Neftaly Management of Pediatric Epilepsy
1. Introduction
Epilepsy is one of the most common neurological disorders in children, characterized by recurrent, unprovoked seizures. While pediatric epilepsy can be a lifelong condition, many children can live healthy and productive lives with early diagnosis, appropriate treatment, and ongoing support.
Neftaly is committed to reducing the burden of pediatric epilepsy through evidence-based care, community education, and accessible treatment models, especially in resource-limited and rural settings.
2. Objectives
- Improve early identification and accurate diagnosis of epilepsy in children.
- Guide appropriate treatment using safe and effective anti-seizure medications.
- Reduce seizure frequency and associated complications.
- Promote social inclusion and reduce stigma.
- Support families and caregivers through education and community resources.
3. Understanding Pediatric Epilepsy
3.1 Definition
Epilepsy is defined as:
- Two or more unprovoked seizures occurring more than 24 hours apart, OR
- One unprovoked seizure with a high risk (>60%) of recurrence, OR
- A diagnosed epilepsy syndrome
3.2 Common Causes in Children
| Age Group | Common Causes |
|---|---|
| Neonates (0–1 month) | Birth injury, infections, metabolic disorders, genetic conditions |
| Infants and children | Febrile seizures, cerebral palsy, trauma, tumors, developmental disorders |
| Adolescents | Genetic epilepsy syndromes, head trauma, infections, substance use |
4. Types of Seizures
| Seizure Type | Features |
|---|---|
| Focal (Partial) | Begins in one area of the brain; may involve abnormal movements, awareness changes |
| Generalized Tonic-Clonic | Full-body convulsions, loss of consciousness, post-ictal confusion |
| Absence | Brief staring spells, unresponsive, sudden stop in activity |
| Myoclonic | Sudden, brief muscle jerks |
| Atonic | Sudden loss of muscle tone, may cause falls |
| Febrile Seizures | Triggered by fever; usually outgrown by age 5 |
5. Diagnosis
5.1 Clinical Evaluation
- Detailed seizure history: onset, frequency, duration, triggers, behavior during and after seizure
- Family history of epilepsy or neurological conditions
- Developmental milestones and physical exam
5.2 Investigations
- EEG (Electroencephalogram): to confirm seizure type or syndrome
- Neuroimaging (MRI preferred over CT): if focal signs, developmental delay, or abnormal neurological findings
- Metabolic and genetic testing if clinically indicated
6. Acute Seizure Management
6.1 First Aid During a Seizure
- Stay calm; lay the child on their side (recovery position)
- Protect from injury (remove harmful objects, loosen tight clothing)
- Do NOT restrain the child or put anything in their mouth
- Time the seizure; if it lasts >5 minutes, seek emergency care
6.2 Emergency Medication for Prolonged Seizures
- Rectal Diazepam or Buccal Midazolam (as per protocol)
- Refer to a health facility if:
- Seizure lasts >5 minutes
- Repeated seizures without recovery
- Child is injured or has breathing difficulties
7. Long-Term Treatment
7.1 Anti-Seizure Medications (ASMs)
| Medication | Use | Notes |
|---|---|---|
| Phenobarbital | Neonatal seizures, generalized | Effective and affordable; may cause drowsiness |
| Carbamazepine | Focal seizures | Not for generalized epilepsy |
| Valproic Acid | Generalized, absence, myoclonic | Avoid in adolescent females due to teratogenicity |
| Lamotrigine | Broad-spectrum | Good safety profile |
| Levetiracetam | Broad-spectrum | Fewer interactions; well-tolerated |
- Start with monotherapy, increase gradually to effective dose.
- Monitor for side effects, compliance, and drug interactions.
- Maintain treatment for at least 2 years seizure-free before considering tapering.
7.2 Monitoring and Follow-Up
- Regular growth and development checks
- Medication adherence and side effects
- School performance and psychosocial well-being
- Periodic EEG or imaging (if needed)
8. Non-Pharmacological Management
- Ketogenic diet: High-fat, low-carb diet for refractory epilepsy (requires medical supervision)
- Vagus Nerve Stimulation (VNS): For drug-resistant epilepsy (where available)
- Psychosocial support: Mental health care, peer groups, school counseling
- Neurosurgery: In selected cases with identifiable seizure focus
9. Family and Caregiver Support
Neftaly promotes:
- Education on seizure recognition and response
- Guidance on medication administration and adherence
- Safety at home and school (helmets, supervision, swimming precautions)
- Support groups and caregiver mental health
10. Addressing Stigma and Inclusion
- Train community health workers to educate families and schools
- Raise public awareness that epilepsy is not contagious or spiritual
- Promote inclusive education and community participation
- Work with schools to develop seizure action plans
11. Referral Guidelines
Refer to a specialist if:
- Seizures are not controlled after 2 appropriate medications
- Developmental delay or regression occurs
- Suspicion of structural brain lesion or genetic disorder
- Diagnosis is unclear or non-epileptic events are suspected
12. Data Collection and Monitoring
- Use standard epilepsy registers to track diagnosed children
- Monitor:
- Seizure frequency and type
- Medication use and side effects
- School attendance and behavior
- Report drug stock-outs or treatment gaps to Neftaly’s Health Systems Unit
13. Neftaly Community Outreach Model
- Mobile clinics to identify and manage epilepsy in rural areas
- Training for primary care providers and CHWs on epilepsy care
- Family education workshops in collaboration with local leaders
- Referral networks for advanced diagnosis and treatment
14. Conclusion
Pediatric epilepsy is treatable and manageable. With early diagnosis, continuous care, and community support, children with epilepsy can lead full, active lives. Neftaly is dedicated to making epilepsy care equitable, affordable, and stigma-free through integrated services and strong community partnerships.
For clinical tools, referral forms, training materials, or support services, contact the Neftaly Child Neurology and Disability Program.