Pediatric Epilepsy

Seeing your child have a seizure can be frightening. If your child has epilepsy, you may have questions about what caused the seizures, whether they will happen again and how epilepsy will affect your child's life. The good news is that many children with epilepsy can control their seizures with treatment and continue to learn, play and participate in the activities they enjoy.

At UVA Health Children's, pediatric neurologists and epileptologists, doctors who specialize in epilepsy, have extensive experience diagnosing and treating children with seizures and epilepsy. Our epilepsy program is certified by the National Association of Epilepsy Centers (NAEC) as a Level 4 epilepsy center, the highest designation for epilepsy care possible. This means your child has access to comprehensive evaluation and treatment, including advanced testing, medications, dietary therapies, devices and epilepsy surgery when appropriate.

What Is Epilepsy?

A seizure happens when there is a sudden burst of abnormal electrical activity in the brain. A child can have a seizure for many reasons, including fever, illness, an injury or changes in blood sugar or electrolytes. Epilepsy is a neurological condition in which a child has an ongoing tendency to have seizures.

Epilepsy can begin at any age, including during infancy. There are many different types of epilepsy, and seizures can look very different from one child to another. Some children have seizures that affect their entire body, while others have brief or subtle changes in movement, behavior, awareness or sensation.

Some children eventually outgrow their epilepsy, while others need lifelong treatment. Your child's epilepsy team will consider the type and cause of seizures, how often they occur and how your child responds to treatment when developing a care plan.

Symptoms of Epilepsy in Children

Seizures do not always look like the dramatic shaking many people associate with epilepsy. Depending on which part of the brain is involved, a seizure may cause changes in movement, awareness, emotions, sensations or behavior.

Signs of a seizure may include:

• Stiffening or rhythmic jerking of the arms or legs
• Sudden loss of muscle tone or falling
• Staring and being unable to respond
• Brief periods of confusion or unusual behavior
• Repetitive movements, such as lip smacking or picking at clothing
• Sudden muscle jerks
• Temporary changes in vision, hearing, smell or other sensations
• Unusual fear, confusion or other sudden emotional changes
• Loss of bladder or bowel control
• Temporary loss of awareness

Some seizures are so brief that they can be difficult to recognize. Your child's teacher, caregiver or other family member may notice changes that you have not seen at home.

After a seizure, your child may be confused, sleepy, have a headache or have difficulty remembering what happened. Some children return to normal quickly, while others need more time to recover.

What Causes Epilepsy?

There is not always a clear cause of epilepsy. Possible causes include differences in how the brain developed, genetic conditions, brain injuries, infections, stroke or other neurological conditions.

In some children, epilepsy is associated with a genetic condition or structural difference in the brain. In others, testing does not identify a specific cause.

Understanding the cause of your child's epilepsy can help their doctors determine the best treatment. Your child's evaluation may include genetic testing, brain imaging or other specialized tests when appropriate.

Diagnosing Epilepsy in Children

Diagnosing epilepsy involves more than simply determining whether your child has had a seizure. Your child's neurologist will want to understand exactly what happened, how long it lasted and what your child was doing before and after the event.

Diagnosis may include:

• Medical history and neurological examination to understand your child's symptoms and development
• Electroencephalogram (EEG) to record electrical activity in the brain and look for patterns associated with seizures
• Video EEG monitoring to record your child's brain waves and behavior at the same time
• Brain imaging, such as an MRI, to look for structural differences or other potential causes
• Genetic testing when a genetic cause of epilepsy is suspected
• Blood or other laboratory tests when doctors need to look for medical conditions that could contribute to seizures

Keeping a record of your child's seizures can also be helpful. If it is safe to do so, a video of an unusual event can give your child's neurologist valuable information about what happened.

Epilepsy Treatment for Children

Treatment depends on your child's type of epilepsy, the cause of their seizures, their age and other health and developmental needs. Our specialists have experience with the full range of epilepsy treatments.

Epilepsy Medications

Most children with epilepsy begin treatment with an anti-seizure medication. There are many medications available, and your child's epileptologist will choose one based on the type of seizures your child has and their individual needs.

Some children become seizure-free with their first medication. Others may need to try different medications or combinations of medications to find the treatment that works best.

