Epilepsy is a neurological disease that affects more than two million people in the United States. This disease of the central nervous system most often manifests as spontaneous, recurring seizures which come from a disruption in the electrical communication between groups of cells in the brain that impair its normal functioning.
The seizures that arise from these abnormal electrical discharges in the brain and can manifest in different ways, from simply staring absentmindedly to grand mal seizures that involve uncontrollable shaking and loss of motor control.
Though epilepsy can manifest at any age, it most commonly appears in childhood. When seeking a diagnosis or treatment of epilepsy in children, care should be taken to find the best pediatric neurologist who will be able to offer treatment tailored to specifically for children.
What Causes Epilepsy?
There are many causes of epilepsy that include infectious illnesses such as meningitis and encephalitis, and also include brain trauma, brain tumors, strokes and blood vessel malformation, among others. Childhood epilepsy can arise from difficult and premature births that effect the newborn’s brain in a way that causes them to experience seizures.
Because of this, diagnosing the cause for epilepsy in children can be challenging and pediatric neurologists will attach a type to each diagnosis: idiopathic, cryptogenic or symptomatic.
An Idiopathic diagnosis means there is no apparent underlying cause for a patient’s condition based on tests such as the electroencephalogram (EEG) or magnetic resonance imaging (MRI). This diagnosis makes up around one-third of all pediatric epilepsy cases, and is thought to be caused at the cellular level.
Because an idiopathic diagnosis usually indicates a genetic link to a child’s seizures, it’s important for the pediatric neurologist to understand the child’s family history with seizures and the disease. However, an idiopathic diagnosis doesn’t necessarily indicate a genetic link; it is also possible for children to develop epilepsy at the cellular level because of other factors such as exposure to toxins in the womb.
Symptomatic refers to a confident identification of the cause. These diagnoses are made when the pediatric neurologist identifies specific damage or structural abnormalities in the child’s brain using brain imaging tests.
Symptomatic epilepsy can arise from diseases like congenital brain malformation or brain tumors, as well as trauma such as an extended lack of oxygen to the brain or a brain infection that causes permanent damage.
Cryptogenic means that the underlying cause hasn’t been identified yet, though it’s likely it will be found. However, while there is no clear injury or structural issue with the child’s brain, the seizure doctor may still suspect a link due to abnormal findings on the child’s neurological exam.
Diagnoses of cryptogenic epilepsy are not common, and have continued to shrink due to improvements in brain imaging techniques that allow experts in pediatric neurology to identify ever smaller and more subtle abnormalities in the brain.
There are a variety of available treatments for epilepsy in children that range from an alteration in diet to surgery. Antiepileptic drug therapy is a common form of treatment for pediatric epilepsy as it allows the alleviation of seizures in most patients.
Often, these treatments can be combined to create a plan that best addresses the specific circumstances of type and frequency of the child’s seizures. The best pediatric neurology teams will work to find the correct diagnosis and then develop a specific treatment plan based on it.
Antiepileptic Drug Therapy
Just as there are a variety of diagnoses for epilepsy, there are a variety of medications used to treat each one. For the majority of children, anticonvulsant medication ceases or greatly diminished the occurrences of seizures. However, not all children respond to medication. This is often because the medicine for the specific does not yet exist, but also highlights the need for a correct diagnosis.
The ketogenic diet program is a natural and non-invasive way to control epilepsy in some patients. It’s based on the principle of depriving the body of carbohydrates to put it in a state of ketosis. In this state, blood chemicals called ketones are released into the bloodstream at a higher rate. Ketones have been shown to prevent some seizures.
Unfortunately, some children do not respond to anticonvulsive medication or alternative seizure controls. When there is concern that the seizures will directly impact the quality of life and development of the child, they may be a candidate for resective surgery or palliative surgery. What type of surgery is deemed necessary depends on the cause of the epilepsy and the severity of the seizures experienced.
The best pediatric neurologists know how critical it is to make a correct diagnosis to ensure the correct treatments are being used, so surgery is often the last step in finding effective treatments for childhood epilepsy.