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Children's Epilepsy Program

What is epilepsy?

Epilepsy is a condition where a person has more than one unprovoked seizure. A seizure arises due to a brief electrical disturbance of the brain. There are many types of seizures. Causes of epilepsy include genetic factors, abnormal formation of the brain, head injuries, brain tumours and infectious illnesses.

Some people can experience a seizure and not have epilepsy. For example, 3% of young children have febrile seizures. A single seizure does not mean that you have epilepsy.

For more information, visit the Epilepsy Foundation of Victoria website or the Epilepsy Foundation of America website via our Links page.

 

How is epilepsy treated?

Anti-epileptic medication controls seizures for the majority of people. Around 70 per cent of people with epilepsy are controlled with one anti-epileptic medication. However, for some people, medication does not allow full seizure control.

There is a range of tests that can be performed to help medical staff to diagnose a person's particular type of epilepsy, which in turn can help to optimise treatment. These tests include like electroencephalograms (EEG), video EEG monitoring (VEM), single-photon emission computerised tomography (SPECT), positron emission tomography (PET) and magnetic resonance imaging (MRI) scans. Some of these tests require an admission to the Paediatric ward. These tests can play an important role in determining whether the person might benefit from treatments other than, or in addition to, anti-epileptic medication, such as:

  • Epilepsy surgery
  • The Ketogenic Diet
  • Drug trials for new anti-epileptic medication
  • Vagal Nerve Stimulator (VNS).

These options are available as part of the Children's Epilepsy Program at the Austin Hospital.

Admission to the program

Initially, a child or adolescent with epilepsy or seizures is referred to the program for a consultation with an Austin Health epilepsy neurologist. The young person is then booked in to the Paediatric ward if the epilepsy neurologists think that an admission would be beneficial, and if the family is happy for this to take place.

The epilepsy liaison nurse will discuss with the family the best time for the admission to take place, and organise the admission. She/he may also be able to assist with accommodation if the family is coming from interstate, country Victoria or overseas.

Once the child arrives on the ward, a number of tests take place. Some tests are organised prior to admission.

Tests

  • Routine EEG
  • Video EEG Monitoring (VEM)
  • Magnetic Resonance Imaging (MRI)
  • Positron Emission Tomography (PET)
  • Single-photon Emission Computerised Tomography (SPECT)
  • Neuropsychological testing
  • Psychiatric Assessment

 

Routine EEG

An electroencephalogram (EEG) is a very useful test in determining whether a person is having seizures or not, and if so, what kind of seizures. An EEG measures the brain's electrical rhythms.

Before the test begins, the child is fitted with an electrode-covered cap, which will transmit the brain's rhythms to the recording equipment. Muscle tension can interfere with the test, so it's important to relax - the child is able to lie on a bed during the test.

The EEG technicians may ask the child to open or close their eyes and may turn on flashing lights to monitor the different brain rhythms. For small children, it's often useful to book the EEG around the time they usually take a nap.

 

Video EEG Monitoring (VEM)

Video EEG monitoring involves the same test as a routine EEG, but the child wears the electrodes for a much longer period of time. The electrodes are glued to the head and the head is bandaged. The child is video recorded for 24 hours a day (apart from in the bathroom) during the monitoring.

During the admission, the child has to stay in bed or in range of the camera all the time, except to go to the bathroom. This way, any seizures that occur will be captured on video and recorded on the EEG. This kind of monitoring is only useful if the child has frequent seizures, typically occurring at least every 1-2 weeks. Medication may be reduced upon admission to increase the likelihood of episodes or seizures.

 

Magnetic Resonance Imaging (MRI) scan

An MRI scan uses magnetic fields to scan a person's brain. The scan allows doctors to see the structure of the brain, and to see if there are any abnormalities in this structure. The patient must remove any jewellery before the scan. The scan takes about 35 minutes. The machine is quite noisy, so patients can wear headsets and listen to music during the procedure. The MRI scan is not dangerous or painful. In some young children, sedation or a general anaesthetic may be required so they do not move around.

 

Positron Emission Tomography (PET) scan

Twenty minutes or so before a PET scan, a low-dose radioactive substance (tracer) called a radioisotope is given to the young person intravenously. This substance allows doctors to see how the brain metabolises glucose. The region of the brain in which the seizures start often has reduced metabolism in between seizures, and increased metabolism during a seizure.

The test takes about 35 minutes of lying still, and in some young children sedation may be required so they do not move around. Every care is taken to ensure that the administration of the intravenous substance does not distress the patient.

In some children, the EEG (brainwave tracing) may be recorded during the 20-minute uptake phase immediately after when the radioactive tracer is injected intravenously. This is to help interpretation of the scan, which may be altered by frequent or continuous epileptic activity.

 

Single-photon Emission Computerised Tomography (SPECT) scan

A SPECT scan looks at the picture of blood flow to the brain during a specific 30-second time window. We have shown that an ictal SPECT scan early in a seizure is very helpful in localising where a seizure begins in the brain.

It is very important to have a parental carer observing the child to indicate as soon as a seizure begins and call the attention of the nursing staff. The nursing staff will then race into the room and draw up the appropriate dose of radioactive substance out of the radioactive safe in the video monitoring room. They will then inject this into the intravenous line of the child. The radioactive substance then localises in the brain within 30 seconds giving a picture of the blood flow at that moment. Thus, the earlier this can be given following seizure onset, the more reliable and helpful the picture is in terms of determining seizure origin. The scan can then be taken at any time over the next two hours and will show the picture of the blood flow to the brain at the time of the radioisotope injection.

Many children will be able to lie still for this scan, however, some children may require sedation to lie still. Interpretation of the ictal SPECT scan is more reliable with an interictal (between seizures) scan. Sometimes this is only performed after the ictal scan can be obtained as one does not always successfully obtain an ictal scan. Some patients may require more than one ictal SPECT scan if there is a suggestion that there are multiple types of focal seizures coming from different areas of the brain.

 

Neuropsychological testing

Children who are admitted under the Children's Epilepsy Program undergo neuropsychological assessment with one of our neuropsychologists. This helps to determine whether there are subtle difficulties with learning or memory that reflect where seizures arise in the brain. This also helps inform whether possible epilepsy surgery will affect language, memory or learning. The neuropsychologists also have an important role in testing the child post-operatively to look for changes.

Who is eligible?

Children or adolescents with epilepsy are eligible for admission to Austin Health's Children's Epilepsy Program after assessment by a paediatric neurologist or epilepsy neurologist.