A child who experiences a seizure should be evaluated by a pediatric epileptologist (a neurologist who specializes in seizure disorders) to identify the cause. Although having repeated seizures means a child will likely be diagnosed with epilepsy, determining the reason for the seizures is an important step in the development of a treatment plan (see Doctors Who Treat Epilepsy in Children).
Diagnosis begins with a complete physical examination as well as a medical and family history. (Because some seizure disorders can run in families, having a close relative with epilepsy can increases a child’s risk of having or developing the disorder.) Describe the seizure activity that is observed by others or experienced by the patient is essential in providing important clues as to the type of epilepsy and potential location of onset.
Additional testing is then used to better localize the area of onset of seizure activity:
An electroencephalograph (EEG) records electrical activity in the brain. Children with epilepsy often have abnormal electrical patterns even when not experiencing a seizure. EEGs can therefore provide helpful information both during and between seizures.
Imaging tests can reveal internal structures of the brain and identify lesions responsible for seizures. Magnetic resonance imaging (MRI) produces tiny “slices” of images of the brain. These scans can detect structural abnormalities as well as tumors and vascular malformations, providing important clues as to the source of the epilepsy. Since these scans require a patient to remain still, young children usually need to be sedated for these tests in order to obtain good images.
Positron emission tomography scans (PET scans), SPECT scans, MEG scan, and functional MRI (fMRI) scans can provide a real-time view into the brain's activity during and between seizures to help locate the focal points for seizures. They can help determine whether a child is a good candidate for surgery and this information can be used to guide safe surgical approaches to identified areas of seizure onset. (see Surgery for Epilepsy in Children).
Genetic and developmental tests are also helpful in diagnosing epilepsy in specific cases.
Medication is the first step in a treatment plan for epilepsy, and it is often very effective in controlling seizures. There are several different types of epilepsy medication, not all of which are approved for use in children. It is common for a patient to try a few different medicines before finding one that works to control seizures. Medication works to control seizures in as many as 75 percent of patients. These patients typically remain on medical treatment for life.
If two different medications fail to control seizures, it’s unlikely that another medication will help. Since uncontrolled seizures can lead to brain damage – and even mild seizures can cause social isolation and emotional distress – children whose seizures can’t be medically controlled are described as medically refractory and should be evaluated for surgery. Medically refractory epilepsy occurs in 25 percent of patients with seizures.
Localizing the Seizures
The first step in determining whether a child is a good candidate for surgery is determining where the seizures start, a process called “localizing” the seizure onset zone(s). If the seizures begin in one small part of the brain, and that area is a safe area to remove, surgery may represent a cure or may greatly reduce the number and severity of the seizures. To localize the seizures, a multidisciplinary team consisting of neurologists, neurosurgeons, neuroradiologists, neuropsychologists, nurse specialists, language therapists, and occupational and physical therapists works together to find evidence that points to a particular part of the brain as the source of seizures. These teams are found at major medical centers and include the Comprehensive Epilepsy Center at NewYork-Presbyterian/Weill Cornell Medical Center (see Doctors Who Treat Epilepsy in Children).
If a child’s seizures can be localized, the team may recommend surgery as the best option for controlling seizures and even curing the epilepsy (see Surgery for Epilepsy in Children).
Reviewed by: Caitlin Hoffman, M.D.
Last reviewed/last updated: January 2021