Types of Epilepsy & Seizure Disorders in Children

Epilepsy is a medical condition that affects about 1 percent of all children. It can affect children at any age, from birth through adolescence. Some children outgrow it, and for others it’s a lifelong condition.

At the Comprehensive Epilepsy Center, specialists from Hassenfeld Children’s Hospital at NYU Langone distinguish among the many types of epilepsy and seizure disorders affecting children.

A seizure is an excessive surge of electrical activity in the brain that can cause a variety of symptoms, depending on which parts of the brain are involved. Epilepsy is a neurological disorder in which a person has two or more unprovoked seizures. “Unprovoked” seizures have no clear cause, such as alcohol withdrawal, heart problems, or hypoglycemia, which is extremely low blood sugar levels.

Seizures may be the result of genetics or a brain injury, but often their cause is unknown. The words “seizure disorder” and “epilepsy” are often used interchangeably. However, “provoked” seizures, such as those due to a fever in a young child or severe hypoglycemia, are not considered to be forms of epilepsy.

Epilepsy and seizure disorders in adults and children can differ. Regardless of a person’s age, however, seizures are categorized into two main types: focal, which are also called partial seizures, and generalized.

Focal Seizures

Focal seizures begin with an abnormal electrical discharge in one small region of the brain. They are further categorized by their effect on a child’s consciousness, responsiveness, and memory.

Symptoms can include changes in behavior, thinking, or movement. A focal seizure can spread to the other side of the brain, causing a tonic-clonic seizure, which is a generalized seizure that leads to a loss of consciousness.

Focal seizures may be caused by an underlying structural abnormality in the brain. However, MRI scan results are often normal. Even though doctors can’t see an abnormality, they presume something is wrong with the neuron, or brain cell, connections in the area. A child may have a cortical dysplasia, in which a region of the brain did not develop as it should, with brain cells failing to form in proper layers.

Focal seizures can also be due to head trauma, stroke, infection, or tumors. They can be so mild that a child remains completely aware during the seizure.

Temporal Lobe Seizures

Temporal lobe seizures, a category of focal seizures, are the most common type of epilepsy in both children and adults. The temporal lobe is located beneath the temples, on either side of the head. It is responsible for memory, emotions, interpreting sounds, and understanding language.

Seizures in the temporal lobe vary in intensity. Sometimes they are so mild children barely notice them, or they notice only an odd sensation in the stomach or a “funny” smell.  At other times a child or teen may feel consumed by feelings of fear and anxiety or a sense of déjà vu or loss of reality.

People with temporal lobe seizures tend to perform repetitive movements during seizures. These are called automatisms and may include lip smacking and rubbing the hands together.

Frontal Lobe Seizures

Frontal lobe epilepsy is the second most common form of epilepsy. The frontal lobe is located beneath the forehead and is the part of the brain responsible for decision-making, problem solving, and emotions.

Depending on the area of the frontal lobe involved, symptoms may include night waking, thrashing, and bicycling movements of legs or arms. These seizures often occur at night, during sleep.

Occipital Lobe Seizures

The occipital lobe is located at the back of the brain, behind the parietal and temporal lobes. This is the site of the brain’s visual system.

Occipital lobe seizures are rare in children. Their cause may be unknown, or a child may have a lesion in the occipital lobe.

The first sign of an occipital lobe seizure can be visual hallucinations of flickering or colored lights, although these aren’t always present. Symptoms may occur spontaneously or can be triggered by visual stimuli, such as flashing lights or a repeating pattern.

Occipital seizures are often mistaken for migraine headaches because they cause similar symptoms, including visual disturbances, partial blindness, nausea, vomiting, and a headache.

Parietal Lobe Seizures

Parietal lobe seizures are also relatively rare in children. The parietal lobe, located near the center of the brain, is responsible for processing information about the sense of touch, pain, and space.

Parietal lobe epilepsy may result from head trauma, birth injury, stroke, tumor, or unknown causes. Symptoms can start at any age and may include a feeling of tingling or burning in the hands or feet.

Generalized Seizures

Generalized seizures begin with a widespread, excessive electrical discharge that involves both hemispheres, or sides, of the brain. Symptoms include blinking and staring, loss of muscle tone, stiffening of limbs, and, when the entire brain is involved, rhythmic, full body jerking.

Seizures that begin in both hemispheres of the brain at the same time are characteristic of a type of epilepsy that is called primary generalized epilepsy or idiopathic generalized epilepsy.

The cause of these types of seizures is often unknown and presumed to be genetic. Usually, the specific genetic abnormality is not known, and no one else in the family is known to have epilepsy.

There are three main types of generalized seizures.

Absence Seizures

Absence seizures are also known as “petit mal” seizures because they are very brief and do not cause the child to fall or have significant shaking movements.

In a typical absence seizure, a child suddenly stops moving and begins staring and blinking. Sometimes, a child experiences a mild loss of body tone, causing him or her to lean forward or backward slightly.

These seizures usually last only a few seconds, and there is no confusion before or after the seizure.

