Brain, Nervous System and Mental Conditions

Epilepsy

What is epilepsy?

Epilepsy is a brain condition that causes repeated seizures (SEE-zhurs). Seizures are also called convulsions or episodes. They often come on suddenly.

Seizures temporarily change your child’s state of awareness and physical activity. They also affect the senses, such as smell, vision or touch. You might not notice that some types of seizures are happening. Your child may seem to be having staring spells or twitching on one side of the face.

Having a seizure doesn’t mean your child has epilepsy. Doctors say a child has epilepsy if 1 of these applies:

  • They have 2 or more “unprovoked” seizures more than 24 hours apart. “Unprovoked” means the seizures do not happen because of a temporary problem, such as high fever (febrile seizures), chemical exposure or abnormal levels of blood sugar.
  • They have 1 seizure and there is a high risk of having another seizure. Risk is determined by the doctor’s findings from an exam and whether a child has other conditions or family members with epilepsy.
  • They have been diagnosed with an epilepsy syndrome, which has a recognized pattern of symptoms.

Epilepsy happens more often in children than in adults. In the United States 1 in 26 people will develop epilepsy.

  • Changes in the electrical and chemical activity of the brain trigger seizures. Many things can cause these changes. Seizures can start in different places in the brain.

    Head injuries, including concussion, can cause both epileptic and nonepileptic seizures.

    Seizures that are not epilepsy may be caused by:

    • Exposure to poisons, too much alcohol or certain medicines
    • High fever
    • Infections

    In a child with epilepsy, seizures may be caused by:

    • Abnormal brain development before birth (such as cortical dysplasia)
    • Genetic changes, either passed down by parents or that happen when the baby is developing before birth
    • Stroke
    • Brain tumors
    • Problems turning food into energy (if metabolic disorders are not treated)

    Doctors can’t always find the exact cause of a child’s seizures.

  • There are many kinds of seizures and different types of epilepsy. It’s important to find out what kind your child has, because they are treated differently. See our Epilepsy Program for a description of some of the conditions we treat.

Epilepsy at Seattle Children’s

The key to treating your child successfully is to accurately diagnose the type of seizures they have and the type of epilepsy or epilepsy syndrome. Our team is experienced in child development and in diagnosing and treating epilepsy.

Our Epilepsy Program is the only comprehensive epilepsy program in the Pacific Northwest especially for children and teens. We have 4 convenient locations in the Puget Sound area: Seattle, Bellevue, Everett and Federal Way.

The Epilepsy Program is part of our Neurosciences Center. Please contact us at 206-987-2016 for more information.

    • Our Epilepsy Program is the only program in the Northwest for children that is accredited level 4 by the National Association of Epilepsy Centers (NAEC). A level 4 center uses the most advanced technology to diagnose epilepsy and evaluate patients before surgery. Only level 4 centers perform a broad range of complex surgeries to treat epilepsy.
    • Seattle Children’s has the busiest pediatric epilepsy program in the Pacific Northwest and the largest program on the West Coast.
    • We are part of the University of Washington Regional Epilepsy Center, which gives our patients access to more research studies and technologies to diagnose and treat epilepsy.
    • Seattle Children’s neurology and neurosurgery programs were ranked #1 in the Northwest in 2017 by U.S. News & World Report. We are consistently ranked among the nation’s best neurosciences programs.

    • Our Epilepsy Program brings together experts in:
      • Epilepsy (epileptologists)
      • The brain and nervous system (neurologists)
      • Brain surgery (neurosurgeons)
      • Behavior and learning (neuropsychologists)
      • Making detailed images of the brain and nervous system (neuroradiologists)
      • Genetics (geneticists)
      • Development of the brain, nerves and senses (neurodevelopmental pediatricians)
      • Rehabilitation medicine
    • Our board-certified doctors and nurse practitioners all have focused training and experience in treating children with seizures.
    • We care for your whole child. We don’t just treat their epilepsy. Your child’s team may also include experts in nutrition, social work, emotional health and other specialties as needed.
    • We stay in close communication with you – and with one another – from your child’s diagnosis through treatment and follow-up.

