About This Page
This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
The Bottom Line
- Epilepsy = 2+ unprovoked seizures >24 h apart. Prevalence ~1 in 200 children
- Classification: focal (partial) or generalised (absence, myoclonic, tonic-clonic, atonic). Syndrome classification guides treatment
- Common childhood syndromes: childhood absence epilepsy (CAE — 3 Hz spike-and-wave, hyperventilation trigger), juvenile myoclonic epilepsy (JME), self-limited epilepsy with centrotemporal spikes (SLECTS/BECTS)
- First-line treatment per NICE NG217: focal seizures — carbamazepine or lamotrigine. Generalised tonic-clonic — sodium valproate (NOT in females of childbearing potential) or lamotrigine. Absence — ethosuximide or sodium valproate
- CRITICAL: sodium valproate must NOT be started in females of childbearing potential unless Pregnancy Prevention Programme conditions are met (MHRA)
- EEG supports diagnosis but does NOT exclude epilepsy if normal. MRI brain for all children with epilepsy (unless clear CAE or SLECTS)
Overview
Epilepsy is one of the most common serious neurological conditions in childhood, affecting approximately 1 in 200 children. It is characterised by recurrent unprovoked seizures due to abnormal excessive neuronal activity. Classification follows the ILAE framework: seizure type (focal or generalised), epilepsy type (focal, generalised, combined, unknown), and epilepsy syndrome. Common childhood epilepsy syndromes include childhood absence epilepsy, self-limited epilepsy with centrotemporal spikes (formerly benign rolandic epilepsy), and juvenile myoclonic epilepsy. Accurate classification is essential as it determines treatment choice and prognosis.
Epidemiology
Epilepsy prevalence in children is approximately 5 per 1,000 (1 in 200). Incidence is highest in the first year of life. Common causes include genetic (most common), structural (cortical dysplasia, tuberous sclerosis, HIE), metabolic, immune, and infectious. In many cases the cause is unknown. Prognosis varies by syndrome: CAE and SLECTS have excellent prognosis with most children achieving remission; Dravet syndrome and Lennox-Gastaut have poor prognosis.
Clinical Features
Symptoms
Generalised tonic-clonic seizure: loss of consciousness, stiffening (tonic) then jerking (clonic), post-ictal drowsiness
Absence seizures: brief (5–15 sec) episodes of staring/blanking, no post-ictal phase. Provoked by hyperventilation. May occur hundreds of times daily
Focal seizures: stereotyped episodes with preserved or impaired awareness — motor (jerking of one limb/face), sensory, or autonomic features
Myoclonic seizures: sudden brief involuntary jerks — especially on waking (JME)
Loss of previously acquired skills (developmental regression)
Status epilepticus: seizure lasting >5 min or repeated seizures without recovery
Signs
May be entirely normal between seizures
Neurocutaneous markers: ash-leaf macules, cafe-au-lait spots, adenoma sebaceum (tuberous sclerosis, NF1)
Focal neurological signs (suggest structural cause)
Dysmorphic features or learning difficulties (suggest genetic cause)
Investigations
First-line
EEGSupports classification of seizure type and epilepsy syndrome. CAE: 3 Hz generalised spike-and-wave. SLECTS: centrotemporal spikes. A NORMAL EEG does NOT exclude epilepsy
MRI brainRecommended for all children with epilepsy EXCEPT clear-cut CAE or SLECTS. Look for structural causes (cortical dysplasia, tumour, hippocampal sclerosis, tuberous sclerosis)
Second-line
Blood testsGlucose, calcium, magnesium, U&Es — exclude metabolic causes. FBC, LFTs as baseline before starting AEDs
Genetic testingEpilepsy gene panel or whole exome/genome sequencing — especially if early onset, refractory, or dysmorphic features. SCN1A (Dravet), TSC1/TSC2 (tuberous sclerosis)
Specialist
Video telemetry (prolonged EEG)If seizure classification unclear or considering epilepsy surgery — capture and characterise habitual seizures
1
First-line AEDs by seizure type
- Focal seizures: carbamazepine or lamotrigine (first-line). Alternatives: levetiracetam, oxcarbazepine
- Generalised tonic-clonic: sodium valproate (males, NOT females of childbearing potential) or lamotrigine
- Absence seizures: ethosuximide (first-line for pure absence) or sodium valproate
- Myoclonic seizures: sodium valproate or levetiracetam. AVOID carbamazepine (worsens myoclonic and absence seizures)
2
Key prescribing safety
- Sodium valproate: MUST NOT be started in females of childbearing potential unless Pregnancy Prevention Programme conditions are met (MHRA)
- Carbamazepine can worsen absence and myoclonic seizures — do NOT use in generalised epilepsy syndromes
- Start monotherapy at low dose, titrate slowly
- If first AED fails: try second monotherapy before add-on therapy
3
Rescue medication for prolonged seizures
- Buccal midazolam: first-line rescue medication for seizures >5 min in the community
- Prescribe an individualised emergency care plan (seizure rescue plan)
- Status epilepticus: follow APLS protocol — benzodiazepine, phenytoin/levetiracetam, RSI if refractory
4
Referral and follow-up
- All children with suspected epilepsy should be seen by a specialist (paediatrician with expertise in epilepsies) within 2 weeks
- Regular review: seizure control, AED side effects, school performance, mental health
- Consider drug withdrawal after 2 years seizure-free (discuss risk of recurrence)
- Discuss SUDEP risk and provide information
Complications
- Status epilepticus: Life-threatening — requires emergency management per APLS protocol
- SUDEP (Sudden Unexpected Death in Epilepsy): Risk ~1 in 1,000 per year in children. Higher with uncontrolled seizures, nocturnal seizures, polytherapy
- Learning and behavioural difficulties: Common comorbidities — ADHD, ASD, anxiety, depression
- AED side effects: Weight gain, drowsiness, rash (lamotrigine — Stevens-Johnson syndrome), teratogenicity (valproate)
- Social impact: Driving restrictions (epilepsy-free for 1 year), sports participation, stigma
UKMLA Exam Tips
- 1EEG does NOT exclude epilepsy — it supports diagnosis and syndrome classification
- 2Carbamazepine worsens absence and myoclonic seizures — NEVER use in generalised epilepsy
- 3Sodium valproate MUST NOT be started in females of childbearing potential unless PPP conditions met
- 4CAE: 3 Hz spike-and-wave on EEG, provoked by hyperventilation. Excellent prognosis — most remit by adolescence
- 5SLECTS (benign rolandic epilepsy): centrotemporal spikes on EEG, seizures during sleep, remits by mid-teens
- 6Buccal midazolam is the first-line rescue medication for prolonged seizures
- 7A first unprovoked seizure does NOT = epilepsy. Two unprovoked seizures >24 h apart = epilepsy
practicetest your knowledge on childhood epilepsyApply what you've learnt with UKMLA-style questions from the iatroX Q-Bank — paediatrics and beyond.
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