Seizures in Children
Content
SEIZURES IN CHILDREN
http://www.emedicinehealth.com/seizures_in_children/article_em.htm
Seizures in Children Overview
A seizure occurs when the brain functions abnormally, resulting in a change in movement, attention, or
level of awareness. Different types of seizures may occur in different parts of the brain and may be
localized (affect only a part of the body) or widespread (affect the whole body). Seizures may occur for
many reasons, especially in children. Seizures in newborns may be very different than seizures in
toddlers, school-aged children, and adolescents. Seizures, especially in a child who has never had one,
can be frightening to the parent or caregiver.
Around 3% of all children have a seizure when younger than 15 years, half of which are febrile
seizures (seizure brought on by a fever). One of every 100 children has epilepsy-recurring seizures.
A febrile seizure occurs when a child contracts an illness such as an ear infection, cold, or
chickenpox accompanied by fever. Febrile seizures are the most common type of seizure seen in
children. Two to five percent of children have a febrile seizure at some point during their childhood.
Why some children have seizures with fevers is not known, but several risk factors have been
identified.
o
Children with relatives, especially brothers and sisters, who have had febrile seizures
are more likely to have a similar episode.
o
Children who are developmentally delayed or who have spent more than 28 days in a
neonatal intensive care unit are also more likely to have a febrile seizure.
o
o
One of 4 children who have a febrile seizure will have another, usually within a year.
Children who have had a febrile seizure in the past are also more likely to have a
second episode.
Neonatal seizures occur within 28 days of birth. Most occur soon after the child is born. They
may be due to a large variety of conditions. It may be difficult to determine if a newborn is actually
seizing, because they often do not have convulsions. Instead, their eyes appear to be looking in
different directions. They may have lip smacking or periods of no breathing.
Partial seizures involve only a part of the brain and therefore only a part of the body.
o
Simple partial (Jacksonian) seizures have a motor (movement) component that is
located in one portion of the body. Children with these seizures remain awake and alert. Movement
abnormalities can "march" to other parts of the body as the seizure progresses.
o
Complex partial seizures are similar, except that the child is not aware of what is going
on. Frequently, children with this type of seizure repeat an activity, such as clapping, throughout the
seizure. They have no memory of this activity. After the seizure ends, the child is often disoriented
in a state known as the postictal period.
Generalized seizures involve a much larger portion of the brain. They are grouped into 2 types:
convulsive (muscle jerking) and nonconvulsive with several subgroups.
o
Convulsive seizures are noted by uncontrollable muscle jerking lasting for a few
minutes-usually less than 5-followed by a period of drowsiness that is called the postictal period.
The child should return to his or her normal self except for fatigue within around 15 minutes. Often
the child may have incontinence (lose urine or stool), and it is normal for the child not to remember
the seizure. Sometimes the jerking can cause injury, which may range from a small bite on the
tongue to a broken bone.
o
Tonic seizures result in continuous muscle contraction and rigidity, while tonic-clonic
seizures involve alternating tonic activity with rhythmic jerking of muscle groups.
o
Infantile spasms commonly occur in children younger than 18 months. They are often
associated with mental retardation and consist of sudden spasms of muscle groups, causing the
child to assume a flexed stature. They are frequent upon awakening.
o
Absence seizures, also known as petit mal seizures, are short episodes during which
the child stares or eye blinks, with no apparent awareness of their surroundings. These episodes
usually do not last longer then a few seconds and start and stop abruptly; however, the child does
not remember the event at all. These are sometimes discovered after the child's teacher reports
daydreaming, if the child loses his or her place while reading or misses instructions for
assignments.
Status epilepticus is either a seizure lasting longer than 30 minutes or repeated seizures
without a return to normal in between them. It is most common in children younger than 2 years, and
most of these children have generalized tonic-clonic seizures. Status epilepticus is very serious. With
any suspicion of a long seizure, you should call 911.
Epilepsy refers to a pattern of chronic seizures of any type over a long period. Thirty percent of
children diagnosed with epilepsy continue to have repeated seizures into adulthood, while
others improve over time.
Seizures in Children Causes
Although seizures have many known causes, for 3 out of 4 children, the cause remains unknown. In many
of these cases, there is some family history of seizures. The remaining causes include infections such as
meningitis, developmental problems such as cerebral palsy, head trauma, and many other less common
causes.
About one fourth of the children who are thought to have seizures are actually found to have some other
disorder after a complete evaluation. These other disorders include fainting, breath-holding spells, night
terrors, migraines, and psychiatric disturbances.
