12252 Epilepsy In Children

Overview

Epilepsy is a brain condition that causes repeated seizures. A seizure is a sudden, uncontrolled burst of electrical activity in the brain that temporarily affects how a person moves, feels, or behaves. Having one seizure does not mean a child has epilepsy — epilepsy is diagnosed when a child has two or more seizures that are not caused by another medical condition.

Yes. Epilepsy is one of the most common neurological conditions in childhood. In the UK, about 1 in 200 children has epilepsy.

Epilepsy can begin at any age, but it often starts in early childhood or the teenage years. It affects both boys and girls and children from all backgrounds.

Symptoms

Common symptoms

• Jerking or twitching of the arms, legs, or face
• Staring blankly and not responding
• Loss of awareness or confusion
• Sudden falls without a clear reason
• Unusual feelings, smells, or sounds just before a seizure (called an aura)

Symptoms in children

• Brief staring spells that look like daydreaming (absence seizures)
• Jerking or stiffening of the body
• Lip-smacking, chewing, or fidgeting movements
• Suddenly dropping to the floor
• Not waking up or responding after a seizure

Symptoms in older adults

• This article focuses on children, but in older adults, seizures can sometimes be mistaken for confusion or fainting. The symptoms are similar, but the underlying causes may be different — such as stroke, head injury, or other health conditions. Any new seizure-like symptoms in a child or adult should be checked by a healthcare professional.

Causes

Main causes

• In many cases, the cause is unknown (called idiopathic epilepsy)
• Genetic factors — epilepsy can run in families
• Brain injuries, such as from a head injury or lack of oxygen at birth
• Brain infections, like meningitis or encephalitis
• Structural differences in the brain, such as a malformation or tumour

Risk factors

• Family history of epilepsy
• A past head injury or brain infection
• Complications during pregnancy or birth
• Certain genetic conditions

When to see a doctor

See a doctor urgently if:

• If your child has a first suspected seizure, call your local emergency number or go to the nearest emergency department immediately.
• If a seizure lasts more than 5 minutes or your child does not wake up afterward, seek emergency care.

Book a routine appointment if:

• If your child has episodes that look like staring, unusual jerking, or strange movements, make an appointment with your GP or paediatrician to discuss them.
• If your child has been diagnosed with epilepsy and has new or worsening seizure types, see your specialist.

Diagnosis

A doctor will take a detailed history of what happens before, during, and after the episodes. They will also examine your child and may refer you to a specialist (a paediatric neurologist) for further assessment.

Tests that may be done

• Electroencephalogram (EEG) — a painless test that records brain waves and can show unusual electrical activity
• MRI scan — takes detailed pictures of the brain to look for any structural causes
• Blood tests — to check for infections or metabolic conditions
• Sometimes, video recordings of the episodes are used to help diagnose the type of seizure

What to expect at your appointment

The doctor will ask many questions, so be ready to describe what happens before, during, and after a seizure. You may need to wait a few weeks for tests and a specialist appointment. During this time, keep a diary of any episodes and note what your child was doing.

Treatment

The main goal of treatment is to stop or reduce seizures so your child can live as normally as possible. Most children with epilepsy take daily medicine to prevent seizures. Treatment is tailored to each child and their type of epilepsy.

Self-care at home

• Always give seizure medicine exactly as prescribed, and never stop suddenly without medical advice
• Keep a seizure diary to track triggers, timing, and recovery
• Ensure your child gets enough sleep — lack of sleep can lower the seizure threshold
• Teach family members, teachers, and caregivers what to do during a seizure
• Make the home environment safer by padding sharp corners and avoiding leaving a child alone in a bathtub

Medical treatments

The most common treatment is anti-seizure medication, chosen carefully by a specialist based on the type of seizures, the child's age, and other factors. The dose is started low and adjusted until seizures are controlled with the fewest side effects. If medicines do not work well, a doctor may discuss other options such as a special ketogenic diet (a very high-fat, low-carbohydrate diet) or epilepsy surgery.

When is surgery considered?

Surgery may be an option if tests show that all seizures start from one small area of the brain, and its removal would not cause serious loss of function. This is considered only when medicines fail to control seizures and the condition is significantly affecting the child's life.

Living with this condition

Most children with epilepsy go to school, play with friends, and join in activities. With good seizure control, the only adjustment may be safety supervision, especially for swimming, bathing, and climbing. It is helpful to share a clear seizure action plan with teachers and other caregivers so everyone knows what to do.

Lifestyle tips

• Keep a regular sleep schedule and avoid late nights
• Identify and avoid personal seizure triggers (like flashing lights, if your child is photosensitive)
• Encourage your child to wear a helmet for cycling, skiing, or other activities where a fall could injure the head
• Always supervise your child in or near water — shower instead of bath for older children where possible
• Speak openly with your child about epilepsy in a positive, matter-of-fact way

Diet and exercise

There is no special diet for most children with epilepsy, but a balanced, heart-healthy diet is important. A ketogenic diet is only used under medical supervision for certain types of epilepsy. Exercise is encouraged, and most sports are safe — just avoid activities where a sudden seizure could cause a dangerous fall, and always have a buddy or coach nearby.

Mental health and emotional wellbeing

Epilepsy can affect a child's confidence, self-esteem, and emotional wellbeing. Children may feel different from their peers, struggle with worry, or experience low mood. It is essential to talk openly, reassure your child that epilepsy is only one part of who they are, and consider speaking to a counsellor or psychologist if you see signs of anxiety, depression, or withdrawal. As a parent, your own stress is also real — seek support for yourself too.

Prevention

Most cases of epilepsy cannot be prevented, but you can reduce the risk of head injuries by using car seats, seat belts, and helmets when appropriate. Controlling fevers quickly and treating infections early may also lower the chance of seizures that follow a fever.

Vaccines

Vaccinations do not cause epilepsy. Keeping your child's vaccines up to date is important because it prevents infections like meningitis that could lead to epilepsy.

Screening programmes

There is no routine screening test for epilepsy in children. Epilepsy is usually diagnosed after a child has had a seizure or something that looks like one.

Complications

If left untreated

• Injuries from falls or jerking movements during a seizure
• Drowning or accidents during a seizure in water or near traffic
• Status epilepticus — a prolonged seizure lasting longer than 5 minutes, which is a medical emergency
• Impact on school, relationships, and emotional wellbeing

Long-term outlook

The outlook for children with epilepsy is often very good. Many children become seizure-free with treatment, and a significant number eventually outgrow their epilepsy as they get older. Even when epilepsy continues, most children can lead full and rewarding lives. With the right medical care, safety planning, and emotional support, your child can thrive.

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