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Success, defined as seizure freedom, is achieved in about 50 percent of patients treated with the first antiepileptic medication.
Overall, between two-thirds and three-quarters of all patients will become seizure-free. The remaining group of patients is much harder to control; the term for their condition is “medically refractory” or “intractable epilepsy.”.
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That is just one of the reasons why Cleveland Clinic Children's Epilepsy Center is proud to partner with Tristan Thompson and the Cleveland Cavaliers to help raise more awareness around pediatric epilepsy. More than 45,000 children ages 18 and younger are diagnosed with epilepsy every year.
Specialists in Pediatric Neuropsychology and Child and Adolescent Psychiatry are an integral part of the treatment team. Some patients with epilepsy do have learning or memory difficulties and alterations in mood or behavior, which should be brought to the attention of the treating neurologist for appropriate diagnostic testing and treatment. Cleveland Clinic Epilepsy Center offers a comprehensive and multidisciplinary treatment approach for managing such issues.
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After two or more antiepileptic medications fail, there is only a 5 to 10 percent chance that future medication trials will result in seizure freedom. After failure of the first drug, the patient is placed on another drug, or uses a combination of two drugs, and the seizure-free rate drops between 11 to 15 percent.
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The primary care provider may refer such a patient to a neurology service for consultation and specialized testing, including a tilt table test and continuous video EEG monitoring to establish the correct diagnosis. Misdiagnosis with epileptic seizures may occur if there is no clear history of a precipitating cause, while on the other hand, although infrequent, some epileptic seizures may have syncope as one of their manifestations.
If you have a specific question regarding a patient or our SWS program, contact Ajay Gupta, MD, locally at 216.445.0601 or toll-free at 1.800.223.2273, ext. 50601.
The treating physician can advise you to which activities are safe. Reasonable seizure precautions are advisable, however, to prevent injury due to falls, drowning or motor vehicle accidents.
Testing is carried out to localize the seizure focus and determine whether it can be removed safely. Pediatric patients are often best suited for epilepsy surgery due to the fact that their still-developing brains can better adjust after recovery. Seizure-free rates after surgery can range from 50 to 90 percent, depending upon many factors. Each year, our neurosurgeons perform more than 80 pediatric surgical procedures.
Below, find frequently asked questions about epilepsy in children:
We are here to help you and your family. Each year, our team sees over 2,000 children with pediatric epilepsy in our outpatient clinics, and evaluates more than 300 children in our dedicated state-of-the-art Pediatric Epilepsy Monitoring Unit. Come see us. More than 100 children with severe conditions undergo epilepsy surgery annually, making Cleveland Clinic's Surgical Epilepsy program one of the foremost programs of its kind in the world.
Other special services for children with epilepsy include sophisticated neuroimaging with advanced tests. These help doctors pinpoint the source of seizures and determine the best treatment options:.
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Each year, our team sees more than 2,000 children with pediatric epilepsy in our outpatient clinics.
Even for those who may not respond to medication, epilepsy surgery and electrical brain stimulation may be options. Epilepsy is a treatable disorder with two-thirds of patients becoming seizure-free on medication. Advancements in our understanding of the causes of epilepsy and new treatments continue to offer hope to ever more patients.
We work to meet the unique needs of children with epilepsy, including educating parents about symptoms, diagnosis and treatment.
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To diagnose epilepsy, doctors work to determine the type of seizure a child is experiencing (epileptic or non-epileptic) and its cause because particular seizures respond best to certain medications.
During an episode a child cries out and then seems to hold his breath. His lips and mucous membranes may appear bluish (cyanotic breath holding spell) or less commonly, a child may appear very pale (pallid breath holding spell) during an episode. They occur in response to a minor injury or as an emotional response if a toddler gets upset and cries. Breath holding spells may occur in toddlers.
For convulsive (grand mal) seizures:
Cleveland Clinic also offers same-day appointments. In most cases, depending on the level of care you need and the time of day when you call, you'll be seen by a physician that day.
