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?”
Repeated episodes of spontaneous electrical misfiring in the brain
Not due to temporary brain irritation (ex. high blood pressure, uncontrolled diabetes, alcohol / drug intoxication)
Misconceptions
Not “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

4. “What kind of epilepsy?”

5. “What caused my child’s epilepsy?”
SYMPTOMATIC
CAUSES
IDIOPATHIC
GENETIC

6. Chromosomal Abnormalities

8. “Does my child need to see a geneticist?”
“Chromosomal Microarray (CGH microarray)”
Tests for larger pieces of missing or extra DNA
“Whole exome genetic testing”
Tests for smaller variations in DNA

9. “Why did the seizures start now?”
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 medication stop my child’s seizures?”
~70 % controlled with 1 med
~15 % controlled with >1 med
~15 % uncontrolled
Best chance for seizure
control is if medication well
matched to seizure type(s)
Other non-medication therapies available
Increasing
Medication
Options

11. “Are the medications safe?”* * * * * * * * *

12. “Will my child have to take medication forever?”
~ 65 % of children 2 years seizure-free on medication will remain seizure free when medication stopped
If seizures restart off medication, usually stop again on med
Seizures that don’t recur off medication:
Benign Rolandic
Childhood Absence
Seizures that commonly recur off medication:
Lennox-Gastaut syndrome
Juvenile Myoclonic Epilepsy**

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

14. Increased seizure recurrence risk if neurologic exam or EEG abnormal
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 %

15. “How do I keep my child safe?”
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 (clean hands when eating a must!)
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 > 10 ft without a harness
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 a seizure?”
SUDEP – Sudden Unexpected Death of someone with Epilepsy, who was otherwise healthy.
Most common with certain seizure types if uncontrolled
Rare in children, more common in adults
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

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