Epilepsy is a neurological disorder characterized by the presence of recurrent or repeated seizures or a tendency to have recurrent seizures. If your child is living with epilepsy, you may be worried about how it will affect their progress in school, what will trigger the next seizure, medical complications of having epilepsy and how epilepsy may affect your child's development. For children with epilepsy, timely and accurate diagnosis in combination with effective treatment can be life-changing.
While many children with epilepsy will thrive despite their diagnosis, for some children epilepsy can significantly impair their medical health, academic performance and psychological and social development. NewYork-Presbyterian’s Pediatric Epilepsy Program offers a multidisciplinary team of specialists that bring innovative and comprehensive care to children with epilepsy. The goal of this team is to provide prompt and accurate evaluation of children with epilepsy and and devise an effective treatment plan that addresses these problems early. Regardless of whether a child has been newly diagnosed or has a history of hard to manage epilepsy, comprehensive epilepsy care that provides seizure freedom has been shown to change a child’s outcome.
About Our Program
The NewYork-Presbyterian Epilepsy Centers, operating across NewYork-Presbyterian Morgan Stanley Children's Hospital and NewYork-Presbyterian Komansky Children's Hospital, are among the most active programs on the East Coast and are major referral centers for the treatment of children with hard-to-control seizures. We are distinguished by a comprehensive and multidisciplinary approach and excellent success in the use of innovative approaches to minimize the impact of seizures on a child’s development and well-being.
We take a stepwise approach to managing seizures, tailoring therapy to the unique needs of your child that take into account other factors — such as other medical diagnoses, lifestyle, stress, sleep habits, and diet — that may trigger your child's seizures. Our goal is to offer the most advanced treatments at the appropriate time to give children the best opportunity for seizure freedom and long term success.
Our patients range in age from newborn to young adults. While our specialists work with you and your child to build the skills needed for them to navigate their condition and advocate for their own healthcare needs as they get older, we also work with our adult epilepsy colleagues to ensure that young adult patients can transition seamlessly into NewYork-Presbyterian’s renowned adult epilepsy care programs if needed.
What is Epilepsy?
Epilepsy is a brain condition that results in ongoing seizures and is one of the most common neurological disorders. When a child has repeated seizures that are not associated with fever, trauma, or other temporary conditions known to cause seizures, the child is said to have epilepsy.
Epilepsy can be categorized as either focal or generalized, Seizures in focal epilepsy begin in a specific area of the brain. Seizures in generalized epilepsy affect multiple sites in the brain or both sides of the brain simultaneously. Understanding if a child’s epilepsy is due to a focal brain problem or is generalized is an important first step in developing the best treatment plan and guides which medicine may be recommended or what other treatments may be possible if medicines do not control the seizures.
Epilepsy can also be categorized by the area of the brain where seizures begin, as in temporal lobe epilepsy, frontal lobe epilepsy, occipital lobe epilepsy, parietal lobe epilepsy, and insula. While seizures can begin in one area of the brain based on the cause of a child’s epilepsy, if left untreated they can involve multiple other areas of the brain resulting in greater brain dysfunction.
Seizures in children often begin early in life, and even if seizures appear mild, there is a risk of cumulative disruption to a child’s development over time. Seizures should therefore be treated as early as possible to prevent uncontrolled seizures and consequences as a result of the unpredictable nature of seizures, such as injuries from fall, respiratory or cardiac rhythm abnormalities, and aspiration.
Causes of Pediatric Epilepsy
Pediatric epilepsy may be inherited due to genetic causes, or as the result of a brain malformation (cortical dysplasia),or may develop after an accident or injury. It may also be caused by an infection effecting brain (such as meningitis, encephalitis), a tumor, or a vascular anomaly such as an arteriovenous malformation (AVM). The following are some commonly known causes of pediatric seizure disorder that, in some cases, can be successfully treated with surgery and/or medication.
Cortical dysplasia is a malformation that occurs during fetal development when normal brain cells migrate to incorrect locations in the developing brain. It is one of the most common causes of epilepsy in children. The presence of these abnormal clusters of cells irritates the surrounding brain and triggers seizures. Surgical treatment involves resection of the focus of dysplasia, or abnormally located cells. These dysplasia can be small and focused or can involve an entire lobe of the brain.
