Childhood Epilepsy & Seizures

What Is a Seizure? 

Normally, our brains generate their own electrical impulses to send messages between neurons, allowing us to think, feel and move. A seizure is a sudden, uncontrolled, abnormal surge of this electrical activity in the brain. It can temporarily affect behavior, movements, sensation, awareness or consciousness. Think of it as a brain “coughing” in reaction to some irritation.

Seizures fall into two broad categories: focal and generalized. Additionally, a specific type of seizure affects infants.

Focal Seizures

Focal seizures originate in one area of the brain.

• Focal aware seizures: The child remains conscious and fully responsive, but they may twitch, see flashing lights or experience unusual smells or tastes. These seizures generally last from a few seconds to a few minutes.
• Focal impaired awareness seizures: The child may appear confused, unresponsive or partially responsive. They might stare, mumble, walk around or perform repetitive movements like lip-smacking. These seizures usually last seconds to a few minutes and may happen during sleep. 

Generalized Seizures 

Generalized seizures originate in and affect both halves (hemispheres) of the brain.

• Absence seizures involve brief staring spells that may look like daydreaming. These typically last from a few seconds to a few minutes.
• Tonic-clonic seizures (previously called grand mal seizures) are the most noticeable type, with two distinct phases:
  • Tonic phase: The body stiffens, and the child may cry out or groan. Other signs include eye rolling, drooling or foaming at the mouth, and loss of bladder or bowel control.
  • Clonic phase: The arms and legs jerk rhythmically.

Tonic-clonic seizures typically last 1-3 minutes. If a seizure lasts longer than 5 minutes, call 911. After the seizure, your child may feel tired or confused.

Infantile Spasms 

Infantile spasms, which typically affect babies and toddlers, are a rare but serious type of seizure. They involve sudden arm, leg or head movements. These spasms typically occur one after another in clusters and often are associated with waking up from or going to sleep. Early diagnosis and appropriate treatments are crucial. Infantile spasms can lead to developmental delays and cognitive issues. 

What Causes Childhood Epilepsy and Seizures?

Epilepsy can stem from multiple causes, including genetics, autoimmune disorders, metabolic issues or infections, but sometimes the cause is unknown. Not all seizures mean epilepsy, but it’s not always clear-cut. For example, a seizure within a week of a brain injury is considered provoked (not epilepsy), while seizures occurring later may indicate epilepsy.

What Are the Signs of a Seizure in Children?

Seizures can be different for each child. Some are easy to recognize, while others can be subtle. Here are a few common types: 

• Tonic-clonic seizures (formerly called grand mal): The child may suddenly fall, stiffen and have rhythmic jerking movements.
• Subtle seizures: The child might pause what they are doing and stare blankly or seem briefly unaware of what’s happening. Sometimes you might see some small movements, like a twitch or fluttering eyelids. These seizures can be mistaken for daydreaming,
• Silent seizures: There are no obvious signs, but an EEG (a test that measures brain activity) can detect these seizures.

How Is Epilepsy Diagnosed in Children?

Diagnosing epilepsy starts with understanding your child’s seizures. If your child has never had seizures before, they’ll likely visit one of our neurologists first. 

A doctor will make an initial epilepsy diagnosis if your child has two or more seizures separated by at least 24 hours and not triggered by an external cause. We call these unprovoked seizures. Seizures triggered by external factors — provoked seizures — don’t necessarily indicate epilepsy. 

The best way to confirm seizure or epilepsy is by capturing a seizure on a video EEG, which records brain activity. If that isn’t an option, your doctor may rely on your descriptions or home videos to help with diagnosis.

Your child may need additional tests. Your doctor may order an MRI to look for any brain abnormalities or genetic testing to check for an inherited cause.

Seizure Mimickers

As part of the diagnostic process, your care team will look for seizure mimickers — conditions that look like seizures but don’t involve abnormal brain electrical activity. These include:

• Colic or reflux (in infants)
• Daydreaming
• Movement disorders
• Syncope (fainting)

How Is Epilepsy Treated in Children?