    • We have a specially equipped area of the hospital to carefully monitor your child’s brain activity and see how seizures affect them. Using EEG and video to study your child for several days helps us understand their seizures, make an accurate diagnosis and recommend the best treatment.
    • State-of-the-art imaging equipment helps us see where seizures start in your child’s brain and protect areas that are important for speaking and moving. We use MRI scans, PET scans, SPECT scans and functional MRI to get a full picture.
    • At Seattle Children’s, our treatment options for children with epilepsy include medicines, special diets, implanted nerve stimulators, brain surgery, physical therapy, occupational therapy and speech therapy. The right choices for your child depend on their seizures.
    • Seattle Children’s is among only a handful of children’s hospitals in the country that offer laser ablation surgery. This minimally invasive procedure offers the chance to live a seizure-free life for some kids who have run out of treatment options.
    • Our services include a First Seizure Clinic. We check children who have had a seizure for the first time to learn more about the type of seizure, its cause and whether they have epilepsy.
    • In our Epilepsy Genetics clinic, our doctors work with experts in genetics and genetic counseling to discover new causes and identify the underlying reason for many of the epilepsies in children.

    • At Seattle Children’s, we have more pediatric neurosurgeons and neurosurgery nurse practitioners than any other hospital in the Pacific Northwest. Each pediatric neurosurgeon is trained to operate on the brain and nervous system and to know the unique needs of babies, children and teens, whose bodies and brains are still developing.
    • Research shows that centers that do many surgeries are more likely to have better results for their patients.
    • If your child may need surgery, we map their brain to identify which parts are critical for language, memory and movement. This careful evaluation helps us safely operate on your child.

  • Seattle Children’s doctors lead research in the lab and in the clinic to improve epilepsy treatment and quality of life for children with seizures. Our patients have the option to take part in research studies of promising new treatments. These are called clinical trials. They can be especially relevant if your child’s epilepsy is not well controlled with standard medicines or surgeries.

    Our studies include:

    • Identifying which patients are most likely to benefit from laser ablation for epilepsy
    • Using functional MRI to make surgery for seizures safer and more effective
    • Combining images from MRI, functional MRI and PET scans with the aim of making a detailed 3-dimensional model of a child’s brain to help plan surgery
    • Using brain tissue donated by patients after surgery to learn about the links between genes and epilepsy

    To learn more, see:

    • Children don’t react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them. They need a healthcare team specially trained to understand and meet their needs.
    • Our doctors have special training in how to diagnose and treat children with epilepsy. They are focused on how today’s treatment will affect your child’s brain as they develop and become adults.
    • Our experts base their treatment plans on years of experience and the newest research on what works best – and most safely – for children and teens.

    • Learning that your child has epilepsy can be stressful for the whole family. If your child has urgent needs, we see them the same day in our clinic or Emergency Department. Seattle Children’s is the only hospital in the region with coverage 24 hours a day, 7 days a week by a pediatric neurosurgeon. If needs are not urgent, we can offer appointments in 1 week.
    • During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.
    • Our doctors, nurses, child life specialists and social workers help your child and your family through the challenges of their illness. We connect you to community resources and support groups.
    • At Seattle Children’s, we work with many children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

Symptoms of Epilepsy

There are many kinds of epileptic seizures, but doctors put seizures in 3 main groups:

  • Focal seizures begin in an area or network of cells on 1 side of the brain.
  • Generalized seizures involve both sides of the brain from the start.
  • Unknown onset seizures, where the starting location of a seizure is not known.

    • Tightening of muscles on 1 side or part of the body
    • Jerking of muscles on 1 side or part of the body
    • Eyes and head move to 1 direction
    • Repeated chewing and swallowing

    • Jerking of muscles or the entire body
    • Increased stiffness (rigidity) in the entire body
    • Staring spells with blinking

    • Brief loss of memory
    • Passing out (loss of consciousness)
    • Uncontrolled peeing (urination)
    • Rhythmic mouth movements
    • Confusion and sleepiness after the seizure

Diagnosing Epilepsy

Having a seizure doesn’t mean your child has epilepsy. Your doctor will talk with you and your child and do tests to find out if your child has epilepsy.

