Epilepsy is a medical condition that affects nearly half a million children in the United States. 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 Pediatric Epilepsy Program, part of NYU Langone’s 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. Seizures can be provoked or unprovoked. Provoked seizures, caused by fever in a young child or severe hypoglycemia, are not considered to be forms of epilepsy. Unprovoked seizures have no clear cause but can be related to genetics or brain injury. When a child has two or more unprovoked seizures, epilepsy is often the diagnosis.
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. Another, rarer, type is progressive myoclonic epilepsy. Infantile-onset epilepsy syndromes and childhood-onset epilepsy syndromes and seizure disorders are both categorized by the age at which symptoms began, among other factors. Finally, genetic and neurologic disorders can also lead to seizures in children.
Focal seizures begin with an abnormal electrical discharge in one 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 can be normal. Even if doctors can’t see an abnormality, there may be something 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 proper connections with each other.
Focal seizures can also be due to head trauma, stroke, infection, or tumors. They may involve only small regions of the brain, so that a child remains completely aware when they are having a seizure.
Focal seizure symptoms often relate to the area or lobes of the brain from which the seizures start.
Temporal lobe 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 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 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.
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. They may be caused by a lesion in the occipital lobe, or their cause may be unknown.
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 are also relatively rare in children. The parietal lobe, located near the center of the brain, is responsible for processing information about the senses 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.
Symptoms of gelastic epilepsy may include brief, repeated seizures characterized by uncontrollable laughter that has no known cause.
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.
Generalized seizures begin with a widespread, excessive electrical discharge that involves both hemispheres, or sides, of the brain at the same time. Symptoms include blinking and staring, loss of muscle tone, stiffening of limbs, and, when the entire brain is involved, rhythmic, full-body jerking.
Generalized epilepsies can be divided into two categories: idiopathic generalized epilepsy, in which the child is otherwise behaviorally and neurologically normal between seizures, and developmental and epileptic encephalopathies, in which intellectual and developmental problems occur between seizures.
Seizures associated with idiopathic generalized epilepsy tend to begin in the early school-age years or in the teens. The cause of this type of epilepsy is presumed to be genetic. Typically, the specific genetic abnormality is unknown, and no one else in the family is known to have epilepsy. In many cases, the cause is likely due to a combination of genes. Sometimes these epilepsies are called genetic generalized epilepsies. There are three main types of idiopathic generalized seizures.
Absence seizures are also known as “petit mal” seizures because they are very brief and do not cause your 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 them 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 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. These seizures usually begin in childhood. However, this type of seizure can occur in adults and at any age.
Generalized convulsive seizures are any seizures that cause the body to convulse. Violent muscle contractions or body spasms occur during these types of seizures.
Developmental and epileptic encephalopathies is a term used to describe syndromes that typically begin at birth or become evident during early childhood. There are several epileptic seizure disorders that are characterized as developmental and epileptic encephalopathies. Some of them are associated with multiple seizure types, but they are often generalized seizures.
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. Your child may also experience spasms, as well as tonic seizures, in which the body, arms, or legs make sudden stiffening movements. They may also have atonic seizures, in which the body’s muscles suddenly lose strength, causing their eyelids to droop and head to nod or your child to fall to the ground.
Progressive myoclonic epilepsy is rare and frequently results from hereditary metabolic disorders or neurodegenerative conditions, such as neuronal ceroid lipofuscinosis, Lafora body disease, and mitochondrial encephalopathy. In addition to seizures, symptoms may include unsteadiness, muscle rigidity, and mental deterioration.
When a disorder has a constellation of features that tend to occur together, it is termed a syndrome. Some children with seizure disorders have certain characteristics in common and have an epilepsy syndrome—defined by the age at which seizures start, seizure types, presence or absence of developmental delay, and findings on the electroencephalogram (EEG). Some examples of epilepsy syndromes in infants are listed below.
Benign familial neonatal seizures cause recurrent seizures in newborns. The seizures usually begin when the infant is about 3 days old and are brief, lasting 1 to 2 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 they are 4 months old.
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 2, with the majority of children developing it before age 7.
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 a child with infantile spasms flings their 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 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 a child is 1 year old and can be difficult to control. These types of seizures often affect a baby’s cognitive development.
Certain other types of seizures and epilepsy syndromes more commonly start in childhood. They include febrile seizures, Landau-Kleffner syndrome, Lennox-Gastaut syndrome, Rasmussen syndrome, benign Rolandic epilepsy, benign occipital epilepsy, childhood absence epilepsy, and juvenile myoclonic epilepsy.
A febrile seizure occurs when a child between 6 months and 6 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 to 5 percent of children. A child’s risk of having one is slightly increased if their 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 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, also called acquired epileptic aphasia, is a rare disorder in which a child loses their ability to speak and understand others’ speech.
The disorder may start suddenly or slowly. Typically, a child from 3 to 7 years old experiences progressive language difficulties. Seizures are infrequent and mainly occur during sleep.
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 a child is 1 to 6 years old.
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, a 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.
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.
There are two subtypes of benign occipital epilepsy—Panayiotopoulos syndrome and Gastaut-type syndrome. The type depends on your child’s age when symptoms begin. Panayiotopoulos syndrome begins when a child is 3 to 5 years old, while Gastaut-type syndrome can start at any age throughout childhood but tends to peak around the age of 8 or 9.
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.
Absence seizures are generalized seizures that usually occur in children who are 5 to 9 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 them 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 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.
Many disorders that affect the structure and function of the brain in early life can lead to epilepsy, causing seizures in children. Some genetic and neurologic disorders may lead to seizures, along with other neurologic, development, and behavioral symptoms. We treat all types of genetic and neurologic pediatric epilepsy, even the rarest forms. Some of these disorders include Rett syndrome, Angelman syndrome, tuberous sclerosis, Sturge-Weber syndrome, FOXG1 syndrome, Dup15q syndrome, and KBG syndrome. Children with autism also have a higher risk of developing epilepsy.
Rett syndrome is a neurodevelopmental disorder that causes seizures. This genetic condition typically affects girls and begins when a child is 6 to 18 months old.
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 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.
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 2 years old and are resistant to treatment.
Symptoms of FOXG1 syndrome typically develop in the second month of life and include irritability and seizures. Delayed development, difficulty walking and sitting, intellectual disability, and problems with speech and vision are also symptoms of the disorder. Most children with this syndrome have microcephaly, or a smaller head size.
Children who have Dup15q syndrome, a developmental disorder, have weak muscle tone, delays in sitting and walking, and problems with speech, language, and social interaction. Seizures, which may be difficult to control, typically develop between the ages of 6 months and 9 years.
Children who have KBG syndrome are short for their age and may have underdeveloped bones of the spine, arms, leg, head, and face. They may also experience developmental and intellectual delays. Symptoms may include seizures, starting as early as infancy or as late as the teen years. Seizures may respond to medication. Some children with KBG syndrome outgrow seizures.
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