The most common type of seizure in children is the febrile seizure, which occurs when an
infection associated with a high fever develops.
Other reasons for seizures are these:
o
Infections
o
Metabolic disorders
o
Drugs
o
Medications
o
Poisons
o
Disordered blood vessels
o
Bleeding inside the brain
o
Many yet undiscovered problems
Seizures in Children Symptoms
Seizures in children have many different types of symptoms. A thorough description of the type of
movements witnessed, as well as the child's level of alertness, can help the doctor determine what type of
seizure your child has had.
The most dramatic symptom is generalized convulsions. The child may undergo rhythmic jerking
and muscle spasms, sometimes with difficulty breathing and rolling eyes. The child is often sleepy and
confused after the seizure and does not remember the seizure afterward. This symptom group is
common with grand mal (generalized) and febrile seizures.
Children with absence seizures (petit mal) develop a loss of awareness with staring or blinking,
which starts and stops quickly. There are no convulsive movements. These children return to normal
as soon as the seizure stops.
Repetitive movements such as chewing, lip smacking, or clapping, followed by confusion are
common in children suffering from a type of seizure disorder known as complex partial seizures.
Partial seizures usually affect only one group of muscles, which spasm and move convulsively.
Spasms may move from group to group. These are called march seizures. Children with this type of
seizure may also behave strangely during the episode and may or may not remember the seizure itself
after it ends.
When to Seek Medical Care
All children who seize for the first time and many with a known seizure disorder should be evaluated by a
doctor.
Most children with first seizures should be evaluated in a hospital's emergency department.
However, if the seizure lasted less than 2 minutes, if there were no repeated seizures, and if the child
had no difficulty breathing, it may be possible to have the child evaluated at the pediatrician's office.
After the seizure has stopped and the child has returned to normal, contact your child's doctor for
further advice. Your pediatrician may recommend either an office or an emergency department visit. If
you do not have a pediatrician or none is available, bring the child to the emergency department. If you
are worried about possible absence seizures, evaluation at the pediatrician's office is appropriate.
Caregivers of children with epilepsy should contact the child's pediatrician if there is something
different about the type, duration, or frequency of the seizure. The doctor may direct you to the office or
to the emergency department.
Take the child to the emergency department or call 911 if you are concerned that your child was
injured during the seizure or if you think that he or she may be in status epilepticus (seizures of any
kind that do not stop).
Most children who have seized for the first time should be taken to the emergency department for an
immediate evaluation.
Any child with repeated or prolonged seizures, trouble breathing, or who has been significantly
injured should go to the hospital by ambulance.
If the child has a history of seizures and there is something different about this one, such as
duration of the seizure, part of body moving, a long period of sleepiness, or any other concerns, the
child should be seen in the emergency department.
Exams and Tests
For all children, a thorough interview and examination should occur. It is important for the caregiver to tell
the doctor about the child's medical history, birth history, any recent illness, and any medications or
chemicals that the child could have been exposed to. Additionally, the doctor asks for a description of the
event, specifically to include where it occurred, how long any abnormal movements lasted, and the period
of sleepiness afterward. A wide variety of tests can be performed on a child who is thought to have
seizures. This testing depends on the child's age and suspected type of seizures.
Febrile seizures
o
Children should receive medication for the fever such as acetaminophen (for example,
Tylenol) or ibuprofen (for example, Advil).
o
Depending on the age of the child, the doctor may order blood or urine tests or both,
looking for the source of the fever.
o
If the child has had his or her first febrile seizure, then the doctor may want to perform a
lumbar puncture (spinal tap) to test for possible meningitis. The lumbar puncture should be
performed in children younger than 6 months, and some doctors perform them in children as old as
18 months.
o
Most children do not get a CT scan of the head, unless there was something unusual
about the febrile seizures, such as the child not returning to his or her normal self shortly afterward.
o
Very few children with febrile seizures are admitted to the hospital. The treatment for
febrile seizures is keeping the temperature down, and possibly a medication if a specific infection is
found such as an ear infection. Follow up with the child's doctor in a few days.
Movement seizures
o
Movement seizures, which include partial seizures and generalized (grand mal)
seizures, can be very dramatic. If the child is having a seizure in the emergency department, he or
she is given medications to stop the seizure.
o
If the child has returned to normal in the hospital, then the child will probably have a few
tests performed. Blood is drawn to check the child's sugar, sodium, and some other blood
chemicals.
o
If the child is on antiseizure medications, then the medication's levels in the blood are
checked (if possible).
o
Most children undergo a CT scan or MRI (studies looking at the structure of the brain),
but this may be scheduled for several days later rather than in the emergency department. In
children, these imaging studies are usually normal but are performed to look for unusual causes of
seizure such as bleeding or tumor.
o
Most children eventually undergo an EEG, which is a study looking at the brain waves
or electrical activity of the brain. An EEG is almost never performed in the emergency
department but is performed later.
o
The child will probably be admitted if he or she is very young, has another seizure,
has abnormal physical examination findings or lab test results, or if you live far from a hospital.
