Even more than in adults, it is critical to correctly diagnose the type of seizures occurring in a child. Starting, for instance, could be a symptom of either absence or complex partial epilepsy seizures, and these are treated very differently.
More in children than adults, it is sometimes reasonable not to give medication even after epilepsy seizures have been diagnosed. As children are less likely to be at high risk for injury it might make sense to tolerate a rare, relatively minor seizures rather than expose the child to daily medication which is potential for side effects.
Also, many seizure syndromes in children resolve spontaneously with no long term consequences. Again, simple caution may be advisable as opposed as opposed to the risks of medication.
Most children with epilepsy, however, do require medication. Many physicians and parents worry about the potential influences of epilepsy medicines on critical learning processes that take place during childhood. If a child falls behind in school because he is always sleepy or inattentive, it may be difficult for him to catch up. In general, the influences of epilepsy medications on learning are theoretical rather than known.
Behavior is also a concern in children whenever drugs are used that affect the brain. Even with no effect on learning per se, a drug that effects a child’s ability to sit still in class, or one that makes her irritable and difficult to control, may be much more disruptive and harmful than a rare seizure.
Again, most children do not develop personality changes or irritability when taking drugs for epilepsy, but these effects are possible. Gebapentin, for example, is an extremely safe drug and therefore is often used in children with epilepsy, but a small percentage may develop behavior problems.
Some drugs have side effects in children that do not occur in adults. A rash can occur with any drug, but children seem more susceptible to serious rashes from lamotrigine.
As in adults, anticonvulsant drugs don’t always work in children. Surgery can be an option whenever seizures persist and adversely affect a child’s life. Many epilepsy specialists actually think that children should be referred for extensive evaluation sooner than adults, as year lost in trials of drug may lead to a lifetime of emotional dependency and limited abilities, whereas early treatment of a child with epilepsy will allow her to develop normally, socially and intellectually.