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How are epilepsy and seizures diagnosed in children and teens?
If your child is having seizures, they might undergo a variety of evaluations in order to identify which type(s) of seizures they’re experiencing and to learn what’s causing them.
At Gillette Children’s, we use many methods to evaluate children who have seizures. Once we have those answers, we can develop the right treatment plan for epilepsy.
At Gillette Children's, when we diagnose seizures and epilepsy, we use a system developed by the International League Against Epilepsy (ILAE). Used worldwide, the system classifies seizures and epilepsy according to defined terms. The ILEA calls each classification category an “axis.”
Axis 1: Seizure Event
We describe a child’s seizures in detail, using findings from tests, along with observations from the child and family.
Axis 2: Seizure Type
Based on the description, we try to identify the particular type of seizure a child experienced.
Axis 3: Epilepsy Syndrome
We try to figure out whether a child has an epilepsy syndrome. A syndrome is a particular combination of signs and symptoms that can include:
- Seizure type
- The age when seizures started
- Various clinical findings
Axis 4: Seizure Causes
We try to identify the causes of the seizures, such as:
- Brain injury
- Genetic disorders
- Brain malformations
- Conditions associated with premature birth
Axis 5: Impairments
We identify ways the seizures affect (impair) a child’s quality of life. We categorize impairments based on the International Classification of Functioning, Disability and Health—developed by the World Health Organization.
To support our five-axis approach to diagnose epilepsy in children, we collect information and run tests, including:
- History: Our clinicians gather a history of the seizure event and your child’s medical and neurologic story. Observations from your family and primary care providers help us identify the seizure type and possible causes.
- Neurological Examinations: A pediatric neurologist runs a very thorough examination.
- Neuropsychology Evaluations: A neuropsychologist might run tests on a child who has epilepsy to learn whether the seizures or related conditions affect learning and behavior. An early neuropsychology test lets us track skills and abilities as they change over time.
- Psychology Evaluation: Psychologists can test your child’s intellectual development. They can also help plan for adjustments at school, if needed.
Our specialists might order a number of tests, including:
- Electroencephalogram (EEG) and video EEG (VEEG): An EEG measures electrical activity in the brain through small electrodes placed on the head. An EEG can help identify seizure type. With VEEG, we add a video camera to record images to show how body movements link to brain activity.
- MRI: When an EEG shows that atypical electrical activity in a particular area of the brain is triggering seizures, we might recommend an MRI. The MRI uses magnetic fields to take detailed pictures of the brain.
- Sleep study (polysomnography): During an overnight sleep study, we watch and record electrical activity in the brain during sleep. We also track oxygen levels, breathing difficulty and muscle movement.
- Lab Tests: We might order blood tests to measure levels of electrolytes, glucose, calcium and magnesium. We might also test these samples for toxic substances.
- Genetic testing: We might order genetic tests to learn whether genetic factors increase your child’s likelihood of having seizures.
How are epilepsy and seizures treated in children and teens?
If your child has epilepsy, Gillette Children's can help by offering a variety of seizure treatment options. We’ll work with you to figure out which one makes the most sense based on your child’s medical history and particular type of seizures.
Medical treatment for epilepsy and seizures can include antiepileptic medication, such as prescribing midazolam (Versed) for seizures. At Gillette, full diagnostic exams help us decide which medicines are best for treating your child’s seizures. In some cases, trying different medicines and doses helps us find the best possible results.
For some children who have severe epilepsy, a strictly controlled diet can make seizures less frequent—or stop them altogether. Gillette specializes in providing the following highly controlled dietary treatments for epilepsy:
Some kids who have epilepsy respond well to a surgically placed vagus nerve stimulator device to control their seizures. Our neurologists and neurosurgeons specialize in VNS, having implanted VNS devices since receiving FDA approval. We also offer consultations, support, and referrals for children who might respond well to other neurosurgical procedures.
For some children with epilepsy, surgery is recommended. Epilepsy surgery is a type of surgery where areas of the brain are removed, disconnected, or stimulated by a neurosurgeon to control epileptic seizures. These changes to the brain can stop or reduce the frequency or intensity of seizure activity. There are different types of operations for different types of epilepsy. The type of surgery that is recommended depends on the type of seizures, location of seizures, and any brain abnormality.
Brain tumors, vascular (blood vessel) abnormalities, old strokes, and congenital (inherited) irregularities might also be treated if they are believed to be causing the seizures.
Our neurology team—including neurologists, neurology nurse practitioners and nurses—meets with you and your family at various points throughout your child’s life. We can help you navigate conversations about school, sports, and social situations. We can also help kids understand how to stay safe, talk to others about epilepsy, and handle common challenges.
During these visits we answer questions, offer guidance, and help you respond to changing needs, and prepare for what’s next. We also talk about health care issues, such as medicines and routines. We want to make sure your child gets all the care they need to live well with epilepsy.
Curious about how Life Stages® for Epilepsy visits work? Check out more information:
Epilepsy Services at Gillette Children's
If your child experiences seizures or has epilepsy, we offer complete diagnostic services and a team of experts to provide comprehensive care, beginning with a first seizure evaluation by experts in nursing and neurology (pediatric neurologists, epileptologists, and neurology nurse practitioners).
As your child grows into their teen years and adulthood, we’ll continue to work closely with your family to provide the most effective management and best care for epilepsy and seizures. Over the course of treatment, your child might receive care from providers in the following specialties and services:
- Chaplaincy
- Child life
- Endocrinology
- Medical genetics and genetic counseling
- Neurodiagnostics for tests such as EEGs, VEEGs and overnight sleep studies
- Neuropsychology
- Neurosurgery
- Nutrition and feeding
- Pediatrics and general medicine
- Psychology
- Radiology and imaging
- Rehabilitation medicine
- Rehabilitation therapies, including occupational, physical, and speech and language therapy
- Sleep medicine
- Social work
- Therapeutic recreation
You can trust your child’s care to our expertise in treatment of epilepsy and seizures. As a regional leader in pediatric neurology and neurosurgery, we understand that many kids who have epilepsy also have complex associated conditions, such as cerebral palsy, developmental delays or traumatic brain injuries. That’s why we offer a large team of specialists and extensive support services.
For more information, learn about epilepsy and find resources from advocacy and support organizations like the Epilepsy Foundation.
Get a Second Opinion
Getting a second opinion is particularly helpful with a complex or unclear diagnosis or treatment that is no longer working. Often having another expert’s opinion can help you feel more knowledgeable and confident when taking the next steps to care for your child.