Children in status epilepticus are admitted to an intensive care unit.
o
If the child is doing well, doesn't have recurring seizures, and has a normal physical
examination findings and blood test results, then the child will most likely be sent home to follow up
with a pediatrician in a few days to continue the evaluation and arrange other tests, such as the
EEG.
Absence seizures (petit mal)
o
These can be evaluated without going to an emergency department. Most likely, the
doctor will only order an EEG. If the EEG tells the doctor that the child is having absence seizures,
then the child will most likely be placed on medications to control them.
Neonatal seizures and infantile spasms
o
Seizures of this type occur in young children and are often associated with other
problems such as mental retardation. Children suspected of having these seizures may have
multiple lab tests done in the emergency department. They would include blood and urine samples,
lumbar puncture, and possibly a CT scan of the head. These children are usually admitted to the
hospital and may even be referred to a pediatric specialty hospital. In the hospital, these children
undergo several days of testing to look for the many possible causes of the seizures.
Self-Care at Home
Your initial efforts should be directed first at protecting the child from additionally injuring himself or
herself.
Help the child to lie down.
Remove glasses or other harmful objects in the area.
Do not try to put anything in the child's mouth. In doing so, you may injure the child or yourself.
Immediately check if the child is breathing. Call 911 to obtain medical assistance if the child is
not breathing.
After the seizure ends, place the child on one side and stay with the child until he or she is fully
awake. Observe the child for breathing. If he or she is not breathing within 1 minute after the seizure
stops, then start mouth-to-mouth rescue breathing (CPR). Do not try to do rescue breathing for the
child during a convulsive seizure, because you may injure the child or yourself.
If the child has a fever, acetaminophen (such as Tylenol) may be given rectally.
Do not try to give food, liquid, or medications by mouth to a child who has just had a seizure.
Children with known epilepsy should also be prevented from further injury by moving away solid
objects in the area of the child. If you have discussed use of rectal medication (for example, Valium)
with your child's doctor, give the child the correct dose.
Medical Treatment
Treatment of children with seizures is different than treatment for adults. Unless a specific cause is found,
most children with first-time seizures will not be placed on medications.
Important reasons for not starting medications
o
During the first visit, many doctors cannot be sure if the event was a seizure or
something else.
Many seizure medications have side effects including damage to your child's liver or
o
teeth.
Many children will have only one, or very few, seizures.
o
If medications are started
o
The doctor will follow the drug levels, which require frequent blood tests, and will watch
closely for side effects. Often, it takes weeks to months to adjust the medications, and sometimes
more than one medicine is needed.
o
If your child has status epilepticus, he or she will be treated very aggressively with
antiseizure medications, admitted to the intensive care unit, and possibly be placed on a breathing
machine.
Next Steps
Prevention
Most seizures cannot be prevented. There are some exceptions, but these are very difficult to control,
such as head trauma and infections during pregnancy.
Children who are known to have febrile seizures should have their fevers well controlled when
sick.
The biggest impact caretakers can have is to prevent further injury if a seizure does occur.
The child can participate in most activities just as other children do. Parents and other caretakers
must be aware of added safety measures, such as having an adult around if the child is swimming or
participating in any other activities that could result in harm if a seizure occurs.
One common area for added caution is in the bathroom. Showers are preferred because they
reduce the risk of drowning more than baths.
Outlook
The prognosis for children with seizures depends on the type of seizures. Most children do well, are able
to attend regular school, and have no limitations. The exceptions occur with children who have other
developmental disorders such as cerebral palsy and in children with neonatal seizures and infantile
spasms. It is important to talk with your child's doctor about what to expect with your child.
Many children "outgrow" seizures as their brains mature. If several years pass without any
seizures, doctors often stop the child's medications and see if the child has outgrown the seizures.
A seizure in general is not harmful unless an injury occurs or status epilepticus develops.
Children who develop status epilepticus have a 3-5% risk of dying from the prolonged seizure.
Children with febrile seizures "outgrow" them, but they often have repeated seizures when they
develop fevers while they are young. Some children with febrile seizures go on to have epilepsy, but
most doctors believe the epilepsy was not caused by the febrile seizures.
