Children and young people

Children and young people

Questions from healthcare professionals

Q: What is Benign Myoclonic Epilepsy?

A: Benign Myoclonic Epilepsy is a childhood epilepsy syndrome. There are articles about childhood syndromes in our articles section under The spectrum of epilepsy. You can also find out more about syndromes on this website under 'children and education' and 'syndromes'. 
August 2008

Q: The NICE (National Institute for health and Clinical Excellence) advocate that children with epilepsy should have a comprehensive care plan. Would a clinic letter be enough or is a more comprehensive document needed.

A: We are not aware of any standard care plans that are used for compiling a comprehensive care plan. Obviously a care plan has to be personalised to the individual so the contents of the plan will vary according to the situation, individual, and their epilepsy and needs arising from this. A minimum requirement could include: types of seizures the individual has (including a full description of each seizure type including the pre-ictal, ictal and post-ictal symptoms, as well as seizure classification); length and details of standard recovery from seizures; seizure frequency; any known triggers; details of medication (or other treatment) including type and does of anti-epileptic drugs; details of any rescue medication if indicated, including which, a protocol for giving the rescue medication and details of how much and when to give/repeat doses, and what to do in the event this fails to stop status. A care plan may also include details of lifestyle, schooling and leisure issues where indicated by the particular situation. 
April 2008

Q: Where can I find out more about Salaam-type seizures?

A: 'Salaam' describes a particular type of epileptic seizure, that takes on a very particular form. They usually only occur in early life. Salaam spasms or seizures can be a feature of West Syndrome (or Infantile Spasms). There is more information about West Syndrome in the articles section of this website under Severe paediatric epilepsy syndromes.
February 2008

Q: What are the precautions for taking a child with epilepsy swimming?

A: It is helpful to look at an individual risk assessment for taking a child with epilepsy swimming. Many safety issues can be addressed by taking safety measures. It can be helpful for someone who can recognise and manage the child’s seizures to go with the child: this could be the parents or carers, or they could alert the pool’s lifeguard. Some people will swim when the pool is quiet so that the child can be easily seen. If they have a seizure while swimming, the general guidelines are to keep their head above water and to gently tow them to the side of the pool. It may or may not be necessary to remove them from the pool during the seizure but this depends on the situation. But again, an individual risk assessment is helpful here.
February 2008

Q: Are communication problems – such as lack of fluency in speech, rapid repetitions, disorganised sentences, sounds and syllables missed from words - seen in Rolandic epilepsy? If so, what can be done to help increase fluency and intelligibility?

A: Cognitive problems, particularly in speech and language, have been associated with this type of epilepsy, but clinically noticeable issues are rare, unless associated with a lot of ongoing EEG activity, continuous in sleep. If a child has shown deterioration in language then a sleep EEG would be recommended.
March 2006

Q: Do seizures secondary to hypoxic-ischemic encephalopathy respond preferentially to any anti-epileptic drug or combination of drugs before and after one year of age?

A: There are no particular drugs that have been noted to be particularly effective.
September 2005

Q: For how long should ACTH be given to patients with West syndrome? If seizures recur, should ACTH be given again?

A: ACTH is given for four weeks at a high dose and four weeks weaning, therefore a total of eight weeks. If there is a relapse when fully weaned, it can be given again, although alternatives may be considered, such as vigabatrin or valproate.
September 2005

Q: Is there a link between omega 3, brain wave activity and epilepsy? Can a child with epilepsy take omega 3 supplements?

A: There is no definite evidence about the role of omega 3. Most of the suggestive data is to do with cognition. There is no contraindication to a child with epilepsy taking omega 3.
June 2005

Q: Is it safe to give valproic acid to infants? Should L-carnitine be co-prescribed to ensure safety?

A: It is safe, preferably as monotherapy but with care otherwise - particularly if the aetiology is known. Carnitine does not routinely need to be given. When cases of liver dysfunction thought to be related to valproate therapy were reviewed, those at most risk were children under the age of two on polytherapy - therefore care needs to be taken in such children, particularly where the diagnosis is unclear and may be metabolic.
March 2005

Q: What are the indicators that valproate monotherapy should be stopped in infants below 12 month old if their seizures are completely controlled on it? What are the indications of giving carnitine to infants below 12 months old on valproate monotherapy?

A: There is no evidence to indicate that valproate monotherapy should be stopped if seizures are controlled for less than 12 months, and no evidence to support the use of carnitine. The possibility of carnitine deficiency is theoretical, not proven and it is not routinely used.
March 2005

Q: Is there any documentation of increased challenging behaviour in children prescribed sodium valproate and ritalin?