Your child's team will monitor both seizure control and possible medication side effects. Never stop an anti-seizure medication suddenly without talking with your child's doctor.

Ketogenic and Other Dietary Therapies

For some children, changing the way the body uses energy can help control seizures. The ketogenic diet is a high-fat, low-carbohydrate diet used under close medical supervision to treat certain types of epilepsy.

Other dietary therapies may also be appropriate for some children. These treatments require careful planning to make sure your child receives enough calories, vitamins and nutrients for healthy growth.

Epilepsy Devices

Some children whose seizures are not adequately controlled with medication may benefit from an implanted device that changes electrical activity in the brain or nervous system.

Device-based treatments may include vagus nerve stimulation (VNS) and other neuromodulation therapies. Your child's epilepsy team will determine whether a device is appropriate based on the type and severity of their seizures and their overall health.

Epilepsy Surgery

If seizures continue despite appropriate medications, your child may have drug-resistant epilepsy. In some cases, surgery can reduce or even eliminate seizures.

Before surgery, your child undergoes an extensive evaluation to determine exactly where seizures begin and whether that area can be safely treated. Testing may include prolonged video EEG monitoring, brain imaging, neuropsychological testing and other specialized studies.

Epilepsy surgery can take different forms. Some procedures remove or disconnect the part of the brain where seizures begin. Other procedures may use less invasive techniques to destroy or disrupt seizure-producing tissue. For children who are not candidates for seizure-removing surgery, other surgical or neuromodulation approaches may help reduce seizures.

Pediatric Epilepsy Monitoring Unit

Our Pediatric Epilepsy Monitoring Unit (PEMU) is a child-friendly inpatient facility designed specifically for children with seizures. During an admission, your child can have continuous video EEG monitoring, allowing our team to see what is happening in the brain during suspected seizures.

Monitoring can help doctors:

• Determine whether unusual events are seizures
• Identify the type of seizure your child is having
• Locate where seizures begin in the brain
• Adjust or evaluate seizure medications
• Determine whether your child may benefit from epilepsy surgery or another treatment

The PEMU is staffed by pediatric neurologists and epileptologists, nurses, EEG technologists and other specialists experienced in caring for children with epilepsy.

Helping Your Child Live With Epilepsy

Managing epilepsy involves more than controlling seizures. Some children with epilepsy also experience challenges with learning, attention, behavior, mood, sleep or development. These concerns can be related to the underlying cause of epilepsy, seizures themselves or medication side effects.

Your child's care team can help identify these challenges and connect your family with appropriate support. Depending on your child's needs, care may include developmental services, physical, occupational or speech therapy, neuropsychological evaluation, school accommodations or behavioral health support.

We also help families understand seizure first aid, medication safety and precautions for activities such as swimming and sports. Your child's doctor can help you determine which activities are safe and what precautions are appropriate.

Comprehensive Epilepsy Care at UVA Health Children's

Epilepsy can change as your child grows. Our team provides ongoing care to help control seizures while supporting your child's development, education and quality of life.

At UVA Health Children's, families have access to comprehensive pediatric epilepsy services, including advanced diagnostic testing, medication management, dietary therapies, implanted devices and epilepsy surgery. Our specialists work together to determine the least invasive treatment that can provide the best possible seizure control for your child.

PEMU Resources

• Welcome to the Pediatric Epilepsy Monitoring Unit (Pediatric EMU) (PDF)

•  Preparativos para su Ingreso en la Unidad de Monitorización de Epilepsia para Adultos (EMU por sus siglas en inglés): Qué Puede Esperar (PDF)

• What to expect when having an EEG (PDF)
• Emma Acude a la Unidad de Motorización de Epilepsia (UME) de UVA Health para Someterse a un Electroencefalograma por Vídeo (PDF)

Epilepsy Health Care Transition Clinic

Some forms of epilepsy resolve during childhood. But others continue into adulthood. Being a young adult already comes with a lot of change. Managing epilepsy adds a layer. But we can help. 

The Epilepsy Transition Clinic helps young adults with epilepsy navigate this challenging time. Whether they need help managing their epilepsy or support for daily living, we work to meet each individual's needs. 

This clinic helps us bridge care from pediatrics to adult, so that each person's care is continuous.