Seizures and Epilepsy in Children A Comprehensive Guide,
4th Edition
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be based solely on its contents. Instead, treatment must be developed in a dialogue between the
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Contents
Introduction
Part I. Why Do Seizures and Epilepsy Occur?
Chapter 1. How the Brain Works: Keys to Understanding Seizures and
Epilepsy
Normal Brain Structure
Normal Brain Function
What Triggers a Seizure? The Concept of Seizure Threshold
What Is a Seizure?
Epilepsy Is More than Seizures
Explaining to Your Child How the Brain Works and Why a Seizure
Happens
Chapter 2. The Kinds of Seizures and Where They Arise in the Brain
The Many Types of Seizures
Terms Describing the Phases of a Seizure
How Are Seizures Classified?
The Old System: Grand Mal and Petit Mal Seizures
The New System: Generalized and Focal Seizures
Focal Seizures and the Anatomy of the Brain
Motor and Sensory Areas
The Temporal Lobes: Lateral (Outer)
The Temporal Lobes: Mesial (Inner)
The Frontal Lobes
Other Areas of the Brain: The Occipital and Parietal Lobes
Focal Onset Seizures
Motor Onset
Nonmotor Onset
Level of Awareness during Seizures
Generalized Onset Seizures
Motor Seizures
Nonmotor (Absence) Seizures
Differentiating between Types of Seizures
Locating the Site of Onset
Part II. Diagnosing Seizures and Epilepsy
Chapter 3. How Doctors Diagnose a Seizure and Decide What It Means
for Your Child
Was It a Seizure?
Provoked and Unprovoked Seizures
Episodes Often Mistaken for Seizures
Is It Fainting or a Seizure?
Is It Daydreaming or a Seizure?
Tics
Myoclonic Jerks
Breath-Holding Spells
Migraine Headaches
Shuddering Attacks
Self-Stimulatory Behavior
Paroxysmal Behavioral Disturbances
Nonepileptic Events and Psychogenic Nonepileptic Seizures
The Physician’s Evaluation
Chapter 4. How Doctors Evaluate and Think about a First Seizure
Febrile Seizures
What Should You Do during a Seizure?
After the Seizure Is Over
Questions You Might Ask
Evaluating the Child with a First Seizure without Fever
Chapter 5. Decision Making: Assessing Risks and Benefits after a
Nonfebrile Seizure
Whether to Use Medicine
Decisions about Everyday Life
Chapter 6. What to Do during a Second Big Convulsive Seizure
What Should You Not Do?
What Should You Do?
When Should You Call for Help or an Ambulance?
If the Clonic (Jerking) Phase Lasts 5 Minutes, Should You Call an
Ambulance?
What Should You Do If Your Child Has a Seizure?
Chapter 7. Understanding Your Child’s Tests: EEG, CT, and MRI
The Electroencephalogram
When to Do an EEG
Performing an EEG
Accompanying Your Child to the EEG
Special EEG Procedures
Normal and Abnormal EEG Findings
Spikes
Slowing
EEG Abnormalities Related to Certain Seizure Types
Absence Seizures
Atypical Absence Seizures
Other Special Patterns
Why Do an EEG?
Why Repeat an EEG?
Intensive EEG Monitoring
Ambulatory EEG Monitoring
Video-EEG Monitoring
CT and MRI Scanning
CT Scanning
Why a CT Scan?
MRI Scanning
Chapter 8. The Epilepsies of Childhood, Part I: Special Patterns
Epilepsy and Its Special Forms
Epilepsy Syndromes
Childhood Epilepsy with Centrotemporal Spikes
Benign Occipital Epilepsies of Childhood
Childhood and Juvenile Absence Epilepsies
Juvenile Myoclonic Epilepsy
Infantile Spasms (West Syndrome)
Lennox-Gastaut Syndrome
Landau-Kleffner Syndrome and Other Language Impairments
Dravet Syndrome and the Generalized Epilepsy with Febrile Seizures
Plus Spectrum
Neonatal Seizures
Chapter 9. The Epilepsies of Childhood, Part II: Special Causes
Acquired Conditions that Cause Epilepsy
Strokes
Infections
Autoimmune Disorders
Genetic Conditions that Cause Epilepsy
How Do Genetic Changes Result in Epilepsy?
Spontaneous and Inherited Genetic Changes
Who Should Be Tested for Genetic Causes of Epilepsy?
Potential Risks and Benefits of Evaluating for a Genetic Cause
Specific Genetic Syndromes
The Neurocutaneous Syndromes
Degenerative Diseases
Part III. Treatment
Chapter 10. Using Medicines
Philosophy of Treatment
Terms You Need to Know
Medication, or Drug, Levels
Toxicity
Half-Life
Blood Levels of Antiseizure Medications and the Therapeutic Range
Common Questions about Blood Levels
Choosing the Best Medication
Antiseizure Medications
The Older Medications
The Newer Medications
The Newest Medications
Chapter 11. Rescue Medicine and Treatment of Status Epilepticus
Status Epilepticus
Chapter 12. Ketogenic Diet Therapy
What Is the Ketogenic Diet?
