Cheryl Martin (Host): This is Children's Health Checkup, where we answer parents most common questions about raising healthy and happy kids. I'm Cheryl Martin. As part of a new series focused on epilepsy in children, we begin this episode to answer the question, What is Epilepsy with our expert, Dr. Andrea Lowden, a Pediatric Neurologist and Epilepsy Specialist at Children's Health and Associate Professor at UT Southwestern.

When children have epilepsy, they often experience recurring seizures; quick, uncontrollable disturbances in the brain. While epilepsy and seizures can develop in any person at any age, they are more common in young children and people over the age of 65. Today, we're taking a deep dive into understanding pediatric epilepsy, its causes, and how it can be treated. Dr. Lowden, delighted you're on with us.

Andrea Lowden, MD: Thank you so much, Cheryl, for the invitation.

Host: First, What is epilepsy?

Andrea Lowden, MD: So, when we talk about epilepsy, epilepsy is the fourth most common neurological disorder in the world. Worldwide, we have approximately 65 million people that suffer from epilepsy. And in the United States, there is approximately three and a half million people that have epilepsy. When we describe specifically the term epilepsy, what it means; it's two or more unprovoked seizures in your lifetime. And unprovoked means seizures that are not caused either by a low blood sugar or an alcohol withdrawal. And when we talk about seizures, these are sudden surges of abnormal electrical impulses that affect your brain or a specific area of the brain.

And depending on the area of the brain, then you can have the symptoms, either how the person reacts or how the person appears.

Host: So, what's the difference between convulsions, seizures, and epileptic attacks?

Andrea Lowden, MD: So, all three terms mean the same thing. Typically when we talk about convulsions, what someone envisions, it's more someone that is having what we call in medical terms a generalized tonic clonic seizure. Which means that they're having body movements that are secondary to the abnormal electrical impulses of the brain.

When we talk about a seizure itself, it's that abnormal electrical or the manifestation secondary to the abnormal electrical impulse of the brain. So, all three terms, mean the same thing.

Host: So what are the most common causes of epilepsy?

Andrea Lowden, MD: There are many differet, causes of epilepsy. And these can be divided into many different categories; what we call either structural, which means that there is a brain abnormality or a brain damage in the brain. And this abnormality can be caused by many different things. Either a loss of oxygen when someone was born to the brain, or it can be secondary to how the brain formed itself.

We also have what we call genetic causes of epilepsy. We have many different genes which carry our genetic information that if they're not functioning properly, it can lead to seizures and epilepsy. We also have infection causes. This doesn't mean that epilepsy is contagious. However, if someone has a certain Infection to the cover of the brain, the meninges, or an infection in the brain itself, it can lead to brain malformations that may cause the person to have seizures and epilepsy in their lifetime.

We also have metabolic causes, autoimmune or immune causes that might lead to seizures. And in about 50 percent of cases, the causes for epilepsy itself can be unknown.

Host: So how is epilepsy diagnosed?

Andrea Lowden, MD: First, when someone has a seizure like event they can be seen by a neurologist or by an epilepsy specialist. And before making a diagnosis, the physician is going to ask many questions and take a detailed history and also perform a physical exam. And the history is very important because with the history they're going to ask questions of for example, how did the seizure start?

Because this can give us a lot of information of even what is the area of the brain that is generating the seizure? They will also ask questions, not only how did it start, but what did it look like, or if the patients lose or did not lose consciousness.

Besides doing a detailed history and the physical exam, then the doctor may order also some blood work because we want to rule out other causes of that seizures and rule out provoked seizures. So either by an electrolyte abnormality, like low sodium or salt in your body, or low sugar, because if the patient does have these abnormalities, then this is considered a provoked seizure. And, if we go back to what is epilepsy, epilepsy is two or more unprovoked seizures.

So, they might do blood work. Other things that we use to diagnose epilepsy is performing a brain waves, or what we call an electroencephalogram,

or EEG. And what this does, it looks at the electrical activity of the brain.

As we talked, seizures are caused by abnormal electrical impulses of the brain. So, if we do find abnormal electrical activity with the EEG, this might also give us an understanding of what type of seizure, what type of epilepsy the patient has.

Then other testing that we do that can help us diagnose or understand what is causing the seizures, is to do brain imaging in the form of a brain MRI. And what we're looking with this is mainly the structure of the brain. We're trying to understand if the patient has any abnormalities in the brain that might put them at risk of having seizures.

Then once we perform testing and get our history, and many times we might find that the brain wave or, the imaging of the brain, the MRI can be completely normal, and this does not exclude the possibility that the patient has epilepsy. Epilepsy is mainly a clinical diagnosis that we perform with, taking a detailed history of the patient.

