The consequences of drug-resistant seizures in children

Seizures, or abnormal brain waves between seizures, can affect how the brain functions. This is especially true if seizures start early in life. They are often associated with intellectual impairments, epileptic encephalopathy, and autism.

Ongoing seizures can stunt development

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.

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.

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.

“most children presenting with seizures and a radiological diagnosis of focal cortical dysplasia will develop drug-resistant epilepsy and are candidates for epilepsy surgery.”

Ido Ben Zvi, Noelle Enright, Felice D’arco, M. Zubair Tahir, Aswin Chari, J. Helen Cross, Christin Eltze, Martin M. Tisdall. Children with seizures and radiological diagnosis of focal cortical dysplasia: can drug-resistant epilepsy be predicted earlier?. Epileptic Disorders. 2022;24(1):111-122. doi:10.1684/epd.2021.1368