy: Support and Strategies for Families

Your child being diagnosed with epilepsy may be a challenging process for you. However, remember that it is possible to manage this process with the right information and support. First of all, it is important to create a safe environment at home. Softening sharp corners, installing safety gates on stairs, and supervising your child during activities such as bathing can reduce the risk of injury.

It is also important to learn the basic first aid information about what to do during a seizure. It is important to place your child on their side, put something soft under their head, remove dangerous objects around them, and track the duration of the seizure. Do not try to put anything into your child’s mouth during the seizure.

Using medication regularly and as your doctor recommends is of vital importance for seizure control. You can use reminders or create a daily routine to avoid forgetting medications. It is also important to recognize seizure triggers and avoid them. Adequate sleep, regular nutrition, and a life away from stress can help reduce the frequency of seizures.

Most importantly, stay in constant communication with your child’s doctor and do not hesitate to share any questions or concerns you may have. In addition, epilepsy associations and support groups can also provide emotional, informative, and practical support to you and your family. Communicating with other families who have similar experiences can help you feel that you are not alone.

Frequently Asked Questions