Babies and epilepsy

Contents

The causes of epilepsy in babies
Types of seizures
Diagnosis
Treatment
Long-term development
Further information

Introduction

This information relates to babies who are up to one month old.

The causes of epilepsy in babies

There are many causes of seizures in babies. In around seven to eight out of 10 babies with seizures, a cause will be found. These are the most common ones.

• Being born more than two or three months early. If your baby is born so early, they are at risk of having bleeding inside their brain. This is called intracranial haemorrhage.
• Being born on time but suffering a lack of oxygen to the brain. This is called perinatal hypoxia and can cause an injury to the brain called ‘hypoxic-ischaemic encephalopathy’.
• Having low levels of glucose, calcium or sodium in the blood.
• Having an infection such as meningitis or encephalitis.
• Being born with an abnormal brain. This is called cerebral dysplasia or dysgenesis. Cerebral means relating to the brain. Dysplasia or dysgenesis means abnormal development.
• Inheriting a medical condition, such as benign neonatal convulsions.

Epilepsy Action has more information about inheriting epilepsy and benign neonatal convulsions. 

Types of seizures

Seizures in babies can be difficult to recognise. They are often brief and affect only some parts of the body. 

• Your baby may have jerking or stiffening of an arm or leg that can switch from side to side. Or their whole upper body may suddenly jerk forward. Or both their legs may jerk up towards their stomach, with their knees bent. These are usually called myoclonic or, if the jerks happen repeatedly in clusters, clonic seizures.
• Sometimes, only the baby’s face is involved. Their eyes twitch and their head turns to one side. These are usually called focal seizures.
• If your baby’s body stiffens with or without eyelid flickering, these are usually called tonic seizures.
• Your baby may go bright red in the face and their breathing and heart rate may change. They will be less alert than usual. You may notice that, for a short time, you can’t attract your baby’s attention. Or you might notice your baby’s eyes are not focusing. These are usually called subtle seizures.

Epilepsy Action has more information about types of seizures.

Diagnosis

It can be difficult to recognise seizures in babies.  That’s why it’s important that they are referred to a doctor who has had specialist training in diagnosing and treating epilepsy. The specialist will ask you about:

• any behaviour changes that are unusual for babies at that age
• whether all the seizures look the same, and last the same length of timehether the seizures happen while your baby is awake or  asleep, or both
• whether the seizures are caused by changes in your baby’s posture or when they are doing different things
• whether the seizures interfere with, or stop, your baby’s activities such as feeding
• whether you can stop the seizures after they have started.

If you can record any behaviour changes (maybe on a mobile phone) to show the specialist what happens, this might be very important. It can help with making the diagnosis.

Epilepsy Action has more information about diagnosing epilepsy.

The specialist may then arrange for some, or all, of the following tests.

Electroencephalogram (EEG)

Electrical activity is happening in our brain all the time. A seizure happens when there is a sudden burst of intense electrical activity. This intense electrical activity causes a brief disruption to the way the brain normally works, meaning that the brain’s messages become mixed up. The result is an epileptic seizure.

An EEG gives information about the electrical activity that is happening in your baby’s brain at the time of the test. The electrical activity shows on the EEG as a particular brainwave pattern. EEGs can be very useful in older children and adults, but are less valuable in helping to diagnose epilepsy in babies. This is because the brains of babies are immature, and can’t usually show the changes in brainwave patterns that are seen in older children. This means that even during an epileptic seizure the EEG may not show anything abnormal.

However, if the EEG is very abnormal, it will tell the doctors more about your baby’s epilepsy.

Epilepsy Action has more information about EEGs.

CT scans (computed tomography)

A CT scan is a type of X-ray that shows the physical structure of the brain. It doesn’t show if your baby has epilepsy. However, it may show if there is anything in your baby’s brain, such as a scar, or damaged area, that could cause epilepsy. Not every baby will need to have a CT scan.

Epilepsy Action has more information about CT scans

MRI scans (magnetic resonance imaging)

An MRI scanner uses radio waves and a magnetic field to show the physical structure of the brain. An MRI scanner is more powerful than a CT scanner. An MRI scan has a higher chance than a CT scan of showing something in your baby’s brain that could cause epilepsy. Not every baby will need to have an MRI scan.

Epilepsy Action has more information about MRI scans.

Blood tests

Blood tests are used to check your baby’s general health, and to look for any medical conditions that might be causing their epilepsy. They can also be used to find out if the seizures are not caused by epilepsy, but another medical condition. An example would be low blood sugar (glucose) or low calcium levels. 

Some babies will be referred to a genetics department for further testing. This will depend on the individual baby, whether they have any other medical issues, and their family history. The referral will  be made by the paediatrician or the paediatric neurologist.

Treatment

There is a large range of epilepsy medicines used to treat seizures in babies. The choice of medicine will depend on:

• the baby’s seizure type
• the age when the epilepsy began
• the cause of the epilepsy, if known
• whether the baby has any other medical conditions, or takes any other medicines
• the likely outlook for their particular type of epilepsy.

Some of the epilepsy medicines used in babies include phenobarbital, phenytoin, clonazepam, carbamazepine, sodium valproate, levetiracetam, and vigabatrin. Pyridoxine, (vitamin B6) is also sometimes used.

Epilepsy Action has more information about treating epilepsy.

Long-term development

• If a baby’s seizures are caused by bleeding in their brain or severe lack of oxygen at birth, they will often start having infantile spasms (West syndrome) in their first year of life. They may carry on having seizures that are difficult to treat throughout their childhood. They will also have learning disabilities and many will have cerebral palsy.
• If a baby’s seizures are caused by meningitis, they may have seizures during childhood and develop learning disabilities and cerebral palsy.
• Babies who have a low level of glucose in their blood have seizures during childhood and are likely to have learning disabilities. They may also have impairment of their sight.
• If a baby has seizures caused by cerebral dysplasia or dysgenesis, they are likely to have difficult to control epilepsy. Cerebral dysplasia or dysgenesis means abnormal development of the brain. Most of these infants will also have learning disabilities. These are usually moderate or severe. The outlook for babies who have a genetic abnormality will depend on their particular genetic abnormality.

Epilepsy Action had more information about West syndrome and learning disabilities.

Further information

Your health visitor, epilepsy nurse, or epilepsy specialist may be to give your information about your baby’s condition. 

The UK organisation Contact a Family freephone 0808 808 3555 (UK) or cafamily.org.uk may be able to provide information and details of self-help groups for children with specific conditions, including the less common types of epilepsy.