At our First Seizure Clinic, we check children who have had a seizure for the first time to learn:

  • About the type of seizure. There are many kinds of seizures. The same person may have more than 1 type.
  • What caused the seizure.
  • Whether a child may have epilepsy.

Up to half of the children we see at the First Seizure Clinic do not have epilepsy. Of those who do, it is important to do the right testing to identify the seizure type and if they have an epilepsy syndrome. It’s important to know what type your child has, because the different types are treated differently. See our Epilepsy Program for a description of some of the conditions we treat.

We use these ways to diagnose and plan the best treatment for your child:

  • Your doctor will ask questions to learn about:

    • Your child’s general health and nutrition
    • What happens right before, during and right after a seizure
    • Symptoms your child has during a seizure
    • How long a seizure lasts
    • If there is a family history of seizures
    • If certain things trigger your child’s seizures
    • Whether seizures are related to your child’s sleep patterns, breathing or other body rhythms

  • Your doctor may test your child’s blood to check for possible causes of seizures, such as:

    • Genetic conditions
    • Disorders related to turning food into energy (metabolic disorders)
    • Exposure to drugs, chemicals or poisons
    • Abnormal levels of sugar or iron in the blood

  • To learn more about your child’s seizures, we record electrical activity in their brain using an EEG (electroencephalogram). We place small metal cups (electrodes) on the outside of your child’s head. This does not hurt.

    How we do EEG monitoring depends on what your child needs. They may have it:

    • As a day procedure in the hospital (outpatient) (PDF)
    • Using a backpack monitor at home (ambulatory) (PDF)
    • During a few days and nights in the hospital (inpatient) (PDF)

    Getting an EEG at Seattle Children’s (Video. 6:19)

    Seattle Children’s EEG team shows patients and families what to expect when getting an outpatient EEG.

  • Neuropsychological (nur-oh-sy-kuh-LAH-juh-kul) testing is a way to look at your child’s brain development and behavior. We check your child’s memory, attention, language and other skills.

    This helps us find out about your child’s strengths and weaknesses. These will be important to know as we work with you to plan treatment and help your family arrange school services or manage your child’s behavior, if needed.

Treatment Planning for Epilepsy

There are many effective treatments to prevent or reduce seizures.

Controlling seizures is very important. Frequent seizures can harm your child’s development and learning. If seizures last longer than 30 minutes, they can permanently damage a child’s brain.

Sometimes doctors stop seizures by treating an underlying problem, like diabetes, a brain tumor or concussion. For other types of epilepsy, options at Seattle Children’s include medicines, diet, implanted nerve stimulators and surgery, including less invasive laser ablation surgery. Finding the treatment that will work best for your child will take time, and your child might need many tests.

  • We have a special area in our hospital for monitoring children’s brain activity (Epilepsy Monitoring Unit). We use EEG, a painless way to record the brain’s electrical activity. We also record your child by video camera to see what happens when they have a seizure.

    The recordings give us clues to their seizures. They help us plan treatment and check how well medicine or other therapy is working for your child.

    Your child will stay in the hospital:

    • 2 days if they are having EEG testing to help us understand more about their seizures
    • 5 to 7 days if we are planning surgery

    A parent or caregiver will need to stay with your child the whole time. You know your child best and can help other members of your child’s healthcare team tell when seizures are happening.

    For more information, see Tests Before Epilepsy Surgery (PDF).

  • Imaging studies help find the underlying cause of your child’s epilepsy. Usually children have an MRI (magnetic resonance imaging) scan.

    The MRI helps doctors decide if your child’s seizures are caused by:

    • A brain tumor or other condition that needs surgery right away
    • A brain malformation or old injury that does not need immediate treatment

    When considering brain surgery, we do 2 types of brain imaging:

    • To get information on brain structure, we do MRI or CT (computed tomography) scans.
    • To learn about how your child’s brain works, we may use functional MRI or PET scans.

