Kids and epilepsy: sometimes seizures don't cause convulsions

People of any age can develop epilepsy, a neurological disorder that causes recurring brain seizures in half a million children age 17 and younger and 3 million adults in the U.S.

What causes epilepsy itself is largely unknown. However, genetics and medical conditions, including strokes and brain tumors, are linked to seizures, with episodes ranging from losing focus to losing consciousness.

There is no cure for epilepsy, but in many cases — depending on the patient — the right combination of antiseizure medications, diet and surgery can reduce or even stop seizures, said Novant Health pediatric neurologist Dr. Christine Tangredi in a recent interview with WECT News in Wilmington.

Her own experience with epilepsy as an adolescent inspired her to help treat others. Now she treats children with epilepsy at Novant Health Nunnelee Pediatric Multispecialty Care - Autumn Hall.

“I started having seizures in high school when I was about 15 years old,” Tangredi said. “I would stare off in midsentence and notice that my body would jerk involuntarily. It was a blessing in disguise: Over my lifetime, I’ve treated thousands of children with epilepsy.”

Here Tangredi shares the disorder’s effects, the appearances of epileptic seizures and the available options to treat them.

What is epilepsy, and how does it affect the brain?

Epilepsy is synonymous with seizure disorder, and epileptic seizures fall within two categories: focal (partial) seizures and generalized seizures.

“People with epilepsy have random, unprovoked seizures, which are abnormal electrical discharges in the brain,” Tangredi said. “The brain is supposed to be processing information and forming speech, language and development. And when you experience these discharges, you cannot function well.”

What does an epileptic seizure look like? Are they different in babies, children and adults?

Focal seizures begin in one section of the brain, and motor and sensory symptoms include jerking movements and staring into space. Generalized seizures affect the entire brain and can cause the person to lose consciousness.

Seizures can look different across different age groups, Tangredi said. Contrary to popular belief, a seizure is not always marked by convulsions.

“An infant might appear as if they are stretching or blinking their eyes, while an adolescent experiencing a seizure might just stare,” she said. “Adults may demonstrate automatism (characterized by involuntary lip-smacking, blinking or swallowing) or arm dystonia (involuntary muscle contractions). The typical seizure is more violent, where the person falls down and convulses.”

How can epileptic seizures be treated?

Medication

“It’s important to treat epilepsy so that the brain can continue to function normally,” Tangredi said. “Seizures can be treated in a variety of ways, and new antiseizure medications with fewer side effects are coming out every year.”

One in three people with epilepsy does not respond exclusively to medication. But the right food regimen combined with the right drugs can often prevent the need for surgery.

Diet

Certain infants who don’t respond well to medication can benefit from a high-fat, low-carb ketogenic diet, which can help prevent spasms and other symptoms. For adolescents and adults, neurologists and dietitians favor the modified Atkins diet, which is heavy in meat and dairy.

It’s important to remember that diet and medication are tailored to individual patients based on their age and severity of seizures.

Surgery

Epilepsy surgery does not guarantee an end to seizures. But it may be recommended for people whose seizures fail to respond to both medication and changes in diet.

For patients who qualify for surgery, neurosurgeons can remove the seizure focus in the brain. This procedure is effective in about 70% of people with treatment-resistant epilepsy, the American Academy of Neurology reports.

One such advanced procedure is the stereoelectroencephalography (SEEG) electrode implantation. The minimally invasive approach involves drilling tiny holes into the skull and removing tissue without disrupting the brain’s other functions.

Patients who neither respond to medication nor are candidates for surgery have other options. Nerve stimulation is another approach to treating focal and generalized epilepsy. A vagus nerve stimulator device is surgically implanted in the chest to reduce seizures by delivering electrical impulses to the brain.