Early Signs of Epilepsy in Infants and Children

Epilepsy is a chronic neurological disorder characterized by recurrent, short-term episodes of abnormal brain function caused by excessive electrical discharges in brain neurons. These seizures can be difficult to detect in the early stages, especially in young children who may not have the verbal ability to express what they are experiencing. Parents and caregivers should therefore be attentive to subtle behavioral and physical changes that may indicate epilepsy.

Common Early Epilepsy Syndromes in Children

Infantile Spasms (West Syndrome)

Infantile spasms typically begin within the first year of life, with a peak onset between 4 and 6 months. These spasms can often be linked to underlying conditions such as developmental brain abnormalities, intrauterine infections, or genetic and metabolic disorders. The seizures usually occur in clusters and may present as flexion, extension, or mixed-type spasms. Additionally, children may experience delays or regression in motor and cognitive development. EEG findings typically show hypsarrhythmia, a chaotic high-voltage brain wave pattern. In many cases, infantile spasms evolve into other forms of epilepsy, such as Lennox-Gastaut syndrome, after the age of 2 or 3.

Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS/Rolandic Epilepsy)

This is one of the most common forms of childhood epilepsy, accounting for about 25% of pediatric cases. It often runs in families and typically begins between the ages of 2 and 14, with a peak between 5 and 10 years. Seizures often occur during sleep or shortly after waking. Symptoms may include numbness or tingling in the face and throat, unusual vocalizations, drooling, and difficulty speaking while remaining fully conscious. Facial twitching and drooping of the mouth are also common. The EEG typically shows characteristic centrotemporal spikes.

Ohtahara Syndrome (Early Infantile Epileptic Encephalopathy)

This severe form of epilepsy begins within the first three months of life, often as early as the first month. It is characterized by tonic spasms and significant developmental delays. Infants typically show signs of severe psychomotor retardation and abnormal brain imaging results. Early diagnosis and treatment are crucial due to the progressive nature of this condition.

Acquired Epileptic Aphasia (Landau-Kleffner Syndrome)

This syndrome usually develops between the ages of 2 and 8. Prior to onset, language development is typically normal. However, children may suddenly experience auditory agnosia—meaning they can hear normally but cannot understand spoken language—leading to a progressive decline in speech or even a complete loss of verbal ability. Seizures such as generalized tonic-clonic or focal motor seizures may also occur. While intelligence is often preserved, behavioral issues are common. EEG findings usually show spike-and-wave discharges predominantly in the temporal regions, which increase during sleep.

Continuous Partial Epilepsy

This type of epilepsy typically begins between the ages of 2 and 12 and is characterized by localized, continuous twitching of the face or limbs, with the child remaining fully conscious during episodes. It includes two subtypes:

Kojewnikov Syndrome

This form is often associated with identifiable causes such as inflammation, trauma, or vascular abnormalities. Seizures remain focal and may later progress to include myoclonic jerks. EEG shows focal spikes in the central region. Cognitive development is usually unaffected, and the condition does not typically worsen over time.

Rasmussen's Encephalitis

Potentially linked to autoimmune mechanisms, this condition involves continuous focal seizures, often accompanied by hemiparesis and cognitive impairment. Myoclonic seizures may appear early, and EEG shows widespread and multifocal spike-wave bursts during both interictal and ictal periods. The disease follows a chronic, progressive course and requires long-term management.

Generalized Epilepsy with Febrile Seizures Plus (GEFS+)

This genetic epilepsy syndrome is diagnosed at the family level and is marked by a range of seizure types within a single family. Children often experience febrile seizures before the age of 6, followed by generalized tonic-clonic seizures with or without fever after 6. Additional seizure types such as absence, myoclonic, or atonic seizures may also occur. GEFS+ is age-dependent, with most febrile seizures resolving before puberty. Neurological and imaging evaluations are typically normal, and the long-term prognosis is generally favorable.

Why Early Detection Matters

Childhood epilepsy can manifest in a wide variety of ways, and many early symptoms are subtle and easily overlooked. Relying solely on observable symptoms is not enough for a diagnosis, yet untreated epilepsy can significantly impair a child's physical and cognitive development and, in severe cases, pose life-threatening risks. If any of the above symptoms are observed, prompt medical evaluation is essential to ensure timely diagnosis and treatment. The goal is to preserve and restore the child's normal physiological and social functioning as much as possible.