Epilepsy / seizures

Epilepsy, or “epilepsy spectrum disorder,” is a complex condition that makes a person prone to seizures. Seizures occur due to abnormal electrical activity in the brain when certain parts become over-excited and send out too many electrical signals.
Epilepsy appears most often in infants, children, and seniors. Approximately 1 percent of children are affected by epilepsy. In infants and young children, there are special considerations about why seizures occur, how seizures appear, and their impact on a child’s growth. Certain seizure types, such as infantile spasms, begin during this time.

Focal onset: Seizures originate in a specific area on one side of the brain. The seizure activity may stay in one area or spread to other parts of the brain. Focal onset seizures can be categorized as focal aware seizures (previously called simple partial seizures), where a person remains conscious during the seizure, or focal impaired awareness seizures (previously called complex partial seizures), where a person experiences a loss of awareness during the seizure.

Generalized epilepsy: This type of epilepsy involves seizures that involve both sides of the brain. Generalized seizures can be classified into various types, including absence seizures (formerly known as petit mal seizures), tonic-clonic seizures (formerly known as grand mal seizures), atonic seizures, myoclonic seizures, and tonic seizures.

Lennox-Gastaut syndrome : A severe type of childhood-onset epilepsy, is known for generalized tonic seizures, distinctive EEG patterns that show slow spike-and-wave activity, and cognitive impairment. While epilepsy can be caused by genetics, an underlying disease, injury, or brain development disorder, it often appears without an obvious cause. If a child experiences two or more unprovoked seizures, meaning no immediate such as a high fever, they may have epilepsy. Epilepsy can involve different types of seizures. Some seizures are easily identifiable, characterized by shaking of the body and temporary loss of awareness. However, other seizures may not have any obvious outward signs. Epilepsy can also lead to changes in a child’s behavior and personality, as well as other neurological concerns, learning difficulties, anxiety, and depression. Identifying these problems early and timely intervention is crucial for caring for a child with epilepsy.

Symptoms of epilepsy in Children?

Because the brain controls all aspects of the body, epilepsy can have different effects on a child depending on where in the brain seizures occur. Seizures can be subtle and barely noticeable or frightening to witness.

Staring, tremors, convulsions, or jerking movements in the arms and legs
Stiffening of the body, loss of consciousness & breathing problems
Loss of bowel or bladder control, falling suddenly for no apparent reason
Not responding to noise or words for short periods of time, appearing confused or in a haze
Extreme sleepiness and irritability when waking up in the morning, Head nodding or dropping
Periods of rapid eye blinking, changes in vision and speech & vomiting

What causes seizures?

A seizure happens when cells in the brain fire or “talk” too much, temporarily disrupting the brain’s normal electrical signals.

Seizures have many possible causes, including:
Head injuries
Birth trauma
Congenital conditions (conditions that your child is born with) such as brain development disorders
Brain tumors
Genetic conditions
Stroke
Metabolic problems

How is epilepsy diagnosed?

Many conditions, such as stroke, fainting, heartbeat concern, or breath-holding spells, can cause symptoms that look like epilepsy. If you think your child has epilepsy, a neurologist will review your child’s medical history, complete a physical exam, and may order testing, most likely an electroencephalogram (EEG). EEGs measure electrical activity in the brain. At the Epilepsy Center at Boston Children’s Hospital, we use high-definition EEG, which allows our clinicians to get a more detailed picture of your child’s brain activity.

MRI, PET, SPECT, or other brain imaging, MEG (magnetoencephalography), TMS (transcranial magnetic stimulation)
These tests help neurologists diagnose which type of epilepsy your child has — focal onset epilepsy or generalized epilepsy.

