Epilepsy (Children)

Epilepsy is a neurological condition characterised by recurrent seizures. It involves a sudden, abnormal surge in the brain's electrical activity, leading to a temporary 'short circuit' and a seizure. 

What are some of the common misconceptions about epilepsy? 

Here are some common misunderstandings and the facts behind them: 

• Biting the tongue during a seizure is not fatal. 
  
• Epilepsy is not caused by supernatural forces. 
  
• No specific health foods or vitamin-rich diets have been scientifically proven to stop or prevent seizures. 
  
• The occurrence of epilepsy in a child is not due to actions by the child or others—it is not anyone's fault. 
  
• Epilepsy is not contagious. 

Epilepsy can stem from various factors affecting the brain, such as infections (e.g., meningitis or encephalitis), head injuries, birth-related complications, brain tumours or inherited disorders like tuberous sclerosis. 

While epilepsy may run in some families, everyone is born with a unique 'seizure threshold', the point at which they may experience a seizure if the brain is sufficiently irritated. Thus, two children with similar brain injuries may have different risks of developing epilepsy, depending on their individual seizure thresholds. 

In some cases, the exact cause remains undetermined. In these cases, the epilepsy may be due to imbalances in neurotransmitters (brain chemicals) or specific neurotransmitter receptors in brain nerve cells. 

What can trigger more seizures? 

• Insufficient sleep is a common factor increasing the frequency of seizures. 
  
• Poor compliance with prescribed epilepsy medicine often leads to more seizures in children with epilepsy. 
  
• For some types of epilepsy, flashing or flickering lights can trigger seizures. 
  
• Illness or fever. 
  

Do seizures cause brain damage? 

Seizures can lead to brain damage if they are prolonged for over an hour. It is a medical emergency when a child experiences a cluster of seizures without regaining consciousness or a seizure lasting more than 30 minutes. Such situations require immediate medical intervention and treatment at the hospital. 

What should I do when my child is having a seizure? 

• Remain calm. 
  
• Turn your child to the side to help clear the mouth and prevent choking. 
  
• Put a flat, soft object under the head if available. 
  
• Remove sharp objects or furniture nearby to prevent injury. 
  
• Avoid attempting to hold down the child's tongue. 
  
• Do not try to awaken your child by slapping, shaking or splashing water on them. 
  
• Refrain from giving any liquids to drink during the seizure. 
  
• Do not restrain your child. 
  
• Stay with your child until normal breathing resumes and consciousness is regained. 
  
• Be aware that immediately after a seizure, your child may feel irritable and tired. Offer calm reassurance. 
  
• In case of a "wandering around" seizure, remain calm, inform others and gently guide your child away from potential harm. 
  
• Note the type and duration of the seizure for medical reference. 
  

If the seizure lasts more than 5 minutes, administer rectal diazepam as prescribed; it typically takes 15 to 20 minutes for the medication to take effect. Alternatively, you can use buccal or intranasal midazolam as prescribed by your doctor to stop the seizure. 

What precautions do I need to take? 

• Avoid sports that involve high elements, such as rock climbing or gymnastics, as they carry an increased risk of serious injury from falls. 
  
• Always ensure one-to-one supervision for any water activities, such as swimming. 
  
• Use showers over baths to reduce drowning risks during a seizure. 
  
• Use a helmet for activities like cycling. 
  

How is epilepsy treated? 

• Anti-seizure medications are usually prescribed for a minimum of two years, provided there are no breakthrough seizures. These drugs are non-addictive but crucial for seizure control. 
  
• Regular blood tests may be needed for medication dose adjustment.  
  
• Medicine levels in the body must be maintained consistently; therefore, adherence to the medication schedule is vital. 
  
• Continued seizure control suggests the effectiveness of the medication, and not a sign to stop taking the medication. 
  
• Regular medication often prevents seizure recurrence. Changes in dosage might be necessary as the child grows. 
  
• Reduction or discontinuation of medication should only be done under a doctor's guidance.

When should I bring my child to the Children's Emergency? 

• If a seizure lasts more than five minutes (administer rectal diazepam, or buccal/intranasal midazolam, if available) 
  
• If someone has several seizures in a row and doesn’t wake up in between 
  
• If your child remains unconscious for more than 30 minutes post-seizure 
  

What is sudden unexpected death in epilepsy? 

Sudden unexpected death in epilepsy (SUDEP) refers to the unanticipated death of an individual with epilepsy, who was otherwise healthy. It affects one in 1,000 people each year, more commonly in those with uncontrolled seizures. 1The cause of SUDEP remains unknown, as it often happens at night or during sleep without obvious seizure occurrence. Adhering to medication and avoiding triggers, such as sleep deprivation, can reduce the risk of SUDEP. 

Singapore Epilepsy Foundation is a non-profit organisation dedicated to promoting public awareness and education on topics surrounding epilepsy for the welfare of individuals with epilepsy.

Epilepsy Care Group (Singapore) is a non-profit, volunteer-based organisation that addresses the needs of individuals with epilepsy and their caregivers in Singapore.

At NUH, we treat many patients experiencing seizures and have established a comprehensive programme encompassing medical, nursing and education aspects to enhance seizure control. A key component of our education programme involves teaching parents and caregivers on administering first aid medication, such as rectal diazepam, during a seizure episode. 

Our statistics indicate that 86% of patients whose caregivers administered rectal diazepam successfully managed to stop the seizures. This led to a significant reduction in the need for emergency room treatments or hospital admissions, with only 14% of these cases requiring further medical intervention.  

Information correct as of January 2021