Epilepsy in children who also have developmental difficulties
Epilepsy rarely arrives on its own in the children we see. It sits alongside developmental difficulties, a neurological condition or an earlier brain injury — and each one changes how the others should be managed.
What we try to establish
- The exact seizure type — because seizures that look alike are often not alike
- The epilepsy syndrome, where one can be identified
- The likely underlying cause
- How the epilepsy is affecting learning, behaviour and development
- Whether the current medication is the right medication for this seizure type
- Whether side effects are contributing to the child's difficulties
- The simplest treatment strategy that controls the seizures safely
Seizures are only part of what epilepsy does
Parents are usually told to count seizures, and seizure control matters enormously. But a child whose epilepsy is interrupting their attention through the school day, or whose medication is making them drowsy or irritable, can be losing ground even when the seizure count looks acceptable.
So we assess development and behaviour alongside the epilepsy, not after it. In children with developmental difficulties or brain injury, the two questions cannot sensibly be separated.
What we found when we looked at referrals
In 2014 and 2015 we reviewed the records of 56 children who came to us for a paediatric neurology consultation, and compared what we found against the ILAE's recommendations. Most of them arrived already on treatment.
That is why this page is about diagnosis before it is about medication. A child taking three anti-seizure drugs for episodes that were never seizures does not have a prescribing problem. They have a diagnostic one, and no adjustment to the medication would ever have fixed it.
The minimum effective medication burden
Anti-seizure medication is necessary, and for many children it is not negotiable. What varies between children is how many medicines they end up taking, and whether every one of them is still earning its place.
Our objective is the minimum medication burden that achieves safe and effective seizure control for that individual child. That is not the same as saying fewer medicines are better. Some children need more than one, and those children should have more than one — for them, the right burden is the one that stops the seizures.
What we try to avoid is medication that accumulated for reasons nobody can now reconstruct, and side effects that are being read as the child's personality or their disability.
This describes how we review medication. It is not advice to reduce or stop any medicine. No change should ever be made except by the clinician responsible for your child's epilepsy care.
How we work
Our epilepsy practice follows contemporary epilepsy-management principles, including the seizure and epilepsy classifications published by the International League Against Epilepsy (ILAE), and UK NICE guidance on the epilepsies in children and young people.
The team's epilepsy expertise is also used to teach other doctors and professionals.
Talk to us about your child
An assessment starts with a conversation. Tell us what you have noticed and we will explain what would help.
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This page explains how we work and is general information for parents. It is not a diagnosis, and it is not a substitute for advice about your own child. For guidance specific to your child, book an assessment. In an emergency, contact your local emergency services.