Treatment of epilepsy

Epilepsy medication : Medication remains the first line of treatment for epilepsy. There are many types of medications to treat seizures, and doctors can individualize medical treatment to help control your child’s specific type of seizures.
Chronotherapy : This approach involves carefully timing treatment to when seizures most often happen. It can often help medications work more effectively to control seizures.
Genetically tailored treatments : The ICON Foundation uses DNA sequencing to discover previously unknown genetic causes of seizures, some of which disrupt brain biochemistry in a way that can be targeted with drugs.
Pharmacogenomics : Genetic differences in metabolism can affect children’s responses to medications. By studying how an individual’s genetic makeup influences their response to medications, doctors choose the best treatment for each patient
Diet therapy : Diet therapy can be an option for childhood epilepsy when medications don’t control seizures or cause intolerable side effects. It can be especially helpful for certain types of epilepsy, such as myoclonic-astatic epilepsy (Doose syndrome).

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Know more about epilepsy

Classic ketogenic diet, Modified Atkins diet, Medium chain triglyceride diet (MCTD), Low glycemic index treatment diet.
The best diet for your child will depend on their epilepsy diagnosis, age, eating habits, and your family’s needs and preferences. It’s sometimes helpful to transition between the different diets. Diet therapy takes a strong commitment, but it may offer some children better seizure control than medication. Because there isn’t yet an exact way to tell exactly how a child will respond to diet therapy, a three- to four-month trial is usually recommended.


The Epilepsy Center uses various forms of noninvasive neuromodulation to assist with epilepsy diagnosis and treatment as alternatives to epilepsy surgery that involves resection or laser-mediated ablation of brain tissue.



Transcranial magnetic stimulation (TMS) uses a strong magnet on a child’s head to create changing magnetic fields. These fields produce tiny electric currents in the brain, which lower brain activity. TMS is actively used at Boston Children’s to map motor and speech cortical areas before brain surgery.



Cortical brain mapping is a noninvasive technique to map cortical functions such as movements and speech using passive mapping of specific EEG frequencies, known as gamma activity, to help with mapping eloquent brain functions before epilepsy surgery.



Responsive nerve stimulation involves a cortically implanted device that provides closed loop, or responsive, electrical stimulation in response to a recorded EEG signal to stop the seizure event. Deep brain stimulation involves a thalamic implanted device that provides open loop, or regular, electrical stimulation to reduce seizures.



Vagus nerve stimulation involves an implanted device under the chest wall that stimulates the vagus nerve in the neck. This provides a regular electrical signal to the brain. There is also an accompanying magnet that allows for giving extra impulses as needed and a sensor to detect changes in heart rate that may signify an active seizure and lead to an extra impulse.



When seizures don’t respond to medication or other treatments, your child’s doctor may recommend an evaluation to see if surgery is an option. Surgical evaluations are done in the hospital over five to seven days. During this time, clinicians will study your child’s seizures and learn exactly what area of the brain they are coming from. If surgery is an option, your child’s care team will discuss what type of surgery they recommend.



Focal resection: If your child’s care team can pinpoint the specific area of your child’s brain that is over-firing and causing the seizures (a “focal point”), your child may be able to have surgery to remove the abnormal brain tissue without harming neighboring brain areas. This procedure, called “resective” surgery, can often stop the seizures entirely, allowing most children to function normally afterward.



Laser ablation: Laser interstitial thermal therapy (LITT) is a minimally invasive approach to heating/ablating the seizure focus. LITT requires precise mapping of the seizure focus, typically done utilizing stereo EEG (sEEG) intracranial monitoring, and allows our epilepsy surgery team to assess the optimal surgical option for each patient. sEEG and LITT are especially well suited for deep seizure foci in the brain not readily accessible by other methods.



Corpus callosotomy involves cutting the major fibers that connect the two halves (hemispheres) of the brain. This can prevent seizures from spreading from one side of your child’s brain to the other by cutting off communication between the two hemispheres. Corpus callosotomy is particularly effective for children who experience severe “drop attacks” in which they lose consciousness. While seizures won’t usually go away, in most cases, they become milder and less disabling.



A hemispherectomy involves removing or disabling one half (hemisphere) of the brain. This procedure may be used if seizures are coming from a broad area of a single hemisphere. When used appropriately, hemispherectomy can be extremely rewarding but is only recommended for very severe epilepsy that hasn’t responded to medication and less aggressive surgeries.
Hemispherectomy can cause serious side effects, including motor and language skill loss, which must be weighed against the severity of the epilepsy symptoms themselves.

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