Medicine for Seizures

For almost all children with epilepsy, the first and most effective treatment is medicine. More than 20 medicines treat epilepsy. Different medicines are more effective for different types of seizures. These medicines are called anticonvulsants, anti-epileptics or antiseizure medicines.

Medicine helps about 2 out of 3 children with epilepsy stop having seizures. Most children and teens can control their seizures with just 1 kind of medicine. If seizures cannot be controlled by medicines alone, a child is considered to have intractable (in-TRAK-tuh-bull) epilepsy.

Our epilepsy team has access to many medicines, including some new options that are available to children who take part in research studies (clinical trials). These are especially relevant to children who have epilepsy syndromes or whose seizures are not controlled after trying 2 different medicines.

The goal of antiseizure medicine is to prevent seizures without causing major side effects. It may take a while to find the right medicine, schedule and amount. We will test your child’s blood to make sure they have the right level of medicine to control their seizures.

The blood tests also check for signs of damage to your child’s body, such as to their liver. Medicines can have side effects and may affect your child’s emotions or thinking. If this happens to your child, your doctor may be able to change the medicine.

Nutrition Therapy for Epilepsy

If medicine does not control your child’s epilepsy, their healthcare team may recommend a special diet. Diet therapy – usually combined with medicine – lessens or stops seizures for some children.

Two options are the ketogenic diet and the modified Atkins diet. Both diets limit the types of foods your child eats. The diet team will make sure your child is receiving nutrients to grow and keep a healthy weight.

Our team will help you decide if nutrition therapy is the right choice for your child. Read more about nutrition therapy.

Deciding If Surgery Is an Option for Your Child

Surgery may be a good choice to treat your child’s epilepsy in these cases:

  • Medicine does not control your child’s seizures or causes bad side effects.
  • Doctors can find a specific area in your child’s brain (a focus) that causes seizures.
  • The part of the brain where seizures start can be taken out without harming their speech, sight, memory or movement.
  • A brain tumor or other growth is causing their seizures.
  • Surgery can stop seizure activity in 1 half or region of the brain from spreading to the other side. This type of surgery is done for some severe cases of epilepsy.

Your child’s healthcare team will do many tests before deciding if surgery is the best option for your child. After the full team reviews your child’s test results, we will talk with you about next steps.

Besides EEG testing, your child will have imaging studies to show where seizures start in the brain. If the seizure area is near parts of the brain that control critical functions, we will also do tests to identify areas that control speech, memory and movement so surgery does not harm them. In some cases, testing happens during surgery as well to be sure that critical brain tissue is not removed.

Your child may get 1 or more of these tests to help decide if surgery is the best option and to help plan the safest procedure:

  • An MRI takes high-quality pictures that show small details in your child’s brain. Seeing a clear picture of these details will help us understand more about your child’s seizures and the structure of their brain.

    Seattle Children’s uses a 3.0 Tesla MRI scanner with 64 channels, which provides very fine detail of the brain and is better able to show where seizures are starting.

    Sometimes, an MRI scan can identify the part of the brain where seizures start by showing scar tissue in the brain. We compare this picture with an electrical recording of a seizure in your child’s brain. If they match, we can consider surgery to help treat seizures.

  • PET scans can show parts of the brain that are using less energy. Sometimes this helps us find where seizures start in your child’s brain.

    PET is short for positron emission tomography (POZ-uh-tron ee-MISH-un tuh-MOG-rah-fee).

    Before the test, we will place a thin tube (IV line) into your child’s vein. We add a radioactive tracer to sugar (glucose) and inject it. This lets us see the part of your child’s brain that uses glucose for energy differently from other parts.

    During the test, we will also monitor your child with an EEG for any seizures.

  • Functional brain MRI (fMRI) helps show if the brain area where seizures start is also used for important tasks like speaking. This helps guide surgery to be as safe as possible and avoids surgery if it is not the best treatment option.

