The risks of drug-resistant seizures in childhood are serious and can be catastrophic to development. When weighing the decision of whether or not your child should have epilepsy surgery, it is important to understand how seizures can affect a child’s cognitive, behavioral, and developmental outlook if they are not stopped.
Seizures in infants can be very dangerous
Seizures, especially in early infancy, can be catastrophic to cognitive and motor development. Because the human brain is not fully developed at birth, throughout infancy and early childhood, the brains of children go through an extended period of growth and maturation. If seizures occur during this critical time, they can cause serious disturbances in cognitive, behavioral, and psychiatric function. Experts agree that “early surgical intervention is critical in infants with catastrophic epilepsy to prevent developmental arrest/regression.”
Seizures, or abnormal brain waves in between seizures, that start early in life are more likely to be associated with intellectual deficit, epileptic encephalopathy, autism, and reduction in brain volume.
Epileptic spasms, formerly known as infantile spasms, are a particularly catastrophic form of childhood seizures. Infantile spasms is associated with a significant risk of mortality and morbidity. Approximately 31% of children with infantile spasms will die and another 45% will have IQ below 68. The goal of therapy, including surgery, is to achieve control as soon as possible.
Ongoing seizures can cause development to “freeze in time”
Developmental arrest – where the child’s cognitive and motor functions “freeze in time” – can occur if drug-resistant seizures do not stop. Infantile spasms and other seizure types can cause child’s development to stop almost completely.
Drug-resistant seizures can cause cognitive decline and memory impairment
Seizures can cause cognitive decline, especially generalized tonic-clonic seizures. Complex partial seizures are associated with decline in memory and executive functioning skills.
Seizures can cause psychiatric dysfunction
Drug-resistant seizures, as well as the abnormal EEG in between seizures, can cause a child to have epileptic encephalopathy – a serious disturbance in overall mental function and cognitive impairment. This can, for example, cause symptoms such as autistic characteristics. Language may be slow to develop or regress significantly.
Prolonged seizures can cause brain damage, organ failure, and death
Prolonged seizures, including status epilepticus (defined as a seizure that continues for more than half an hour or when a child has several seizures without time to recover between them) can cause brain damage, including fast and profound damage to the hippocampus, amygdala, and piriform cortex, and lesser damage to the cerebral cortex, cerebellum, and thalamus. They can also cause organ failure and sometimes death.
Seizures, especially in childhood, may cause autism
The greatest risk for developing autism for children with epilepsy is among children whose seizures begin at age two or earlier.
Seizures cause seizures
Just like a tiny little spark can kindle a raging forest fire, even the smallest, seemingly benign electrical activity in the brain can escalate into generalized convulsions. This phenomenon, known as kindling, causes the seizures to spread to other parts of the brain. These seizures often take over the motor cortex in stages and can eventually impair the child’s ability to walk and speak.
Seizures can cause sudden unexplained death due to epilepsy (SUDEP)
Sudden unexplained death due to epilepsy (also known as SUDEP) is a serious risk for any child with drug-resistant seizures. SUDEP is the unexpected death of an otherwise healthy person with epilepsy, where no cause of death has been found. Causes of SUDEP are still unknown, but some research points to cardiac or respiratory dysfunction caused by seizures or abnormal EEG patterns.
The death can occur after a seizure or unrelated to seizure (known as non-seizure SUDEP). The chances of a person with epilepsy dying due to SUDEP is 1 in 1,000; however, this risk increases significantly if the person has drug-resistant epilepsy. For a child with drug-resistant epilepsy, the chances of dying due to SUDEP is 1 in 150.
Some conditions are drug resistant by their very nature. Epilepsy surgery should be considered sooner rather than later.
There are many brain malformations and other epilepsies known to be drug resistant by their very nature – this means that there are currently no known drugs, or drug combinations, which will stop seizures caused by these conditions. For example, Rasmussen’s encephalitis is considered a drug-resistant condition.
In rare circumstances, some children with hemimegalencephaly, polymicrogyria, and other cortical dysplasias may find seizure control; however, these conditions are generally known to be drug resistant.
Don’t wait. If your child has drug-resistant epilepsy, ask your child’s neurologist or epileptologist for a referral to a qualified neurosurgeon with specific pediatric epilepsy expertise to discuss whether your child might be a candidate for epilepsy surgery.
Auvin, S., Hartman, A.L., Desnous, B. et al. Diagnosis delay in West syndrome: misdiagnosis and consequences. Eur J Pediatr. 2012; 171: 1695–1701
Bergen, D. Do Seizures Harm The Brain? Epilepsy Curr. 2006 Jul; 6(4): 117–118
Bronen, R. The Status of Status: Seizures Are Bad For Your Brain’s Health. AJNR 2000 21: 1782-1783
Clark, Df. et al. The prevalence of autistic spectrum disorder in children surveyed in a tertiary care epilepsy clinic. Epilepsia. 2005 46: 1970-1077.
Cross, et al. Proposed criteria for referral and evaluation of children for epilepsy surgery: Recommendations of the sub commission for pediatric epilepsy surgery. Epilepsia. 47(6):952-959 (2006).
Esmaeilpour K, Sheibani V, Shabani M. Effect of low frequency electrical stimulation on seizure-induced short- and long-term impairments in learning and memory in rats. Physiol Behav. 2017 Jan 1;168:112-121.
Jeste SS, Tuchman R. Autism Spectrum Disorder and Epilepsy: Two Sides of the Same Coin? Journal of child neurology. 2015;30(14):1963-1971.
Kwan, J.W. Sander. The natural history of epilepsy: an epidemiological view. J Neurol Neurosurg Psychiatry, 75 (2004), pp. 1376–1381.
Laxer, K., Trinka, E., Hirsch, L. The consequences of refractory epilepsy and its treatment. Epilepsy & Behavior, 37 (2014) 59-70.
Shields, W. Infantile Spasms: Little Seizures, BIG Consequences. Epilepsy Curr. (2006) May; 6(3): 64-69.
Thompson, PJ, Duncan, JS. Cognitive Decline in Severe Intractable Epilepsy. Epilepsia 2005;46(11):1780–1787
Tuchman, R. Autism and Epilepsy: What Has Regression Got to Do with It? Epilepsy Curr. 2006 Jul; 6(4): 107–111.
Lhatoo, SD, Nei M, Raghavan, M. Nonseizure SUDEP: Sudden unexplained death in epilepsy without preceding epileptic seizures. Epilepsia 2016 Ju; 57(7) 1161-8.
Goldman, AM. Mechanisms of sudden unexplained death in epilepsy. Curr. Opin Neurol. 2015 Apr; 29(2): 166-74.