1. Frequently Asked Questions in Pediatric Epilepsy
Lorraine M. Lazar, MD, PhD
Pediatric Epilepsy
Northeast Regional Epilepsy Group

2. Individualized answers may differ based on
patient diversity

3. “My child doesn’t have epilepsy, right?”

4. 326,000 children in the U.S. < 15 years old have epilepsy
“Epilepsy” = unprovoked seizures due to spontaneous electrical misfiring in the brain, not due to ‘acute’ (temporary) medical illness or temporary brain irritation
Misperceptions
NOT synonymous with
“Cerebral Palsy”
“Cognitive Disability”
“Mental Retardation”
Fragile / Sickly
NOT uncommon
326,000 children in the U.S. < 15 years old have epilepsy
200,000 new cases diagnosed each year

5. Treatment guided by eizure
Epileptic Seizure Classification
(simplified)
PARTIAL
GENERALIZED
Simple
Complex
Absence
Myoclonic
Tonic-Clonic
Tonic
Atonic

6. “What caused my child’s epilepsy?”

7. Multiple Causes of Epilepsy
SYMPTOMATIC
IDIOPATHIC

8. “Why did the seizures start now?”

9. Age Related Onset Of Childhood Epilepsy Syndromes
JME
Juvenile Absence
GTC on awakening
Childhood Absence
Rolandic
Lennox-Gastaut
Febrile Seizures
Benign Myoclonic
Infantile Spasms
Early Epil Encephalopathy
Neonatal seizures
Age (yrs) at Seizure Onset

10. “Will my child have to take medication forever?”

11. ~ 65 % of children seizure free on medication for 2 years will remain seizure free after medication discontinued
If seizures return off medication, they are typically controlled by restarting medication
Examples of low risk of seizure recurrence off medication:
Benign Rolandic
Childhood Absence
Examples of high risk of seizure recurrence off medication:
Lennox-Gastaut syndrome
Juvenile Myoclonic Epilepsy

12. Factors associated with a higher risk of
seizure relapse if medication is discontinued

13. Increased seizure recurrence risk if abnormal neurologic exam or epileptiform EEG
Non-Epileptiform
EEG
Epileptiform
NORMAL EXAM
ABNORMAL EXAM
Tonic-Clonic
30 %
51 %
47 %
73 %
Simple Partial
50 %
75 %
71 %
92 %
Complex Partial
58 %
83 %
77 %
96 %

14. “How do I keep my child safe?”

15. Medication Compliance
Regular doctor’s appointments
Pill Sorter
Inform doctor of insurance issues
Avoid seizure triggers
sleep deprivation
missing medication (forgetting, running out)
illness/fever
excessive alcohol use, illicit drug use
flashing lights
stress/anxiety

16. Know Basic Seizure First Aid (at Home and School):
Stay calm
Time the seizure
Roll onto side
Move objects away
Don’t restrain
Don’t put anything in the mouth
Be reassuring as seizure stops

17. Water Safety – minimize drowning hazard
Bathe under constant supervision (unlocked bathroom door)
Consider shower (with clear drain) over bath
Never swim alone
Wear life vest in murky water
Sports Safety:
Always wear appropriate sports safety gear (helmets a must!)
Avoid climbing heights without a harnass
Avoid bicycling in open traffic

18. Travel Safety:
Avoid sleep deprivation
Carry medications on trips
Have enough medication to last the trip
For older teens, follow DMV laws for driving
Medication Safety:
Inform your epilepsy doctor of other medications
being taken, whether prescribed or over-the-counter
Benadryl – can lower seizure threshhold

19. “Can my child die from seizure?”

20. SUDEP – Sudden Unexpected Death of someone with Epilepsy, who was otherwise healthy.
Rare in children  
More common in adults, especially if seizures uncontrolled
Cause of death in SUDEP unclear
irregular heart rhythm?
suffocation from impaired breathing, fluid in the lungs, being face down on bedding?
Best prevention is to follow treatment recommendations, including take anti-seizure medication regularly

21. “Should my child see a seizure specialist?”
YES!