    During the fMRI test, we will ask your child to do different tasks, such as tap their fingers together. We look at where brain signals start that tell your child to tap their fingers. This helps us to “map” the brain.

    Your child will be awake during the test and will need to stay very still.

  • In some cases, especially if the fMRI test shows that language or memory are happening on both sides of the brain, doctors may recommend that your child have a Wada (WAH-dah) test. This test looks at each side of your child’s brain to see which part controls language and memory. We give your child medicine to put 1 side of their brain to sleep. Then a neuropsychologist will ask your child to talk and remember simple objects. We test each side of the brain separately.

    The test takes 2 or 3 hours. Your child will have this test at the hospital and stay for 6 hours afterward.

  • If other tests don’t give enough information to decide if surgery is a good option, we may need to do surgery to place electrodes on the surface of your child’s brain to monitor for seizures. This is called invasive monitoring and may be needed if:

    • Other tests still do not show where your child’s seizures start
    • The area identified as where seizures start is too large, and we need to narrow it down

    Electrodes are small, painless sensors that record brain activity. These help your child’s healthcare team learn exactly where seizures are coming from. Pictures from MRI scans guide surgeons as they work. A wand connected to the computerized guidance system tracks the location of tools. The image-guided system allows exact placement of electrodes and avoids disruption of critical brain areas.

    fMRI grid This image combines functional MRI with a grid of electrodes placed on the brain of a patient with epilepsy. The dots are electrodes, color-coded red, green or blue depending on the brain area they cover. The red patches show areas of the brain that are active during tasks related to language, movement and the senses.

    There are several types of invasive monitoring, depending on the number of electrodes, where they need to be placed and how the surgery is done. These tests include “grid placement,” “strip placement,” “depth electrodes” and “stereo EEG.”

    Sometimes neurosurgeons remove part of your child’s skull in order to place the electrodes. In other cases, they can use robotic tools that fit through tiny holes in the skull. This is called robot-guided stereo EEG.

    Your child will stay in the hospital for 5 to 7 days for this type of monitoring. If they do not have seizures during this time, they will stay longer.

    After testing, your child’s healthcare team will do another surgery to take off the electrodes and remove some brain tissue, if possible, to try to stop the seizures.

    To learn more, see Surgery for Grid or Strip Placement (PDF).

Surgery Options for Epilepsy

If surgery is the right choice for your child, research shows it’s better to have the operation sooner rather than waiting.

To make procedures safer and more effective:

  • Before surgery we carefully identify the area of your child’s brain where seizures start and the parts of their brain needed for important functions like speech.
  • We combine images from MRI scans, PET scans and functional MRI to make a very detailed view of your child’s brain.
  • As the neurosurgeons operate, the computerized guidance system shows the exact location in your child’s brain.

In most procedures, neurosurgeons remove the part of your child’s brain where seizures appear to start. Other procedures separate the seizure focus from the rest of their brain or stop the seizure pathway. We do these surgeries to help children with epilepsy:

  • If seizures start in a well-defined area of the brain (seizure focus), surgery to remove that area may stop or reduce your child’s seizures.

    This is the most common type of surgery for epilepsy. It often helps children with abnormal brain tissue, such as:

    • Mesial temporal sclerosis, which affects part of the brain called the temporal lobe
    • Cortical dysplasia, which affects the cerebral cortex

  • Children with brain tumors that cause seizures can benefit from surgery to remove the tumor and a small amount of brain tissue around the tumor. Read more about how we treat brain tumors.

    One cause of benign (noncancerous) brain tumors is tuberous sclerosis complex (TSC). Over 80% of patients with this rare genetic disease develop epilepsy.

  • For some children, MRI-guided laser ablation surgery is an option with fewer side effects than traditional (open) surgery. This minimally invasive procedure uses light to heat and destroy unwanted cells. It is especially helpful for small tumors deep in the brain.

    Seattle Children’s is among a handful of pediatric hospitals in the country to offer laser ablation surgery for epilepsy.

    Read more about laser ablation surgery for epilepsy.

