Epilepsy in children factsheet
Introduction
Epilepsy is a long-term brain condition that causes repeated seizures.
Seizures are uncontrolled changes in your child’s movement and behaviour. They are caused by a disruption in the brain's normal electrical activity.
There are many different causes of epilepsy. These include
- genetics – traits passed down in families, even if no other family members have epilepsy
- changes in the structure of the brain
- conditions that affect the immune system
- infections in the brain
- metabolic conditions – affecting the way the brain cells process energy.
The cause of epilepsy is unknown in up to 60% of cases.
Epilepsy is not the same as seizures that:
- happen once and not again
- are caused by a high temperature or illness, like febrile convulsions.
Fewer than 5% of children who have febrile convulsions are diagnosed with epilepsy.
Signs and symptoms
The main sign of epilepsy is having seizures more than once, not just from something temporary like a fever.
There are a few different types of seizures that can happen in children. The way a seizure affects your child depends on which part of their brain has been affected.
Your doctor will look at the types of seizures your child has to help find out what type of epilepsy they have. This is called an epilepsy syndrome.
Some epilepsy syndromes have more than one type of seizure.
Generalised seizures
Generalised seizures involve the whole brain. They include:
- absence seizures – your child may stare and not respond for a few seconds, they might have twitching of their eye lids
- myoclonic seizures – one muscle or a group of muscles jerk or twitch quickly, then stop
- clonic seizures - muscles jerk or twitch over and over again
- tonic seizures – the body suddenly becomes stiff
- tonic-clonic seizures – a combination of tonic and clonic, where the muscles stiffen, jerk and twitch.
Tonic-clonic seizures are the most recognisable type of seizures.
During a tonic-clonic seizure, your child might go stiff, fall down, and start jerking rhythmically. They might also:
- bite their tongue
- wet themselves
- go blue around the mouth.
After the seizure, your child may be confused or have no memory of the event.
Focal seizures
Focal seizures affect specific parts of the brain. Your child may be conscious or unconscious, depending on which part of the brain is affected. They may stare or seem like they are not paying attention.
Focal seizures can also cause:
- Motor symptoms
- a specific part of the body will twitch, jerk or stiffen
- smacking the lips together
- fiddling with clothing
- grunting.
- Sensory symptoms
- problems with hearing
- odd feelings in a part of their body
- smelling something or seeing things that are not there.
Focal seizures can become generalised seizures if they spread to the whole brain. If this happens, your child may:
- lose consciousness
- fall over
- have stiffness and jerking, like in a generalised tonic-clonic seizure.
After the seizure, your child may be confused or have no memory of the event.
Diagnosis
Epilepsy is usually diagnosed by:
- a child health specialist, called a paediatrician
- a brain specialist, called a neurologist.
The doctor will often ask you lots of questions about the seizures. It is helpful to write down exactly:
- what your child’s seizure looks like
- each time they happen
- when they start and stop.
You can use an event record for each seizure, and an event diary if there are multiple seizures.
This can help doctors make a diagnosis.
Your child may also have tests like:
- Electroencephalogram (EEG ): a test where small sensors are placed on your child’s head to record the brain’s electrical activity.
- Video EEG: records both brain activity and a video of your child at the same time to help doctors understand seizures while your child is awake and asleep.
- MRI (magnetic resonance imaging): a scan that takes detailed pictures of the brain.
Your child’s doctor will make a diagnosis and treatment plan based on:
- results from these tests
- your child’s medical history
- records of seizure details.
Treatment
Treatment of epilepsy depends on:
- your child’s Epilepsy syndrome
- their age
- their medical history
- the types of seizures they are having.
Most children with ongoing seizures are treated with daily anti-seizure medication. Rarely, in some types of epilepsy, medication might not be needed.
Your doctor will help create a care plan, which should include:
- your child’s epilepsy details
- a treatment plan
- a first aid plan, which may include emergency medication to stop long seizures
- specific lifestyle and support advice for your child, including how to avoid triggers.
Some difficult epilepsy syndromes may not respond to initial treatments. Other treatments may be recommended, including:
- ketogenic diet – a special high-fat diet that may help control some types of epilepsy
- surgery – to remove or disconnect the part of the brain causing seizures
- vagus nerve stimulation – a device that sends small electrical signals to the vagus nerve to control epilepsy.
Management
Seizure First Aid
If your child is having a generalised tonic-clonic seizure:
- protect them from injury, especially to their head
- try to note what time the seizure starts and ends, and what happens during it
- roll them onto their side
- monitor their breathing
- stay with them and reassure them until they have fully recovered.
Do not:
- put anything in your child’s mouth, including your hand, during a seizure unless you are giving them emergency medication
- move your child during a seizure unless they are in danger.
If you think your child is having a focal seizure:
- stay calm and reassure them
- make sure they are safe and not in danger
- try to note the time the seizure starts and ends, as well as what happens during it.
Call an ambulance on triple zero (000) if:
- you are concerned about your child while they are having a seizure
- the seizure lasts longer than 5 minutes
- the seizure happens in water
- your child is injured during the seizure
- your child may have inhaled liquid or food during the seizure
- your child’s breathing doesn’t return to normal shortly after the seizure
- your child remains blue around the lips
- you are unsure if your child is recovering normally.
Seizure Safety
Most children recover well after a seizure. The main risk is injury while the seizure is happening.
Seizure safety means taking steps to stop injuries if a seizure happens during certain activities.
Some activities have higher risks for children and teenagers who have seizures. Talk to your child’s doctor before they:
- use heavy machinery or power tools
- do activities at height, like rock climbing, abseiling or building work
- take part in fast-paced activities, like skiing or track racing.
Seizure safety and swimming
It's important to think about what you would do if a child had a seizure in water, including places like:
- oceans and beaches
- rivers
- dams
- swimming pools.
Surfing and swimming in the open ocean, rivers or dams is far more dangerous than in a pool.
Always watch children closely and never leave them alone around water. Adults supervising should know how to swim and be able to assist in an emergency.
Seizure safety is important even when there are lots of people around, including:
- school carnivals
- swimming lessons
- family outings
- trips with friends.
Seizure safety and activities like bike riding or skateboarding
Make sure your child always wears a helmet to protect their head in case of a seizure, crash, or fall.
Children under 16 years should ride on bike paths or in parks, not on the road.
Teenagers over 16 years should avoid riding on busy main roads with lots of traffic, as these are more dangerous.
Seizure safety around the home
- keep doors unlocked, especially in places like the bathroom, so you can help if a seizure happens
- encourage your child to take showers instead of baths, as they are safer
- never leave your child alone in the bath.
Seizure safety and driving
There are rules and legal requirements about driving and getting a driver’s licence if your child has seizures. Talk to your child’s doctor to learn more.
If your teenager or young person already has a driver’s licence before they have a seizure for the first time, they must stop driving and see a doctor.
Daycare and school
Work with your doctor to create a seizure management plan for school or daycare, so teachers and carers know what to do.
