HOW DO YOU SPOT EPILEPSY?
Of the roughly 3.4 million people in the U.S. who have epilepsy, about 470,000 are children, according to the Centers for Disease Control and Prevention. Yet, epilepsy remains a misunderstood condition.
People familiar with day-today behavior of the children they care for may be the first to notice signs associated with epilepsy. Dr. Douglas Nordli Jr., chief of child neurology at Comer Children’s Hospital at the University of Chicago Medicine, answers questions about the neurological disorder, as part of National Epilepsy Awareness Month.
What is the difference between seizures and epilepsy?
A seizure is a momentary, sudden electrical discharge or abnormal activity that temporarily takes away voluntary control. If a child has two or more unprovoked seizures or a condition where they are predisposed to unprovoked seizures, we call that epilepsy.
How do you spot epilepsy?
Usually, some sudden, unprovoked change in the behavior of a child is the first sign. The most dramatic example could be a convulsion. In reality, we have a spectrum with seizures that could present as a subtle interruption in behavior. The child might not respond as quickly to a question. More dramatic convulsions have been called grand mal, and milder ones are known as petit mal seizures.
What are some of the causes of epilepsy in children?
Epilepsy has hundreds of causes and often results from a combination of factors. In the most common form of epilepsy, we believe that several genes come together to make people susceptible. We call this idiopathic epilepsy, which is often favorable because children can grow out of it. In contrast, there are symptomatic causes. Those are epilepsies caused by something else that often causes brain dysfunction. Those are harder to control, and people are less likely to grow out of them. They may also cause problems with thinking, behavior or attention. These latter things can be very severe and cause a lot of disability in pediatric epilepsy patients.
What has changed in the way we diagnose and treat epilepsy?
Ten years ago, we had a lot of cases that we thought were symptomatic but we could not
specify the cause. With modern genetic diagnostic tests like next-generation sequencing, we’ve discovered many of these cases are based in genetics. It’s an incredibly satisfying time to be in child neurology, because we’re getting the answers we’ve long sought. Our hope is, now that we’ve characterized what’s causing seizures, we can customize treatments that get at the true root cause of the epilepsy. Maybe with this, we could reverse dysfunction and normalize brain function in patients.
What are the latest medical and surgical treatments for pediatric epilepsy?
Broadly speaking, there are three major ways we treat it. The first is with medications. One of the compounds people are talking about now is CBD (cannabidiol). It’s shown promising results in some early studies. In addition, we can use diets. Different diets have existed since the 1920s, but we
continue to make refinements. Some of these include a modified Atkins diet, ketogenic diets and a low glycemic index diet. Finally, we can use surgery in some cases. We’re one of a select number of centers doing laser ablations in children for epilepsy. This involves surgeons putting a tiny hole in the skull, introducing a laser and heating up a problem area until it’s destroyed in a very precise manner. Dr. Peter Warnke from our neurosurgery team has done more than 100 of these cases in adults and children. The techniques used for evaluating whether someone is a good surgical candidate have also changed a lot in recent years.
Can a child be cured of epilepsy?
Yes, absolutely. Children can be cured, and that should be the expectation and our goal.