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About one-third of new cases of epilepsy are diagnosed in children, and but they are not "little adults" with a grown-up condition. "Epilepsy manifests itself very differently in children. Seizures change as the kids grow up," says Dr. Jayoung Pak, assistant professor of neurology at New Jersey Medical School and director of the pediatric epilepsy program at University Hospital. "We're also dealing with developing brains. A child whose epilepsy is not well controlled might not reach developmental milestones when he or she should." When seizures begin during infancy, she adds, they tend to be frequent and more difficult to control. Epilepsy in children can also be part of a broader syndrome; Landau-Kleffner Syndrome, for example, produces seizures and affects a child's speech

Making the correct diagnosis in young patients not only helps the epileptologist develop an appropriate treatment plan, but many times, enables the doctor to accurately predict how the seizure disorder will play out over the years. "If we find that the patient has benign partial epilepsy of childhood, we know that there's excellent potential that he or she will outgrow the condition by about 12 years of age," says Dr. Pak.

Like adults, children with seizure disorders undergo a series of evaluations and tests. University Hospital has two continuous video EEG rooms specifically for children, with a play therapist available when young patients are not being tested or having seizures.

Children with seizure disorders can take AEDs, but because of lack of success in controlling seizures with the medications or the drugs' side effects - irritability, insomnia, and hyperactivity among them - some doctors and parents look to alternative treatments, such as surgery or vagal nerve stimulation. But before those measures are tried, some children are placed on a special diet. The ketogenic diet is a high-fat, low-carbohydrate plan that helps the patient's body make large amounts of ketones, which are produced when fats are processed in the liver. It's not known precisely why this diet can help reduce the frequency or severity of seizures, but the role of beta-hydrozybutyrate, a by-product of ketosis that inhibits seizures in animals, is one possibility.

While the diet's mainstay components are foods such as mayonnaise, sour cream, hot dogs, and bacon, the current version features a "reasonable menu" and for some patients, can be taken as a special formula through a feeding tube, says Dr. Pak. "It is still not an easy diet or something the family can do on their own," she says. "The patient must be carefully monitored while on the diet. Nonetheless, for some children, strictly adhering to the diet can produce dramatic results in terms of seizure reduction." About two-thirds of children who adhere to the diet are helped by it, some becoming seizure free. Although the diet has been tried by adults, it has been most successful among children.

Childhood epilepsy is more than a physical problem; it is one that often has psychological and social ramifications, as well. "Some children feel ashamed about having epilepsy and don't want to tell others about it at all. Unfortunately, some parents encourage them to keep their condition a secret," says Dr. James Hill, assistant professor of clinical psychiatry at New Jersey Medical School and director of neuropsychology at University Hospital. "It's better to educate the patient's classmates and teachers about epilepsy, so that no one overreacts when a seizure occurs. In some classrooms where that's the case, the children have jobs to do to help their friend when he or she has a seizure."

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