How Well Does It Work?
Who Does It Work Best For?
What Are the Side Effects?
What Is in the Future of the Ketogenic Diet?
Chapter 13. Alternative and Complementary Therapies for Epilepsy
Vitamins
Acupuncture
Artisanal CBD/THC (Medical Marijuana)
Herbs
Melatonin
Biofeedback
Yoga and Stress Relief
Steroids
Intravenous Immunoglobulin
Chapter 14. Surgery and Devices
Palliative Surgical Options
Devices
Vagus Nerve Stimulator
Responsive Neurostimulator
Deep Brain Stimulation
Getting a Second Opinion
Deciding to Pursue Surgery
Including the Child in the Decision
Tips for Parents of Children Undergoing Invasive Monitoring or Surgery
Monitoring
Surgery
The Hospital Routine for Patients Undergoing Surgery
Part IV. Practical Issues of Living with Epilepsy
Chapter 15. Routine Medical Care and Epilepsy
Chapter 16. Comorbidities: Other Problems that Can Co-occur with
Epilepsy
Developmental Delays
Cerebral Palsy
Types of Cerebral Palsy
Intellectual Disability
Learning Problems
Attention Problems and Hyperactivity
Anxiety and Mood Issues
Behavior
Autism Spectrum Disorder
Chapter 17. From Infancy to College: Navigating the Educational
System
The Laws and Your Child’s Rights
Seizures and Epilepsy in School
Seizure Action Plans
Special Education Eligibility
The General Process: Eligibility Determination, IEP/IFSP/504
Development, and Placement
Early Intervention Services and IFSP
School Age: IEP vs. 504 Plan
Transition Planning
Chapter 18. Playing, Sports Participation, and Other Activities
Camps
Sports
Group Sports
Climbing
Swimming
Gymnastics
Horseback Riding
Other Considerations
Chapter 19. Driving and Epilepsy
Chapter 20. Devices, Apps, and Websites
Devices
Apps
Websites
Chapter 21. Insurance and Other Financial Issues
Chapter 22. The Future: Epilepsy Care, Marriage, Pregnancy, and
Children
Transition of Epilepsy Care
Marriage and Parenthood
Risks of Pregnancy while Taking Antiseizure Drugs
Valproate (Depakote/Depakene)
Phenytoin (Dilantin)
Other Antiseizure Medications
Breastfeeding and Birth Control
Employment
Part Five. Emotional and Psychological Issues
Chapter 23. Initial Strategies and Overview
The First Seizure
What You Should Know
What Do You Tell Your Child after a Single Seizure?
What Do You Tell Other Children after a Single Seizure?
What Do You Tell Relatives and Friends after a Single Seizure?
What Do You Tell the School after a Single Seizure?
Recurrent Seizures: Epilepsy
Absence Seizures
Focal Unaware Seizures
Benign Epilepsy of Childhood
Stages of Acceptance
Communicating with Others
Brothers and Sisters
What Do You Tell Relatives and Your Friends?
The Child’s Friends
What Do You Tell the School and Classmates?
Working with Others
Chapter 24. Psychological Strategies: Coping, Resilience, and
Counseling
Parent Coping and Resilience
The Power of Reshaping Thinking
Child Coping and Resilience
The Child’s Self-Perception
Helping Your Child Cope with Epilepsy
Overprotection and Overindulgence
Counseling
Chapter 25. Coping with Substantial Disability
Intellectual Disability
Commonly Asked Questions
Cerebral Palsy
Really Difficult-to-Control Seizures
Coping with Severe Disability and Epilepsy
A Parent’s Special Needs
Coping with Shattered Expectations
Conclusion
Glossary
Index
Seizures AND Epilepsy IN Children
Introduction
Many families whose children have had a single seizure, and many others
whose children have epilepsy, come to us for a second opinion. There are
common themes among all these families. One theme is that the family and
child are focused on the seizure or seizures; they are unable to look at the
whole child and the bigger picture. Their life and their child’s life have
become centered primarily on the seizures. A second theme is that the
families and children are overwhelmed by the mythology of epilepsy, by the
fear of future disability or intellectual disability. Few families understand
what seizures are and what they are not. They come seeking to understand
what has happened and what is likely to happen.
Many physicians, even those very knowledgeable about seizures,
epilepsy, and their treatment, focus on these medical aspects and do not put
epilepsy in the proper perspective of the whole child and family. We believe
that no child’s life should be defined by seizures. No one is “an epileptic.”
The seizures and epilepsy are often only a small portion of the child’s life.
We believe that to put them in perspective you must understand the brain,
seizures, and how to cope with epilepsy. You must understand the
mythology and how different it often is from reality. Only with this
understanding can you avoid unnecessarily disabling your child, prevent
them being limited by others, and allow them to reach their full potential.
That is why we have written this book and why we continue to revise it.
While primarily for parents, it is also a book for everyone with seizures and
for all who are touched by seizures—families, teachers, and health
professionals.
We hope this book will reassure you that a majority of children who have
epilepsy can have their seizures completely controlled with medication and
