Epilepsy in Children
Recurrent unprovoked seizures in childhood — most outgrow it with the right diagnosis and treatment.
Overview
Childhood epilepsy affects ~1 in 200 children. Syndromes range from self-limited (childhood absence, BECTS) to severe encephalopathies (Dravet, Lennox–Gastaut). Most children achieve seizure control on first or second medication. Accurate syndrome diagnosis guides drug choice and predicts long-term outcome.
Symptoms
- • Generalised tonic-clonic, absence or myoclonic seizures
- • Focal seizures with altered awareness or automatisms
- • Brief vacant staring with eye flutter (absence)
- • Post-ictal confusion, headache, sleep
- • Developmental regression in severe syndromes
Risk factors
- • Family history of epilepsy
- • Perinatal hypoxia, prematurity
- • Febrile seizures (small increase)
- • Neurodevelopmental disorders
Causes
- • Genetic: SCN1A (Dravet), CDKL5, channelopathies
- • Structural: cortical malformation, perinatal stroke, tuberous sclerosis
- • Metabolic: pyridoxine-dependent, glucose transporter deficiency
- • Post-infectious or post-traumatic
- • Idiopathic in many self-limited childhood epilepsies
🚨 Red flags — seek urgent care
- • Seizure >5 minutes (status epilepticus) — emergency
- • First seizure with fever in infant <6 months
- • Focal neurology, papilloedema, head injury
- • Sudden unexplained loss of consciousness with abnormal movements
When to seek care
- • Any first unprovoked seizure — same-week paediatric referral
- • Seizure recurrence, change in pattern, or breakthrough on treatment
- • Any prolonged seizure — call 999
Diagnosis
- • Detailed eyewitness history and video where possible
- • ECG (exclude cardiac syncope), bloods including glucose, calcium, magnesium
- • EEG within 4 weeks of first seizure; sleep-deprived or prolonged if normal
- • MRI brain for focal seizures, abnormal exam, or under 2 years
- • Genetic and metabolic testing for early-onset, drug-resistant, or syndromic presentations
Treatment
- • First-line by syndrome: ethosuximide (absences), sodium valproate (generalised — avoid in girls of childbearing potential), lamotrigine/levetiracetam (focal/generalised)
- • Carbamazepine/oxcarbazepine for focal; avoid in juvenile myoclonic epilepsy
- • Refractory: ketogenic diet, vagus nerve stimulator, epilepsy surgery in selected lesional cases
- • Rescue medication (buccal midazolam) and individualised seizure plan for school
- • Cannabidiol for Dravet, Lennox–Gastaut, tuberous sclerosis
Prevention
- • Antenatal care, immunisations, head-injury prevention
- • Adherence to medication; avoid sleep deprivation and alcohol in adolescents
- • Photic-sensitive children: caution with strobe lighting and screens
Complications
- • Status epilepticus
- • Sudden Unexpected Death in Epilepsy (SUDEP)
- • Learning difficulties, behavioural and mental-health comorbidities
- • Injury during seizures
- • Medication side effects (cognitive, mood, teratogenicity of valproate)
Prognosis
Around 70% achieve long-term remission. Self-limited childhood epilepsies often resolve in adolescence; severe encephalopathies have guarded prognosis.
Education & self-care
Childhood epilepsy is highly individual. A correct syndrome diagnosis enables the right drug, the right monitoring and a realistic conversation about outlook.
Frequently asked questions
Will my child outgrow epilepsy?
Many will, especially in self-limited syndromes. Outcomes depend on syndrome diagnosis.
Can they go to a normal school?
Yes — most children do, with a written seizure plan and trained staff.
Is medication safe long-term?
Modern AEDs are well tolerated; benefits outweigh small risks. Valproate is avoided in girls and women of childbearing potential.