A: There is no specific literature - ritalin would be used for ADHD rather than cause challenging behaviour. There are children who respond behaviourally in an unfavourable way to individual anticonvulsants, and this may occur with sodium valproate. Some children respond in this way to any anticonvulsant, and it may be related to seizure control. However, the relationship between behaviour, seizures and anticonvulsants is complex and will vary with each individual. In cases of increased challenging behaviour, the relative contribution of the medication needs to be considered, and a possible change contemplated.
December 2004

Q: I’m looking for literature regarding children with rolandic epilepsy and reading problems. Is there an association? If treated with AEDs is there an improvement in reading abilities?

A: There are papers relating neuropsychological dysfunction with rolandic epilepsy, and there is also an indication that children with frequent seizures and greater EEG abnormality have a higher degree of problems. You can do a search for papers at Medline. However as far as we are aware, no work has been done suggesting that treatment improves neuropsychological function.
July 2004

Q: Can you tell me about Landau Kleffner syndrome?

A: Landau-Kleffner syndrome is a rare condition that begins in childhood, usually between the ages of four and seven. It is also called acquired epileptic aphasia. Children with Landau Kleffner syndrome have difficulties with speech and most will also have seizures. The long-term prognosis for seizure control is usually good. However in some children difficulties with speech and language remain.
July 2004

Q: How does epilepsy affect the development of motor skills in children?

A: It depends on the type of epilepsy. Certainly children with frequent seizures, particularly associated with the symptomatic epilepsies, may have reduced motor control - very frequent seizures can almost cause a 'pseudoataxia'. In addition, certain medications in high doses can cause reduced motor function. Howver, this is in a small minority.
June 2004

Q: We have a girl with uncontrolled epilepsy school in September. We need to keep her safe and are looking for imaginative solutions that will help her get the most from both educational and social aspects of school life. She has a moderate degree of learning difficulties and does not seem to get any warning of her convulsions. Can you help?

A: There is information on this website on different aspects of epilepsy, including safety, risk, education, learning disabilities and first aid. We also have an information sheet about what is useful to know about a child’s epilepsy and what is useful to record during a seizure – this can be obtained by phoning the helpline on 01494 601400. For specific help relating to this particular girl, you might find it useful to phone our helpline 01494 601400 and discuss the issues with the trained staff there. The helpline is open from 10am to 4pm, Monday to Friday.
June 2004

Q: I am enquiring on behalf of a family whose little girl has severe epilepsy and PMLD (profound and multiple learning disabilities). They would like to know of any specialist clinics that might tell them more about their daughter. They are also looking for support groups for parents of children with PMLD. Can you help?

A: There is a list of epilepsy clinics for children on this website. In terms of support, it may be worth getting in touch with Contact a Family, which provides support and advice to parents whatever the medical condition of their child.
March 2004

Q: How often do you find hyperactivity associated with epilepsy in children? Is there a causal link? Can you recommend any references on this subject?

A: Behaviour difficulties, commonly ADHD, can be associated with epilepsy, particularly that resistant to medication but not exclusively so. The relationship between behaviour and epilepsy is complex, and there is no direct causal relationship - it is probably multifactorial between seizures, underlying cause and medication. All too readily medication may be blamed. Although it may be indirectly related through the effect on seizures, it is uncommon to be the sole cause. Further reading in the chapter by Isobel Heyman in 'Epilepsy in Childhood' ed Sheila Wallace and Kevin Farrell.
March 2004

Q: I am working with a teenage girl with severe epilepsy and very limited speech. Is it possible that her seizures have compromised that part of her brain? Is it realistic to expect her to speak more than she is already doing?

A: The relationship between speech and epilepsy is complex. Although speech can be interfered with by frequent epileptiform activity, early onset seizures may interfere with normal developmental pathways, and all areas of development may be affected. The area of communication can be the most frustrating. For children with early onset seizures, whose speech has always been limited, and who have continued to learn albeit extremely slowly throughout, it is not incorrect to encourage verbal communication, but the likelihood of a significant improvement is slim. Sometimes dependent on seizure frequency, language may fluctuate, and this may indicate some improvement may be seen with further treatment of the epilepsy.
March 2004

Please note: Epilepsy Society is unable to provide a medical opinion on specific cases. Responses contain information relating to the general principles of investigation and management. Answers are not, and should not be assumed to be, direct medical advice.