Myoclonic Seizures

These seizures cause brief, shock-like jerking movements in a muscle or a group of muscles, usually on both sides of the body at the same time.

Myoclonic seizures usually begin in childhood. However, this type of seizure can occur in adults and at any age.

Generalized Convulsive Seizures

Generalized convulsive seizures are any seizures that cause the body to convulse. Violent muscle contractions or body spasms occur during these types of seizures.

Symptomatic Generalized Epilepsy

Symptomatic generalized epilepsy is a term sometimes used to describe syndromes that typically begin at birth or become evident during childhood. There are several epileptic seizure disorders that are characterized as symptomatic generalized epilepsy, some of which are associated with multiple seizure types.

Children with these types of epilepsy have an underlying brain disorder or injury or a genetic condition. This may include cerebral palsy, head trauma, infection, developmental malformations, or chromosomal abnormalities. Most often, a child with this type of seizure has developmental delays in addition to the seizures.

The seizures can be of any type, including generalized convulsions and focal seizures. The child may also experience spasms, as well as tonic seizures, in which the body, arms, or legs make sudden stiffening movements. He or she may also have atonic seizures, in which the body’s muscles suddenly lose strength, causing the eyelids to droop and the head to nod or the child to fall to the ground.

Progressive Myoclonic Epilepsy

Progressive myoclonic epilepsy is rare and frequently results from hereditary metabolic disorders, such as neuronal ceroid lipofuscinosis and mitochondrial encephalopathy. In addition to seizures, symptoms may include unsteadiness, muscle rigidity, and mental deterioration.

Reflex Epilepsy

In reflex epilepsy, seizures are triggered by specific stimuli in the environment. If flashing lights trigger a seizure, for instance, this is called photosensitive epilepsy. Reflex epilepsy usually begins in childhood and is often outgrown by adulthood.

Environmental triggers may also include sounds, such as the ringing of church bells. A certain song or type of music or the sound of a person’s voice may also trigger seizures in children with this type of epilepsy.

For some children, seizures can be provoked by activities such as reading, writing, solving math problems, and even thinking about a certain subject. These nonvisual stimuli may trigger generalized or focal seizures.

Neonatal Onset Epilepsy Syndromes and Seizure Disorders

Neonatal forms of epilepsy and seizure disorders begin between birth and 28 days of life.

Ohtahara Syndrome

Ohtahara syndrome is a rare type of epilepsy that develops in newborns, often within the first two weeks of life. The seizures are primarily tonic seizures but may also include partial seizures and myoclonic seizures. Ohtahara syndrome is often caused by metabolic disorders or brain damage, although in many babies the cause cannot be determined.

Some babies with Ohtahara syndrome die within weeks or months after symptoms begin. Others develop permanent mental and neurological problems. Some babies with Ohtahara syndrome go on to develop other types of epilepsy. These include West syndrome, which usually occurs within a few months after seizures begin, and Lennox-Gastaut syndrome, which can develop around age two, with the majority of children developing it before age seven.

Benign Familial Neonatal Seizures

Benign familial neonatal seizures cause recurrent seizures in newborns. The seizures usually begin when the infant is about three days old and are brief, lasting one to two minutes.

This condition causes generalized tonic-clonic seizures, which affect the entire body, causing muscle rigidity, convulsions, and loss of consciousness. It involves both sides of the brain.

In most infants, benign familial neonatal seizures stop by the time the child is four months old.

Infantile Onset Epilepsy Syndromes and Seizure Disorders

Several types of epilepsy begin in the first year of life. Types of epilepsy and seizure disorders that start during infancy include the following.

Infantile Spasms

Infantile spasms, also known as West syndrome, are rare. This is a severe type of epilepsy syndrome that begins in children who are 3 to 12 months old.

These seizures consist of a sudden jerking movement followed by stiffening. Sometimes the child flings his or her arms out as the body bends forward.

A brain disorder or injury, such as birth trauma with oxygen deprivation, precedes these seizures in 60 percent of infants who have this condition. In the other 40 percent, no cause can be determined.

Dravet Syndrome

Dravet syndrome is a severe type of epilepsy syndrome often resulting from a gene mutation that causes abnormalities in sodium channels in the brain, which play a role in nerve cell communication. Seizures generally begin before the child is one year old and can be difficult to control. These types of seizures often affect a baby’s cognitive development.

Neurologic Disorders

There are several neurologic disorders that may lead to an epileptic syndrome, causing seizures in children.

Rett Syndrome

Rett syndrome is a neurodevelopmental disorder that causes seizures. This genetic condition typically affects girls and begins when the child is 6 to 18 months old.

Angelman Syndrome

Angelman syndrome is a type of epilepsy syndrome that causes learning difficulties, speech delays, and certain behavioral characteristics, such as a cheerful mood and bursts of sudden and unexplained laughter. The condition is a genetic disorder that usually develops when babies are 6 to 12 months old.

