Show Notes:

Seizures are so common that 1/26 people will have a seizure in their lifetime

What is epilepsy? Epilepsy is two or more unprovoked seizures (low calcium, low blood sugar, and concussions are provoked seizures so that is not epilepsy).

There are excitatory and inhibitory neurotransmitters in the brain, and if there’s too much excitement it causes an electrical storm within the brain, therefore resulting in a seizure.

Neonatal seizures: Seizures may not even be noticeable to the clinical eye. What you want to look for is if they aren’t feeding well or they aren’t quite alert but those are broad symptoms so there can be a delay in diagnosis due to the seizures being hard to see.

Infantile Spasms: so subtle, they look like repetitive crunches or twitch of the arm. The most dangerous type of seizure. Considered a neurological emergency.

Convulsions: shaking arms and legs, eyes roll back into head

Photosensitive seizures-flashing light triggers seizures (driving in car on sunny day)

Absence seizures: a type of seizure involving staring spells

Sudden unexpected death in epilepsy SUDEP (0.4/1000 people die of this)

Other things to look for:

Blank stare for a few seconds or the eyes turn to one side for a few seconds. A patient becomes unresponsive. Weird behaviors and they look similar each time. Is there a brain lesion?

*Pediatricians can dismiss these symptoms

What do I do if I think my child is having seizures?

• Go to your pediatrician

• Ask for a neurologist consult

• Go to ER if you know your little one is having seizures

• Be insistent, get educated, as a parent

• Take a video

• Ask for Continuous EEG for diagnosis (non-invasive test)

• Do a background search and make sure your MD has pediatric epilepsy experience and they are board-certified

• Ask for a virtual visit

Is there a predisposition for epilepsy?

• Pediatric seizures are due to a genetic disorder

• Adult seizures are most seen alongside a stroke

• Babies born at 22-23 weeks gestational age are more at risk

• Neonatal strokes can cause seizures vs pediatric stroke is due to genetic etiology

• There are familial and non-familial genetic conditions

• Epilepsy is non-familial, meaning it doesn’t show itself except in the patient

Time the seizures

30 minutes of seizures then we can see brain cell atrophy

Status epilepticus-unstoppable seizure

Support:

epilepsyfoundation.org

Physician support groups on Facebook

Community

Stigma: similar to psychiatric disorders, anything associated with the brain, people are freaked out about it

Typically psychological conditions occur in conjunction with epilepsy so psychotherapy is recommended. It is an organic problem in the brain that consumes both the depression and seizures

*Screen time doesn’t bring out seizures

Medications and treatment

• Neonatal phenobarbitol is safe and effective

• In older children it depends on the clinical presentation for what kind of medications are used

• Goal is no seizures, no side effects

• Vagus nerve stimulator implant in chest only used when patient doesn’t respond to meds and is still having seizures

• Diet: ketogenic has been widely used and it does have efficacy. Requires regular office visits to check ketones in the urine. Used more commonly with patients refractory to meds.

• CBD: Epidiolex

• Depakote may be used but it needs to be monitored as it can cause inflammation of the liver

“Not everything natural is good for you.”

“All drugs need to be studied specifically for the seizures”

Recovery and Prognosis:

Epilepsy has a wide spectrum of presentation and prognosis, some children outgrow seizures

Overall yes a lot of children outgrow their seizures

EEG abnormalities can determine the outcome

If the child has other comorbid conditions it is less common

Treat for 2 years and determine if meds can be weaned based on EEG results

Final Tips:

Don’t delay getting help

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