A lot of times I tell also my families if, you know, seizures are happening frequently and if possible to take a video of the seizure because this can also help the physicianunderstand and see what they're concerned about.

Host: So, once there's been a diagnosis, what are the treatments for epilsepsy?

Andrea Lowden, MD: Throughout the years there has been a lot of evolving different treatments. The first line of therapy, is to find the right anti-seizure medicine for the patient. In the United States many drugs have been approved to treat epilepsy. Right now we have approximately 30 anti-seizure medications that are in the market and in about 70 percent of people with epilepsy, anti-seizure medications can successfully control seizures.

And then if the patient continues to have seizures despite two anti-seizure medications, as we mentioned, seizure medicines can successfully control seizures in about 70 percent of people, so in about 30%, we might need something else other than medicines; then at that point, we can consider other type of therapy options, including what we call neurostimulation devices.

There are also, dietary therapies, for example, the ketogenic diet or modified Atkins diet. And, also we can consider if the patient's self is an epilepsy surgery candidate.

Host: So what complications then can a person experience after having an epileptic crisis or seizure?

Andrea Lowden, MD: There is a risk of what we call sudden unexpected in Epilepsy, also called SUDEP. Typically, the risk of SUDEP is higher in patients that have poorly controlled seizures. Also, that are not taking their medications on time and also the risk is higher in those patients that may have big body convulsive seizures. There's also a risk that when a seizure starts, if the seizure is lasting longer than five minutes, that the patient can have limitations in their breathing that might require either respiratory support or ICU care.

There's also risk if the patient is having poorly controlled seizures, even if they're very short and brief, that this might affect their cognition and also their daily living and quality of life.

So that's why it's important if someone suspects of epilepsy, or that patient is having seizure like events to get medical care.

Host: So, a question, let's say a parent that the child or the teenager, they're having the first seizure that the parents, know that it's a seizure, what should the person do? Do you let them complete the five minutes or what should a caring person do while a person is experiencing a seizure?

Andrea Lowden, MD: We always discuss about seizure first aid, with the families. So if either your child or you witness someone having a seizure; the first and most important thing is to stay calm. And I know for a parent also, it's very difficult to do that, but try to stay calm. Then lay the patient on a flat surface, either on the floor on their side.

Don't put anything in their mouth. Don't try to hold their tongue. Some caregivers expressed concern that if the patient swallows their tongue, that is not possible. So don't try to hold their tongue or stick anything in their mouth, because this can lead, if they put something in the mouth, that the patient can choke with the object.

And then if the patient has any tight clothing or a tie or belt to kind of loosen them up, put them comfortable on their side. The reason why we say on their side is because many times they can have a lot of saliva in their mouth. So on their side, the drooling it can prevent them from choking on their own saliva.

And then oftentimes patient with seizures may have an emergency medicine. An emergency medicine that can be either given by their nose, so intranasal, or through their rectum, rectally. So, if that's the case, we often tell caregivers to give the medication, at the five minute mark, but it's always dependent on what the prescriber tells the families and the patient as you now each individual might differ.

Host: Now can epilepsy be cured?

Andrea Lowden, MD: Although epilepsy cannot be cured, there's many different type of what we call epilepsy syndromes that patients may outgrow with age or when they reach adulthood or, teenage years. But there are many treatment options that can manage the seizures and that can lead to patients having remission of their epilepsy.

And as we mentioned previously with medications, we could reach up to 70 percent of people treated successfully.

Host: Is there anything else you want to share about epilepsy in children before we wrap up this episode?

Andrea Lowden, MD: Yes, I think it's also important to mention that not all seizures may look the same. As we talked previously, depending on which area of the brain is involved, this can influence what the seizure may look like. So, it can either lead to abnormal movements or to different sensation perceptions or different behaviors. And, this is how we also classify the different seizure types. So there are three important things that we consider when we're discussing the terminology of seizure type. So, for example, what does the beginning of the seizure look like, or the level of awareness of the person during the seizure, and also whether or not there's movement involved.

This is how we classify seizure types, and the typical terms that we use are either generalized seizures, when seizures affect both sides of the brain, or we call them also focal seizures, when seizures may start in one area of the brain and may then spread or not to another side or to another area of the brain.

And then we also have unknown onset seizures when we're not sure where the seizure itself began or when the onset of the seizure hasn't been witnessed by someone.

Host: This has all been very, very insightful, Dr. Andrea Lowden. Thanks for sharing your expertise on pediatric epilepsy. Thank you.

Andrea Lowden, MD: Thank you so much for having me.

Host: In the next episode of this Epilepsy Series, we will discuss treatments for epilepsy in children, including medication, diets and surgical options. For more information, visit Childrens.com/epilepsy. Thanks for listening to Children's Health Checkup, and if you found this podcast helpful, please rate and review it or share the episode.

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