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November 1, 2020
One in 26 people will develop epilepsy in their lifetime. Approximately 470,000 children in the United States are diagnosed with epilepsy, which is the fourth most common neurological disorder in the country. During epilepsy awareness month in November, Jennifer Avallone, D.O., a pediatric epileptologist at Johns Hopkins All Children’s Hospital. educates families on what epilepsy is and when parents should seek medical attention.
What is a seizure?
A seizure is a disturbance in the electrical activity of the brain. An epileptic seizure occurs when a restricted group of brain cells (neurons) don’t communicate with each other normally. These groups of neurons are activated together and produce the clinical symptoms of seizures.
What are signs/symptoms parents should look out for?
There are many different types of seizures. Some patients have an aura or warning as the first symptom of a seizure (i.e., nausea). There is then an ictal (middle) phase during which there is an electrical disturbance in the activity of the brain. Patients can have loss of consciousness, loss of awareness/staring, stiffening, color change, extremity shaking, lip smacking, changes in vision, myoclonic jerking or other neurologic symptoms during this phase. As the seizure ends, the postictal phase can include confusion, headache and fatigue.
What causes seizures?
Head injuries, genetic conditions, infections, electrolyte abnormalities and tumors or other structural findings on neuroimaging can be the reason for seizures. Infection, missing anti-seizure medication, lack of sleep and flashing lights can lower seizure threshold in patients with epilepsy.
What is epilepsy?
Epilepsy is when a person has 2 unprovoked seizures that occur more than 24 hours apart from each other. Epilepsy is a spectrum condition with a wide range of seizure types and control varying from person to person.
When are people most likely to get epilepsy?
Children and the elderly are the fastest growing segments of the population with new cases of epilepsy. New cases of epilepsy are most common among children, especially during the first year of life. The rate of new cases of epilepsy gradually goes down until about age 10 and then becomes stable. After age 55, the rate of new cases of epilepsy starts to increase, as people develop strokes, brain tumors or Alzheimer’s disease, which all can cause epilepsy.
What are treatment options for seizures?
Electroencephalogram (EEG), MRI brain and genetic testing can help to understand the cause of epilepsy. Depending on the type of epilepsy, anti-seizure medications are selected and started when the diagnosis is made. Epilepsy surgery evaluations and ketogenic diet (low carb, moderate protein, high fat) with nutritional counseling may also be considered by your child’s epileptologist when anti-seizure medications are ineffective (this is known as refractory epilepsy).
For more information about the Neurology or Epilepsy program at Johns Hopkins All Children’s Hospital, visit HopkinsAllChildrens.org/Neurology.
About the Author: Dr. Avallone is a pediatric neurologist with a specialty in epilepsy. She joined the hospital in 2017 after four years at the Institute of Neurology and Neurosurgery at Saint Barnabas Medical Center in Livingston, New Jersey. Dr. Avallone earned her medical degree at the New York College of Osteopathic Medicine of the New York Institute of Technology. She completed a pediatric residency at the University of Medicine and Dentistry of New Jersey and a child neurology residency at Boston Children’s Hospital/Harvard Medical School. She also completed a clinical neurophysiology/pediatric epilepsy fellowship at Boston Children’s Hospital/Harvard Medical School.