Epilepsy is a syndrome diagnosis.
It's a symptom that
describes brainwave abnormalities.
There are underlying causes
that need to be evaluated.
MRI of the brain to
look for structural abnormality,
EEG to look at
characteristics of the brainwave activity so
the physician can categorize
which type or types of
seizure the patient has.
Then there are, in some children,
genetic causes, neurometabolic
causes or auto-immune causes
that can be looked at.
A seizure action plan is
a roadmap for nurses and teachers at
school to help your child should
a seizure happen at school.
It includes information about what type of
seizure, what your child's seizure looks like,
and if there is
any anti-seizure medication that
should be used while
the seizure is happening to
shorten the seizures or
how to contact the family
should prolonged seizures happen.
So most seizures are brief.
Depending on the patient, there are absence
seizures that are five to six seconds.
Other patients may have generalized
tonic-clonic seizures,
which last two to three minutes.
Those short, brief seizures,
although it may feel like
a lifetime for parents,
they do not cause
negative impact on
growth and development. However,
we do have to worry
about prolonged seizures that are
greater than five minutes
or multiple seizures,
generalized tonic-clonic
seizures, more than three in an hour,
in which case, your doctor may
talk to you about a seizure action plan.
This depends on the seizure type.
For the absence seizures, which are subtle staring,
this depends on your observation
of how often this is happening
to your child.
For those patients where it's not
possible or practical to
monitor all the time,
it is helpful to
ask and talk to your physician
about EEG monitoring with video ongoing.
This could be helpful
for those subtle seizures that
are less detectable by visual inspection.
For those patients who have
nocturnal seizures, where it's not
practical to monitor consistently
when everyone is asleep,
video EEG monitoring can
also be quite helpful in determining
the seizure frequency.
For those patients who have generalized
tonic-clonic seizures where there
are convulsive movements,
there are FDA- cleared devices,
wearable devices, that can detect
these generalized tonic-clonic seizures
based on movements.
About a third of the patients
with epilepsy can continue to
have seizures despite
appropriate treatment.
In those patients, evaluation for
surgery can be an option.
Epilepsy surgery can be
an option for those patients who have
a focal epilepsy, where a focus
can be identified and safely removed.
Epilepsy surgery is also
an option for certain types of
generalized epilepsy, where
disconnection surgery can be performed.
First of all, be prepared with
your questions when you
come to your clinic visits.
Come with your observation of
the different seizure type
or types that you've observed,
know what the duration of
the seizures are and have
a seizure calendar so
that you and your physician and
your care team can review
the frequency of your seizures.