Tuberous Sclerosis

Tuberous sclerosis is a rare genetic disease that causes benign tumors to grow in multiple organs of the body, such as the brain, skin, kidneys, lungs, and heart. When these tumors are in the brain, they trigger seizures.

The condition often appears during the first 12 months of life. It can also cause autism and developmental or neurocognitive delays, although about 33 percent to 40 percent of children with this condition have no neurocognitive delay.

Sturge-Weber Syndrome

Seizures occur in children with Sturge-Weber syndrome, a congenital neurological disorder, due to abnormalities in the blood vessels lining the brain. Children with Sturge-Weber syndrome often have a port wine stain birthmark on the forehead and upper eyelid of one side of the face.

There is a greater likelihood of intellectual impairment when seizures start before a child is two years old and are resistant to treatment.

Childhood Onset Epilepsy Syndromes and Seizure Disorders

Certain other types of seizures and epilepsy start in childhood. They include the following.

Febrile Seizures

A febrile seizure occurs when a child between six months and six years old has a tonic-clonic seizure plus a high fever, which may occur as a result of a viral illness.

Febrile seizures occur in 2 percent to 5 percent of children. A child’s risk of having one is slightly increased if his or her parents, siblings, or other close relatives have had one. The peak age for this type of seizure is about 18 months old.

Febrile seizures can last as briefly as a minute or 2 or continue for 30 minutes or longer. Usually, hospitalization is not necessary, although you should contact your child’s doctor after the first seizure occurs.

Landau-Kleffner Syndrome

Landau-Kleffner syndrome, also called acquired epileptic aphasia, is a rare disorder in which a child loses his or her ability to speak and understand others’ speech.

The disorder may start suddenly or slowly. Typically, a child from three to seven years old experiences progressive language difficulties. Seizures are infrequent and mainly occur during sleep.

Lennox-Gastaut Syndrome

Lennox-Gastaut syndrome is an uncommon form of epilepsy that causes difficult-to-control seizures, including tonic, atonic, prolonged absences, and generalized convulsions. Almost all children who have Lennox-Gastaut syndrome have cognitive and developmental delays.

These seizures usually begin when the child is one to six years old.

Rasmussen Syndrome

Rasmussen syndrome is rare and usually begins in children who are 14 months to 14 years old. The condition is associated with progressive neurologic deterioration and seizures. Seizures often occur first, and mild weakness in an arm or leg usually follows.

Rasmussen syndrome causes progressive weakness on one side of the body, as well as intellectual disability. If the disorder affects the left side of the brain, which controls most language tasks, the child may experience language loss, called aphasia.

Weakness and other neurologic problems often begin one to three years after the seizures start, and imaging scans of the brain often show evidence of a slow loss of neurons. Recent studies suggest that the cause of Rasmussen syndrome is an autoimmune disorder triggered by a viral infection.

Gelastic Epilepsy

Symptoms of gelastic epilepsy may include brief, repeated seizures characterized by laughter that has no known cause and is not controllable.

These seizures are often the result of small benign tumors in the base of the brain, called hypothalamic hamartomas, that affect the hypothalamus. These seizures can also occur with frontal or temporal lobe seizures that are usually not due to benign tumors.

Benign Rolandic Epilepsy

Benign rolandic epilepsy, also called benign epilepsy of childhood with centrotemporal spikes, is one of the most common childhood seizure disorders. Seizures typically begin when children are 2 to 13 years old.

Seizures associated with benign rolandic epilepsy most commonly feature twitching, or they may involve numbness or a tingling sensation in the face or tongue, which can cause garbled speech. They often occur as a child is falling asleep or waking up.

These seizures typically stop by the time a child is 19 years old.

Benign Occipital Epilepsy

There are two subtypes of benign occipital epilepsy—Panayiotopoulos syndrome and Gastaut-type syndrome. The type depends on the child’s age when symptoms begin. Panayiotopoulos syndrome begins when a child is three to five years old, and Gastaut-type syndrome can start at any age throughout childhood but tends to peak around the age of eight or nine.

Seizures associated with this condition originate in the occipital lobe of the brain. Symptoms often include visual hallucinations, a loss of vision, nausea, headaches, and vomiting. Hallucinations tend to involve brightly colored shapes of all sizes. Children may experience jerking movements on one side of the body.

Because it involves visual changes and headaches, this form of epilepsy may be mistaken for a migraine headache.

Childhood Absence Epilepsy

Absence seizures are generalized seizures that usually occur in school-age children who are five to nine years old. Typical absence seizures involve a sudden cessation of movement, with staring and blinking. Sometimes a child may experience a mild loss of body tone, causing him or her to lean forward or backward slightly.

Unlike other types, absence seizures occur without an aura, or warning. Many children with this form of epilepsy have typical intellectual abilities. However, some children may have developmental and intellectual impairments and experience other types of seizures as well.

Juvenile Myoclonic Epilepsy

Juvenile myoclonic epilepsy is one of the most common epilepsy disorders. It usually begins shortly before or after puberty or in early adulthood. Seizures usually occur early in the morning, within a few hours of waking.

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