Managing Epilepsy in Teens: When to Consider Medication and Triggers

A child experiencing a seizure in the first year of high school?

Hello, Doctor.
My child had their first seizure in the third year of junior high school, characterized by stiffening of the limbs, upward eye movement, and loss of consciousness for about 1-2 minutes (this occurred in March 2015).
We went to Chimei Medical Center for an examination.
After an EEG, it was found that there were abnormal discharges in the brain both when awake and asleep.
The doctor suggested monitoring the frequency of seizures before deciding on medication.
This year, in March 2016, my child had another seizure with the same symptoms.
I would like to ask the doctor if medication is necessary given the frequency of once a year.
Additionally, my child is older now and has been playing online games on the computer and mobile games.
Could this type of audiovisual stimulation trigger seizures? Furthermore, we are planning to return for a follow-up appointment; can we request the doctor to conduct additional tests to help identify potential triggers?

len, 10~19 year old female. Ask Date: 2016/03/19

Dr. Gao Chunde reply Neurology

It is really difficult to convince oneself and the patient to take medication daily for an event that occurs only once a year.
However, if there are indeed structural lesions in the brain, then treatment and medication are necessary.
If not, regular follow-up visits are required, including EEG tests and monitoring of various clinical seizures or similar minor episodes to ensure the physician has a clear understanding.
Light and sound stimuli, as well as substances or behaviors that excite brain cell activity, can also trigger seizures.

Reply Date: 2016/03/19

More Info

Managing epilepsy in adolescents can be a complex and nuanced process, particularly when considering the frequency of seizures and potential triggers. In your case, your child experienced their first seizure in March 2015, characterized by stiffening of the limbs and loss of consciousness, which lasted for about 1-2 minutes. The subsequent EEG (electroencephalogram) showed abnormal electrical activity in the brain, both during wakefulness and sleep. After a second seizure in March 2016, you are understandably concerned about whether medication is necessary, especially given the infrequency of the seizures—once a year.

When it comes to the decision to start medication for epilepsy, several factors need to be considered. The general guideline is that if a person has had two or more unprovoked seizures, medication is usually recommended to prevent further episodes. However, in cases where seizures are infrequent and the individual is otherwise healthy, some doctors may suggest a watchful waiting approach, monitoring the situation closely before initiating treatment. This is particularly true if the seizures are well-controlled and do not significantly impact the patient's quality of life.

In your child's case, since they have had two seizures over a span of about a year, it may be worth discussing with your healthcare provider whether starting medication is advisable. The potential risks and benefits of medication should be weighed carefully. Antiepileptic drugs (AEDs) can be effective in controlling seizures, but they also come with potential side effects that need to be considered.

Regarding triggers, you mentioned that your child has been playing online games and using mobile devices. For some individuals with epilepsy, visual stimuli such as flashing lights or rapidly changing images can provoke seizures. This phenomenon is known as photosensitive epilepsy. While not all individuals with epilepsy are sensitive to visual stimuli, it is essential to monitor your child's gaming habits and any potential correlation with seizure activity. If you suspect that gaming or screen time may be a trigger, it may be beneficial to limit these activities and observe any changes in seizure frequency.

As for further evaluations, it is reasonable to request additional tests during your next appointment. A follow-up EEG could provide more insight into your child's brain activity and help identify any specific patterns that may correlate with seizure activity. Additionally, discussing lifestyle factors such as sleep patterns, stress levels, and dietary habits can also be crucial, as these can influence seizure frequency.

In summary, the decision to start medication for epilepsy in adolescents should be made collaboratively with a healthcare provider, taking into account the frequency of seizures, potential triggers, and the overall impact on the child's life. Monitoring lifestyle factors and considering further evaluations can also provide valuable information for managing your child's condition effectively. It is essential to maintain open communication with your healthcare team and advocate for your child's health and well-being.

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