If the diagnosis is epilepsy, the pediatrician or neurologist can refer your child to our Epilepsy Center. The specialists there will determine the best approach based on the type and cause of seizure and how your child responds to different treatments. Medication is the most common treatment. But your child’s doctor may recommend other treatments, especially if medication doesn’t control the seizures.

Medication

Anti-seizure medications are usually the first line of treatment. The majority of children with epilepsy have good seizure control if they take medications as instructed. Many medications are available, and your care team will choose the best one for your child’s particular needs.

For certain rare genetic epilepsy conditions, your doctor may start medication before seizures begin to help lower the risk of epilepsy. Researchers continue to explore this still-new approach.

If your child’s epilepsy continues despite medications, your doctor may recommend dietary therapy, surgery or a medical device.  

Special Diets

Some children benefit from a high-fat, low-carbohydrate diet, such as a ketogenic diet or a modified Atkins diet. Both can reduce seizure frequency. Lurie Children’s has four dedicated ketogenic dietitians to help families manage these diets.

Surgery 

If medications don’t stop the epileptic seizures, your doctor may consider surgery. 

• Laser surgery uses a tiny laser to target the problem area. It requires a much smaller incision and shorter hospital stay than traditional surgery.
• Resection surgery removes the exact part of the brain causing seizures.
• Disconnection surgery disconnects the two hemispheres of the brain to prevent the spread of seizure activity from one side to the other. 

Implanted Devices

If medications are unsuccessful, your doctor may recommend an implanted device. 

• Deep brain stimulator: Implanted in the brain, this device sends electrical impulses to regulate abnormal brain activity and control seizures.
• Responsive neurostimulator (RNS): Implanted within the skull, this device records and watches the brain for abnormal activity. It then sends electrical pulses to abort seizures.
• Vagal nerve stimulator: Implanted in the chest, this device sends indirect electrical pulses to the brain via the vagus nerve to help prevent or lessen seizures. (The vagus nerve extends from the brainstem into the neck and into the chest. It helps control several functions, including digestion, heart rate, mood and movement.)

What Is Lurie Children’s Approach to Epilepsy Care?

We take a personalized, team-based approach to diagnosis and treatment, ensuring your child receives the best possible care. 

Our specialists use advanced tools such as video EEG monitoring, various types of neuroimaging and genetic testing. These tools help us identify seizure causes and develop targeted treatment plans. We offer a full range of treatments. Patients also have access to clinical trials, providing the latest innovations in epilepsy care.

Beyond medical treatment, we support your child and your family with knowledge, resources and compassionate care. Our team includes dietitians, genetic counselors, neuropsychologists, school liaisons and social workers who help ensure comprehensive, child-centered care.

Is There a Connection Between Epilepsy and Other Conditions? 

Yes, there is significant overlap, especially with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD):

• ADHD: Research suggests that between 30 and 40 percent of children with epilepsy also have ADHD, compared to roughly 11 percent of children in the general population.
• ASD: Autism is more common in children with epilepsy, and epilepsy is more common in children with autism. Approximately 20 to 30 percent of children and teens with ASD develop epilepsy by adulthood. Compare that to 1 to 2 percent in the general population.

Living With Epilepsy

Early diagnosis and appropriate treatment are crucial. The long-term impact of epilepsy varies from child to child. Some children outgrow their seizures, while others need lifelong care. But in either case, people with epilepsy can lead long, fulfilling lives.

Among the potential challenges: 

• Daily life: Living with epilepsy can limit independence for some patients. Certain activities, like driving, may have restrictions.
• Medical: Some children may have learning or behavioral challenges related to their seizures or medication.
  Social: Epilepsy can affect school, work and social life.

Pediatric Epilepsy Center at Lurie Children's

The Lurie Children’s Epilepsy Center is a nationally recognized comprehensive program offering expert, coordinated care for children with epilepsy and seizure disorders. The team includes more than 10 pediatric epileptologists, as well as dietitians, genetic counselors, neuropsychologists, nurse practitioners, nurses, school liaisons and social workers. By integrating medical expertise with family-centered support, we work together to help children manage epilepsy, maximize their developmental potential and lead fulfilling lives.

Learn more about Lurie Children’s Epilepsy Center.