    An Inside Look at Laser Ablation Surgery (Video. 1:59)

    Dr. Jeffrey Ojemann, director of epilepsy surgery at Seattle Children’s, explains this cutting-edge treatment for epilepsy.

  • The corpus callosum is a bundle of nerve fibers connecting the right and left sides of the brain. Neurosurgeons cut part or all of the corpus callosum to stop seizures from spreading from 1 half of the brain to the other.

    This surgery helps children who have “drop-attack” seizures, where their muscles suddenly tighten and they fall down or collapse forward in a chair.

  • These surgeries treat children with seizure focus areas throughout an entire half of the outer layer of the brain (cerebral cortex). The cortex controls many complex processes. Each half is called a hemisphere.

    Your child’s neurosurgeon cuts and removes brain tissue to disconnect the affected half of the brain’s cortex from the other half. The goal is to prevent seizure activity from spreading throughout the brain.

    The surgery is called functional hemispherotomy or hemispherectomy, depending on how it is done. This operation is shorter and causes fewer complications than older versions of the surgery, which removed half of the brain’s cortex.

    Sometimes, a child’s brain function will move to the healthy side of the brain before or after surgery. But in other children, the surgery can have long-lasting serious effects, such as permanent weakness on 1 side.

    Because of this, we only do this operation on children who:

    • Have severe seizures that greatly limit their quality of life
    • Are already weak on the affected side, or we expect they will become weak because of stroke or another brain problem

    After surgery, most children need to stay in the hospital for physical therapy and occupational therapy to improve or manage weakness.

  • For some children, medicine and diet therapy do not control their epilepsy and surgery to remove brain tissue is not an option because their seizures:

    • Begin in several brain areas (multiple foci)
    • Start in part of the brain used for critical functions like language

    An implanted nerve stimulator may be an option. The devices reduce seizures but do not completely stop them. One type is placed in your child’s chest. The other is implanted in the brain.

    Vagus nerve stimulator

    The vagus nerve stimulator helps prevent seizures by sending a small, on-and-off electrical current to the vagus nerve. The vagus nerve starts in the brainstem and goes down the neck and into the chest.

    During surgery, your child’s neurosurgeon puts the stimulator under the skin on the left side of your child’s chest. The device is about the size of a small biscuit. After the area heals, your child’s provider sets the device using a wand connected to a computer.

    Both you and your child can turn on the vagus nerve stimulator if your child senses the start of a seizure. You place a small, handheld magnet over the spot where the stimulator is located. This can stop the seizure from starting.

    The U.S. Food and Drug Administration (FDA) has approved the vagus nerve stimulator for children at least 4 years old. We have placed over 70 vagus nerve stimulators in children and care for nearly 200 patients with these devices.

    Responsive neurostimulation

    In responsive neurostimulation, neurosurgeons place a battery-powered device in your child’s skull. The neurosurgeon connects thin wires (leads) from the device to 1 or 2 parts of the brain where your child’s seizures start.

    When the device senses that a seizure may be starting, it sends a signal to stop the seizure.

    Our patients 18 and older have access to this new treatment because we are part of the UW Regional Epilepsy Center.

  • Recovery after surgery varies from person to person and by type of procedure. At first, children may have mood changes or problems with attention. Depending on how much brain tissue was removed, some children have problems with balance, language, memory, vision or weakness on one side.

    Some problems go away as the brain heals. In other cases children work with specialists in our Neuropsychology and Rehabilitation Medicine programs. Depending on your child, they may be helped by physical therapy, occupational therapy, speech therapy, behavior management or education planning.

Contact Us

For more information, contact our Neurosciences Center at 206-987-2016.

If you would like an appointment, ask your child’s primary care provider for a referral to Seattle Children’s Epilepsy Program.

For your convenience, we see patients in Seattle, Bellevue, Everett and Federal Way. Neurologists in those clinics have the skill, experience and tools to diagnose epilepsy. Children, teens and young adults get care at our hospital campus in Seattle if they need imaging studies, overnight EEG monitoring or surgery.