Fact Sheet : Epilepsy in Children and Adolescents
Epilepsy is a common neurological condition which is characterized by two or more unprovoked seizures in 1 year. Seizures can occur in one specific area of the brain (i.e., focal) or generate from both hemispheres of the brain (i.e., generalized). The primary treatment for epilepsy is the use of antiepileptic drugs. Other treatment options that are used when antiepileptic drugs fail include surgery, ketogenic diet and vagus nerve stimulation.
Prevalence and Course
Ten percent of the population experiences at least one seizure during their lifetime. About six out of 1000 children currently have epilepsy in the U.S. Risk of seizures increases with the presence of mental retardation and autism disorder. Seizures can be caused by fevers, brain trauma, and genetic/brain abnormalities; for most children the cause is unknown (i.e., idiopathic epilepsy). Up to 70 percent of children can wean from their antiepileptic medications after a 2-year seizure free period and normal EEG. Factors associated with achieving remission are onset from 5 to 10 years old, early treatment response and idiopathic first seizure.
Health and Psychosocial Consequences
Children with epilepsy represent a vulnerable population who, even when compared to other pediatric conditions, are at highest risk for psychological comorbidities (34 percent), with highest prevalence for disruptive behavioral disorders (e.g., ADHD), followed by learning disorders (executive dysfunction and memory), and internalizing disorders (e.g., anxiety, depression). Continued seizures are associated with significant deficits in academic performance, IQ, quality of life, psychopathology and family functioning. Children with epilepsy are also more likely to have physical health comorbidities (e.g., hearing/vision, asthma, headaches).
Neuropsychological assessments are generally recommended for children with epilepsy to better understand the impact of seizures and treatment on higher cortical functions. Children with developmental and learning delays may benefit from developmental assessments. Given the significant psychosocial comorbidities associated with epilepsy, use of empirically-supported assessment measures related to emotional and behavioral functioning, adherence, health-related quality of life, and family functioning (see 2008 JPP special issue on empirically supported assessment measures) is considered best practice for patients with epilepsy.
Culture, Diversity, Demographic and Developmental factors
Epilepsy is slightly more prevalent in males compared to females and tends to increase with age. Children under 2 years of age and children from lower-income families are at highest risk for epilepsy. A national community-based survey reported that 66 percent of children with a current or previous diagnosis of epilepsy were white non-Hispanic, 13 percent white Hispanic, 11 percent black, and 9 percent multi/biracial/other.
Few evidence-based interventions have been developed in pediatric epilepsy. Cognitive-behavioral treatment (e.g., behavior management, problem-solving, relaxation) can address psychosocial adjustment and internalizing symptoms but research is needed to evaluate efficacy of these therapies. Evidence-based interventions are also needed for medication adherence and self-management (e.g., adequate sleep hygiene) for children with epilepsy.
Barry, J.J., Ettinger, A.B., Friel, P., et al. (2008). Consensus statement: The evaluation and treatment of people with epilepsy and affective disorders. Epilepsy & Behavior, 13, S1–S29.
Dunn, D.W., Austin, J.K., & Perkins, S.M. (2009). Prevalence of psychopathology in childhood epilepsy: Categorical and dimensional measures. Developmental Medicine and Child Neurology, 51(5), 364-372.
Jones-Gotman, M., Smith, M.L. Risse, G.L., et al., (2010). The contribution of neuropsychology to diagnostic assessment in epilepsy. Epilepsy and Behavior, 18, 3-12.
Russ, S.A., Larson, K., & Halfon, N. (2012). A national profile of childhood epilepsy and seizure disorder, Pediatrics, 129, 256-263.
Wagner, J.L., & Smith, G. (2006). Psychosocial intervention in pediatric epilepsy: A critique of the literature. Epilepsy and Behavior, 8, 39-49