Epilepsy is the most common brain disorder worldwide and affects people of all ages. However, it is particularly common among children and the elderly. What are the causes of childhood epilepsy and how is it treated? We spoke with Dr. Colin Nguyen of Renown Children’s Hospital for answers.
November is Epilepsy Awareness Month. And awareness of this brain disorder first begins with a realization of the scope of the problem: It affects 1 percent of the population — approximately 3.4 million people in the U.S. alone (about 470,000 children and three million adults). These numbers easily make it the most common brain disorder worldwide.
Here, we talk with Pediatric Neurologist Colin Nguyen, M.D., who has done extensive work with childhood epilepsy.
What causes epilepsy, and what is it, exactly?
Epilepsy is diagnosed when a person has more than one unprovoked seizure — unprovoked meaning they were not caused by an identifiable external trigger, such as head trauma or toxic ingestion of substances, for example. It is a condition affecting all demographics (ages, race, ethnicity, socio-economic).
There are peaks throughout our lifetimes, where we do see more prevalence of seizures and epilepsy. For example, we do see a peak of seizure prevalence in the neonatal period, then early childhood, adolescence, early teenage years and later in adulthood. More often the underlying cause of disease in infantile or childhood epilepsies tends to be more of a genetic or congenital metabolic condition predisposing these individuals to develop seizures. This is still true later in life and adulthood. But we tend to see more acquired causes (i.e., stroke, diabetes, concurrent diseases) in later stages of life.
Why does epilepsy seem to more often affect children and seniors?
In infants and children, more often there are underlying congenital genetic or metabolic disorders that predispose them to develop seizures. In older adults, more commonly the reasons are acquired (such as diabetes, hypertension), increasing risk factors (smoking, obesity,high cholesterol), or the natural process of aging with decreased ability of our nervous system to maintain itself. However, genetic causes are still a prevalent risk factor throughout our life span. As we age, other acquired risk factors play a role. These may include accidental trauma (traumatic brain injury, concussions), infections (encephalitis, meningitis), and poor habits (smoking, alcohol/drugs, etc.) — which all increase one’s risk factors for developing seizures over time.
If you’re a parent, are there things you should watch for in terms of signs/symptoms of epilepsy in kids?
Most parents and families are pretty astute. Medical professionals give moms and dads a great deal of respect and understanding when they raise some concerns; seizures can manifest in different forms in children, other than the more widely known generalized convulsive seizures. Examples of subtle seizure can include staring/spacing out with non-responsiveness or repetitive focal twitching of face or a body part. These clinical manifestations along with other “spells” that have associated features of confusion, lethargy, speech difficulties, transient weakness of a limb, and/or unexplained tongue biting or bowel/bladder incontinence, raise the suspicion the spells may be more than just benign movements or developmental quirks of childhood.
Symptoms in children can be very similar to symptoms in adults, but in children they can be subtle and missed.
What are you most excited about in terms of advances in treatment or technologies for childhood epilepsy?
Some of our most effective treatment options currently are still medications and similar therapeutic compounds taken orally. Unfortunately, despite the explosion of new anti-seizure medications in the past 10-15 years, they all to varying degrees have side effects that can be just as debilitating as the seizures these children experience. So while new compounds approach epilepsy from a different neurochemical mechanism, they affect the symptoms and are not a cure for epilepsy.
Our tools for fine tuning the diagnosis of epilepsy and ongoing management (high strength MRI, MRI Spectroscopy, stereo EEG) have made great strides. This allows us to pursue epilepsy surgery in patients once thought not to be candidates. This often, in the properly selected epilepsy patient, can provide significant seizure reduction and improvement in quality of life.
Personally what many of us in the field find particularly hopeful is the rapid expansion and efficiency of genetic testing for various forms of epilepsy. Though not all cases of epilepsy have a genetic basis, the vast majority (particularly in children) do. This has many ramifications, of which as our database of epileptic mutations expand:
- We are more quickly able to definitively diagnose affected children. This avoids unnecessary cost in time and resources for families and our overall taxed health system.
- Parents can receive better prognostic guidance regarding their child’s epilepsy.
- We are able to develop a more customized treatment regiment (i.e, medications, supplements, surgery).
What else should parents know about childhood epilepsy?
It can be a scary and daunting challenge to understand. Educate yourself, and plan for your child’s future when they are diagnosed with epilepsy. Do take great heart knowing you have the support of tens of thousands of medical specialists and millions more beyond that of families and epilepsy support groups to guide you along the way, so you will never feel alone or without another resource with which to turn. We have made exceptional strides in the past 15-20 years in epilepsy research and treatment. We are truly at a cusp of transformative, and perhaps revolutionary, change in how we diagnose, manage and treat epilepsy.