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Epilepsy is a disorder that causes seizures or convulsions due to abnormal activity of brain cells, called neurons. The disorder may be caused by head injury, trauma, brain tumors or infections, such as meningitis or encephalitis. Conditions at birth or before birth also may lead to epilepsy, including an insufficient supply of oxygen to the brain, bleeding in the brain or abnormal blood vessels. But in many cases, the cause is unknown.
Some types of epilepsy run in families and have been tied to specific genes. Epilepsy may occur at any age, but it typically develops in early childhood.
The Epilepsy Center at UCSF Benioff Children's Hospital is dedicated to the comprehensive diagnosis and treatment of infants, children and adolescents with epilepsy. Our neurologists and neurosurgeons are among the nation's leading epilepsy experts and will work closely with you to identify the specific type of seizure affecting your child and develop the best possible treatment plan.
Most children with epilepsy experience more than one type of seizure. The two types of seizures are generalized or partial, depending on the part of the brain where a seizure is triggered.
Generalized seizures result from electrical impulses arising from the entire brain. They typically occur without warning. There are six types of generalized seizures.
Partial seizures, also known as local or focal seizures, originate from activity in a smaller part of the brain. They are divided into simple and complex seizures, as well as those that evolve from partial-onset seizures into generalized tonic-clonic seizures. The difference between simple and complex seizures is that during simple partial seizures, your child will retain awareness. During complex partial seizures, your child will lose awareness.
In the United States, about 2 million people have epilepsy, including 300,000 children under the age of 14.
To determine if your child has the condition, a team of doctors and other medical professionals at the UCSF Epilepsy Center will assess your child's medical condition and determine the type of seizures your child is having. This information is essential in determining the best treatment for your child.
The first step is documenting your child's medical history as well as your immediate family's medical history. We will ask many questions about what occurs when your child has a seizure. Some of the questions will include:
If your child's primary care doctor has sent your child's medical records, we will review this information. Be sure to tell the neurologist about any medications your child is currently taking, including over-the-counter medications, vitamins, nutritional supplements or herbal remedies.
Your child will also have a complete neurological examination. This may include scheduling for certain tests, such as:
Your child's team of doctors and health professionals will design a treatment plan for your child's specific needs, a plan that may include more than one kind of treatment. Your child also may be referred to additional doctors or other medical professionals.
Most medical treatments involve some risks or complications. We will explain possible risks or complications related to your child's treatments. Feel free to ask questions about your child's treatment.
In many cases, seizures can be successfully prevented with medications. There are more than 20 medications used to treat seizures in children. Many of these are not formally approved for children but are very commonly used in the pediatric population.
The type of medication your child will receive depends on many factors and every child is different. Your child's neurologist will explain how to take the medication and the side effects that may occur. Over time, your child's medication regimen may be changed. It is very important that your child take the medication exactly as directed. Call your neurologist if you have any questions about the medications or if your child is experiencing unexpected side effects.
If the first medication chosen is not effective, your doctor will discuss the next medication option. The goal is for your child to have no seizures and no side effects, and the treatment plan may change at any time depending on how your child responds. Some children require two to three medications to control their seizures; monitoring for side effects while on these combinations is very important.
Some patients do not respond to medications and continue having seizures. In these cases, other testing and treatments may be recommended.
Surgery is often considered if medications fail to control seizures. There are many different types of surgical procedures used to prevent seizures.
If surgery is an option, your child will undergo additional tests to pinpoint the location of the seizures. These tests include inpatient video EEG monitoring, high-resolution MRI, magenetoencephalography (MEG), brain PET scans or SPECT scanning. Once the presurgical evaluation is complete, your doctor will discuss what type of surgical procedure is the best option for your child.
Procedures used to control seizures include:
Temporal lobectomy, in which a portion of the temporal lobe is removed to control seizures.
Lobar resection, in which a portion of a seizure-producing lobe — frontal, parietal or occipital lobe — is removed, if it can be done without damaging vital functions.
Hemispherectomy, in which one sphere of the brain is removed or disabled. The remaining half of the brain takes over many of the functions of the half that was removed. This procedure is used to treat severe conditions that have not responded to other treatments.
Vagus nerve stimulation helps prevent or lessen the severity of seizures in children when open brain surgery is not an option. Children with a vagus nerve stimulator continue to take medication, but can sometimes reduce the amount or number of medications.
This special high-fat, low-protein, no-carbohydrate diet has been recommended for many years for some children with epilepsy that do not respond to medications. The diet mimics certain effects of starvation, which helps to prevent seizures.
Our pediatric dietitian has specialized training in starting and managing the ketogenic diet. This treatment involves an initial clinic visit, followed by a three- to four-day hospital stay when a team of doctors will follow your child closely and train the caregivers on how to make each meal.
This can be a very effective treatment, with approximately 25 percent of children becoming seizure-free and another 50 percent having more than a 50 percent reduction in seizures. While these are excellent outcomes, the diet is often difficult on the child and the rest of the family. With the appropriate guidance, however, it can often be successful.
To help cope with epilepsy and reduce your child’s chance of injury from seizures, we recommend these guidelines:
UCSF Benioff Children's Hospitals medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your child's doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your child's provider.
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