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Epilepsy

What is Epilepsy?

Epilepsy refers to recurrent seizures, which are abnormal and excessive electrical discharges in the brain, often starting in children and adolescents. There are various types of epilepsy, each with specific set of characteristics, course, age of onset, and treatment paradigm. The diagnosis and management of pediatric epilepsy often involve a comprehensive evaluation, which includes medical history, physical examination, electroencephalogram (EEG) testing, brain imaging, and other diagnostic procedures.

Epilepsy Shown in Connection with a Child Brain
What Causes Epilepsy in Children?

It's important to note that epilepsy is a complex neurological condition, and the causes can vary from individual to individual. Various factors that can contribute to the development of pediatric epilepsy, including:

Genetic Issues Cause Epilepsy in a Child
Infection Causes Epilepsy in a Child

  1. Genetics: Family history of epilepsy or other neurological conditions can increase the risk of a child developing epilepsy. Certain genetic mutations and inherited factors can predispose a child to seizures.

  2. Brain Development: Abnormal brain development, either before birth or during early childhood, can lead to epilepsy. This can be a result of genetic factors or prenatal conditions such as infections, trauma, or lack of oxygen during birth.

  3. Structural Abnormalities: Structural problems in the brain, such as brain malformations, tumors, or cysts, can disrupt normal brain function and lead to seizures.

  4. Infections: Certain infections that progress to encephalitis or meningitis, can cause inflammation and damage that triggers seizures.

  5. Metabolic Disorders: Inherited metabolic disorders, where the body is unable to process certain chemicals or nutrients properly, can lead to imbalances that affect brain function and cause seizures.

  6. Traumatic Brain Injury (TBI): Head injuries resulting from accidents or trauma can sometimes lead to epilepsy, secondary to the damage to the brain tissue.

  7. Febrile Seizures: These are seizures that occur in young children as a result of a rapid spike in body temperature, often due to infections. While most febrile seizures do not lead to epilepsy, some children with certain risk factors may be more prone to developing epilepsy after experiencing febrile seizures.

  8. Stroke:  which are disruptions of blood flow to the brain, can damage brain tissue and increase the risk of post-stroke seizures.

  9. Neurodevelopmental Disorders: Children with neurodevelopmental disorders such as autism spectrum disorder or cerebral palsy may have an increased risk of epilepsy.

  10. Unknown Causes: In many cases, the exact cause of pediatric epilepsy may not be identified, and it may be classified as "idiopathic" or of unknown origin.

What Symptoms Might Epilepsy Cause in Children?

The symptoms of pediatric epilepsy can vary widely depending on the type of seizure and the child's individual condition. Irrespective of the type of epilepsy, chronic seizures can initerfere with normal development. Here are some common symptoms:

  1. Seizures: Seizures are the hallmark symptom of epilepsy. They can manifest in various ways, including:

    • Generalized Seizures: These affect the entire brain and can cause symptoms such as loss of consciousness, convulsions (jerking movements of the body), staring spells, and brief periods of confusion.

    • Partial (Focal) Seizures: These originate in a specific part of the brain and may cause localized symptoms, such as twitching or jerking of a specific body part, altered sensations, or complex behaviors like lip smacking or repetitive movements.

    • Absence Seizures: These involve a brief loss of consciousness with a blank stare and subtle body movements. They are more common in children and can be mistaken for daydreaming.

  2. Auras: Some children may experience auras, which are warning signs that occur before a seizure. Auras can include sensory disturbances, emotional changes, or other unusual sensations.

  3. Altered Consciousness: Seizures often lead to altered levels of consciousness, ranging from mild confusion to complete loss of awareness/conciousness.

  4. Motor Symptoms: These can include repetitive movements, such as hand clapping, lip smacking, or walking in circles during a seizure.

  5. Sensory Symptoms: Some children may experience unusual sensations, like tingling, numbness, or visual disturbances before or during a seizure.

  6. Behavioral Changes: Seizures can cause changes in behavior, mood, or emotions, both during and after the episode.

  7. Cognitive Issues: Children with epilepsy may have difficulties with memory, attention, and learning.

  8. Physical Symptoms: Seizures can sometimes result in injuries due to falls or other movements during the episode.

Epilepsy Causes Seizures in a Child
Epilepsy Causes Behavioral Changes in a Child
What Treatments are Available for Epilepsy in Children?

Once your child’s has been diagnosed with epilepsy, I (as a pediatric neurosurgeon in New York) will work with you, your child, and other medical professionals (e.g., pediatric neurologists and epileptologists) at Children's Hospital at Montefiore (CHAM) to formulate a customized treatment strategy tailored to your child’s needs. This customized treatment will strive to effectively manage seizures while promoting your child's overall development and well-being. Once patients have failed medical management in treating their epilepsy, below is a list of common strategies that I implement for treating pediatric epilepsy:

Vagus Nerve Stimulation (VNS)
Responsive Neurostimulation (RNS)

  1. Vagus Nerve Stimulation (VNS): VNS is a surgical treatment that involves implanting a device under the skin that delivers electrical impulses to the vagus nerve. It can help reduce the frequency and intensity of seizures in some children.

  2. Responsive Neurostimulation (RNS): This is a newer approach where a device is implanted in the brain to detect and respond to abnormal electrical activity, delivering small electrical impulses to prevent seizures from occurring.

  3. Stereoelectroencephalography (SEEG): A procedure involving the placement of electrodes deep within the brain to precisely map the origin of seizures and guide surgical planning.

  4. Laser Interstitial Thermal Therapy (LITT): A minimally invasive technique that uses laser energy to ablate or destroy targeted areas of brain tissue responsible for seizures.

  5. Temporal Lobectomy: Surgical removal of a portion of the temporal lobe of the brain, which may be considered for certain types of epilepsy that originate in this area.

  6. Hemispherotomy: A surgical procedure that disconnects the fiber tracts connecting one hemisphere of the brain to the other, in order to prevent seizures from spreading.

  7. Hemispherectomy: Utilizing advanced endoscopic approach to disconnect one cerebral hemisphere to control severe seizures that are unresponsive to other treatments.

  8. Endoscopic Hemispherotomy: A minimally invasive procedure to disconnect or remove a hemisphere of the brain using an endoscope and specialized instruments.

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