If the episode is prolonged, it may result in a generalized convulsion. Consultation with the primary care provider is the first step and if necessary, further subspecialty consultation with a neurologist may be obtained for accurate diagnosis. It is important to distinguish such a convulsion from epileptic seizures.
Both are associated with brief episodes of a blank stare and lack of awareness for the surroundings. Staring spells due to inattention are commonly misdiagnosed as “absence epilepsy." Absence seizures (the seizure type associated with absence epilepsy) and staring spells of non-epileptic origin may outwardly appear very similar. In order to prevent a misdiagnosis of epilepsy and mistreatment with prolonged use of antiepileptic medications, the help of neurology consultation and EEG testing may be necessary.
Learn to recognize common symptoms of seizures: Staring and unresponsiveness Confusion Jerks and twitches Wandering Shaking or falling.
At six weeks, they usually are able to return to school or work a full day. Soon after recovering from anesthesia, children are observed in the Pediatric Intensive Care Unit for one or two days, followed by another three to five days in the hospital. Some children may need rehabilitative therapy for one to two weeks at Cleveland Clinic Children’s Hospital for Rehabilitation. Some patients may have mild cognitive difficulties, but these improve and stabilize three to six months after surgery. Patients should continue taking their seizure medications after surgery. Following epilepsy surgery at Cleveland Clinic, children are cared for by an expert team of physicians and nurses. By two weeks after surgery, patients can stay awake most of the day. Most children are able to go home, returning in about 10 days for removal of sutures.
Once considered a last resort, epilepsy surgery in the hands of experts has become a safe and highly effective method of treatment for selected patients whose epilepsy cannot be controlled with anticonvulsant medication. Our epilepsy surgery program identifies patients who are appropriate candidates for surgical intervention.
Epilepsy is a chronic medical condition marked by recurrent seizures (an event of altered brain function caused by abnormal or excessive electrical discharges from brain cells).
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A consultation with a neurologist is often necessary in order to determine whether a patient’s symptoms are due to epilepsy or to an underlying psychological disorder. During an attack, the patient often exhibits shaking of the limbs and body as in seizures, and he or she may be unresponsive. Observation of the seizures in the inpatient video-EEG-monitoring unit may be necessary to make a definitive diagnosis.
Non-epileptic behavioral events are often mistaken for epileptic seizures, but they are not due to epilepsy. Such attacks are referred to as “non-epileptic behavioral events." Other less-preferred terms for this phenomenon are pseudo-seizures and psychogenic seizures. Seizure-like reactions can sometimes occur in response to stresses or unfavorable events in a patient’s past or present life.
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Syncope or fainting occurs when a patient falls down and has a brief loss of consciousness. Sudden emotional stress, severe pain, sudden standing up or prolonged standing are some of the common causes which may lead to syncope.
A diagnosis is based on medical history, including family history of seizures, associated medical conditions and current medications.
More than 45,000 children ages 18 and younger are diagnosed with epilepsy every year. As one of the most common neurological disorders, epilepsy affects up to 1 percent of the population in the United States.
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The reason why some patients will respond well to a given medication, and not so well to another is not fully understood. Precise identification of the exact seizure type with Video-EEG monitoring and determination of the underlying cause of epilepsy are important factors when considering the best form of treatment.
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A diagnosis is also based on additional testing, which often includes:
During childhood there are several other conditions that may be mistaken for seizures, both grand mal and petite. Some of the common entities that are misdiagnosed as seizures include:.
Depending upon the degree of seizure control, patients who have epilepsy can participate in many of the same activities that other people do. We recommend that patients engage in an active and healthy lifestyle, including outdoor and indoor sports.
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A complete physical and neurological examination of higher mental functions, muscle strength, reflexes, eyesight, hearing and ability to detect various sensations will be performed so physicians may better understand the cause of seizures. Electroencephalogram (EEG) is a test that records the electrical activity of the brain and gives useful information regarding the location and type of epileptic discharges.
Picking or lip smacking For non-convulsive seizures:
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Epilepsy children treatment