What is a seizure?
Brain cells, or nerve cells, communicate through tiny bursts of energy, or small electrical signals. If too many of these cells suddenly fire together, an abnormal wave of electrical energy goes through the brain, disrupting its normal electrical activity. This causes a seizure. Because the brain controls the body, this disturbance affects the body.
Seizures vary in type, severity and intensity. They are divided into two main categories. If the whole brain is affected, the seizure is defined as generalized. When only a certain part of the brain is affected, the seizure is defined as focal.
Types of seizures
Seizures can look different, depending on the type of seizure a child has. When a child has a seizure, they may show changes in awareness, movement, sensation or behaviour, depending on where the abnormal activity in the brain is occurring.
What is epilepsy?
Epilepsy, or a chronic seizure disorder, is a general term for a number of different conditions. Epilepsy is the same thing as a ‘seizure disorder’.
Epilepsy affects every child differently. Some children with epilepsy have more than one seizure type and may have other problems related to the brain. For some children, seizures are controlled easily, and epilepsy is outgrown. For others, epilepsy can create lifelong challenges.
For in-depth information about epilepsy, please see the Epilepsy Learning Hub.
Causes of epilepsy
Seizures may be caused by many things, such as a brain injury, a tumour, a scar or a tangle of blood vessels in the brain. Seizures have no apparent physical cause in 60–70% of children. In those cases, the brain looks completely normal on an MRI or a CT scan.
Epilepsy can affect anyone at any age. Having one seizure does not always mean your child has epilepsy. Half of children who have one seizure will never have another.
A second seizure means it is much more likely that your child will continue to have more seizures and they may be diagnosed with epilepsy.
How epilepsy is diagnosed
A child is diagnosed with epilepsy if they have two or more unprovoked seizures or they have a single unprovoked seizure and are at high risk to have more seizures (e.g., they may have an underlying condition that carries a risk of having more seizures). Unprovoked means that the seizures were not caused (provoked) by an acute illness, fever or head injury.
When there is a group of children with epilepsy who have similar imaging results, history and presentation, their condition can be defined as a specific epilepsy syndrome. Many epilepsy syndromes have been identified. For more information, see the Epilepsy syndromes section of the Epilepsy Learning Hub.
Treatment of epilepsy
The first choice of treatment is usually medication. For most children with epilepsy, the first medication that is tried will control their seizures. There are more than 20 medications available. Your child’s health-care provider will choose the best one depending on your child’s seizure type, syndrome, possible side effects or other medications your child may be taking. However, if medication does not control the seizures after a reasonable trial period, your child's health-care provider may suggest changing medications or adding another medication. Some children have to try a number of different medications before finding one that works, or they may need to take multiple medications.
While some forms of epilepsy are easily treated with medication, others may respond to a special diet or surgery. One child may respond well to a medication that does not work at all for another child. Epilepsy is a complex disorder, so it can be very difficult and frustrating for children, parents and health-care providers to figure out exactly what is going on and find the best treatment. During this process, it is important to stay optimistic and patient.
Some children still have seizures even after trying two or more different medications or a combination of medications. If this happens, your child's health-care provider may suggest your child be evaluated for surgery. With epilepsy surgery, a surgeon removes or disconnects the part of the brain that is generating the seizures. All children with epilepsy that cannot be controlled with medication should be considered for surgery. Surgery, if an option for your child, can offer seizure freedom and may cure your child of their epilepsy. However, depending on the cause of epilepsy, surgery may not be an option for all children.
If medication does not work and surgery is not a good option, the doctor may consider another kind of treatment, such as a special diet or stimulation medical device called a vagus nerve stimulator (VNS).
Goals of treatment
The goals of treatment vary depending on:
- the age of your child
- your child's seizure types and the severity
- the treatment options available
The primary goal of treatment could be:
- complete elimination of seizures
- having less intense seizures and less often
- some reduction of seizures, balanced with minimal side effects
Other goals of treatment could include:
- improved development
- improved learning and behaviour
- independent living in the future
Treatment goals may change over time as your child and their condition are better understood, their clinical situation evolves, and advances make new treatment options available.
You should decide about treatment in consultation with your child and your child's doctor and treatment team. Explain the treatment options to your child using words that they can understand. This may help them feel less anxious, more cooperative and more in control.
Epilepsy can cause problems with learning and behaviour
Even when seizures are well controlled, children with epilepsy may still have problems with self-esteem, learning, behaviour or social adjustment. Work with your child’s treatment team to address these problems as they arise.
What to expect in the future
Some children become seizure-free when they grow up. Others will have to take medicine to prevent seizures all their lives. Ask your child's treatment team about what to expect for your child.
Research
The Hospital for Sick Children (SickKids) is continuously performing research to improve care for children with epilepsy. Each year, through research, SickKids is learning more about the causes of epilepsy and making additional treatment options available for children and families. Research helps make advances in treatment and care for children with epilepsy. Ask your child’s treatment team about the epilepsy research going on at the clinic or hospital where they are treated. Your child may be eligible to participate in a research study and contribute to improving understanding of epilepsy in children.