Perinatal stroke may result in permanent injury to the brain. Studies show that four of five newborn infants who experience a stroke around the time of birth will develop neurologic disorders such as cerebral palsy, epilepsy, or language delay. Most often, when seizures result from a perinatal injury (injury shortly before, during or after birth), treatment involves disconnection or surgical removal of the affected area of brain to control the seizures. Because this area of the brain is already damaged and not working properly, this kind of surgery can be done safely with little risk of causing new problems for the child.
Mesial temporal sclerosis is scarring of the inner portions of the brain’s temporal lobe which is sometimes caused by brain injury or infection. This can lead to partial (focal) seizures that start in the temporal lobe but can spread to other areas of the brain. It is often associated with intractable epilepsy (seizures that don’t stop with medication). Surgery to remove the scarred areas of the temporal lobe may cure a patient’s seizures.
Tuberous sclerosis complex (TSC) is a genetic disorder that causes tumors to form in different organs, including the brain. While these tumors are usually benign (they do not spread or grow quickly), their presence can disrupt the surrounding brain cells and result in seizures as well as other developmental disorders such as autism. Occasionally, tumors that do grow may also block the flow of fluid in the brain, a condition called hydrocephalus. TSC can be treated with medications that shrink the tumors, specific seizure medications that control seizures that the tumors cause, and in some cases, with surgery to remove them.
Infantile spasms is a rare but serious form of epilepsy that begins in infants usually between the ages of 4 and 12 months. Infantile spasms may develop in children with prior normal development or in children with other known or suspected brain disorders. Seizures are usually brief, lasting only a second, but occur in repeated clusters usually within minutes after waking. Often a child with spasms will have a sudden startle-like movement of both arms with or without the head suddenly falling forward or eyes rolling. Urgent diagnosis is needed. If the spasms continue unrecognized, babies will regress or lose developmental milestones. Other types of seizures may also develop. Treatment is generally with high-dose steroids, vigabatrin, ketogenic diet, and for babies whose spasms are not controlled, prompt evaluation for epilepsy surgery.
Lennox-Gastaut syndrome is a rare form of epilepsy in children that typically starts between the ages of 2 and 5 years. It can result in many different kinds of seizures (both convulsive and non-convulsive) that vary widely from child to child and often happen many times a day, resulting in decreased alertness and loss of skills. Lennox-Gastaut syndrome is difficult to treat, often requiring the use of several medicines at the same time. Some children with this diagnosis benefit from a specialized diet called the ketogenic diet. For some, palliative surgeries such as corpus callosotomy, a surgery that partially disconnects the right and left side of the brain to prevent seizures from spreading to both sides, is recommended to decrease the number of seizures or their severity. For other children, a small implantable device called a vagal nerve stimulator (VNS) may be recommended. This device sends a small electrical signal to the vagus nerve and has been shown to reduce the number of daily seizures for many patients.
Rasmussen encephalitis is a rare childhood disorder in which cells in a part of one hemisphere of the brain become inflamed and swollen, triggering progressive seizures that lead to weakness, loss of function, and cognitive deficits. The cause of the inflammation is not often known, but could be the result of a viral infection, an auto-immune disorder, or trauma. Successful seizure control requires a hemispherotomy which is a surgery to disconnect the affected side of the brain from the healthy side.
Sturge-Weber Syndrome is a rare congenital (present at birth) condition characterized by a birthmark (called a port wine stain) on one side of the face and neck, as well as neurological abnormalities. It is caused by abnormal blood vessels on the surface of the brain that can cause seizures that may become generalized and evolve into other types of seizures over time. Surgery called a hemispherotomy, which involves disconnecting the abnormal side of the brain from the normal side, can be used to treat it.
What We Treat
At NewYork-Presbyterian, we have expertise in all areas of epilepsy, particularly in treating early onset epilepsy and refractory epilepsy. These include:
- New onset seizures
- Infantile spasms
- Newborn seizures
- Lennox Gastaut Syndrome
- Tuberous Sclerosis Complex (TSC)
- Seizures from cortical dysplasia
- Rasmussen encephalitis or mesial temporal sclerosis
- Autoimmune epilepsy
- Hemimegalencephaly, a rare neurological condition in which one side of the brain is abnormally larger than the other
- Dravet Syndrome/PCDH1
- Sturge-Weber Syndrome
- Angelman Syndrome
- Seizures secondary to stroke or vascular malformations
- STXBP1-related epileptic encephalopathy
- SLC6A1, a neurodevelopmental disorder that causes epilepsy