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Definition of Seizures In Children
Article updated and reviewed by Peter B. Kang, MD, Assistant in Neurology, Children's Hospital Boston, and Instructor in
Neurology, Harvard Medical School, Boston, MA. Editorial review provided by VeriMed Healthcare Network on April 18,
2005.
Seizures are characterized by abnormal electrical activity in the brain, usually causing
changes in behavior such as rhythmic movements or confusion. An individual with epilepsy
is someone who has recurrent spontaneous seizures, that is, seizures that are not
associated with triggers such as fevers or head trauma.
Description of Seizures In Children
Please see the “Epilepsy (Seizure Disorders)” section for basic information about seizure
types, emergency management, and medications.
There are a number of seizure syndromes that affect children, not all of which meet the
criteria for epilepsy. Three common seizure syndromes are febrile seizures, Rolandic
epilepsy, and absence epilepsy.
Febrile seizures are seizures that are triggered by fevers, and typically occur in children
from the age of six months to five years. Simple febrile seizure are ones in which the
seizure is brief (up to several minutes in duration), generalized (stiffening and shaking of all
limbs), limited to one seizure for the duration of the illness, and occur in children who are
developmentally normal and have no known chronic neurological disorders. Simple febrile
seizures, barring injury during the seizures themselves, are generally benign, with no
significant long term consequences for neurological development known to date and only a
slightly increased risk for epilepsy in the long term. Simple febrile seizures are not generally
regarded as a form of epilepsy since the seizures are not spontaneous. If there are features
that mark the seizures as being complex (or “atypical”) rather than simple, there may be a
higher risk of epilepsy and serious long term consequences for neurological development.
Many children with complex febrile seizures still do fairly well. Simple febrile seizures often
do not require specialized testing such as electroencephalography (EEG, an electrical
brainwave test like an EKG) or an MRI scan, but complex febrile seizures may require such
an evaluation. If a child has seizures both with and without fever, the child meets the
criteria for epilepsy. An important concern to keep in mind, especially with an infant who has
a seizure with fever, is that such a seizure may be the first sign of meningitis, so any child
with a first time febrile seizure should be evaluated at the nearest hospital emergency
department. Depending on the circumstances, subsequent seizures may require evaluation
also, especially if the seizure is prolonged or if the child does not recover afterwards in the
same manner as in previous events. Febrile seizures sometimes run in families.
Rolandic epilepsy is a common form of childhood epilepsy that is characterized by partial
seizures. This disorder begins between infancy and puberty. The most common seizure type
is the simple partial seizure, characterized by abnormal motor activity of a specific part of
the body (for example, one arm or one leg). The face may be affected, leading to difficulty
speaking. These seizures generally occur at night. Sometimes one of these partial seizures
will generalize (spread to the rest of the brain) and develop into a generalized tonic-clonic
(“grand mal”) seizure. This form of epilepsy can be diagnosed based on the description of
the events and a characteristic pattern of abnormalities (centrotemporal spikes) on EEG.
There may be variants with slightly different forms of seizures or slightly different
abnormalities on EEG. The seizures are usually easy to control with medication, and by
adolescence they typically resolve and the medication can gradually be weaned off. This is a
benign form of childhood epilepsy, and affected children generally have normal neurological
development.
Absence (“petit mal”) epilepsy typically begins in the first decade of life (after infancy). The
seizures are mild generalized events characterized primarily by brief staring spells that last
a few seconds, followed by a resumption of the interrupted activity. To others, including
teachers and parents, they may appear only as a brief pause in activity. There are no
convulsions (stiffening or shaking), but occasionally there may be other mild manifestations
such as lip smacking or drooling. These seizures may happen dozens of times per day. Some
children with absence epilepsy are thought by their parents or teachers to be daydreamers
or to have attention deficit hyperactivity disorder because the spells interrupt schoolwork
and make them appear distracted and unfocused. The description of the spells may be
subtle, and are often not sufficient for diagnosis. Two aids to diagnosis include
hyperventilation and an EEG. Hyperventilation is known to trigger these seizures, so a
neurologist may ask the child to blow at a fan or other object during the office visit for
several minutes. If the child stares off while hyperventilating, the neurologist may call out a
color or other word, and then when the child stops staring, ask him or her what word was
spoken. If the staring spell was a true seizure, the child should not have any recollection of
hearing that word. In some cases, the child has the episodes so frequently that this test can
be done without hyperventilation. The EEG is very accurate in diagnosing this form of
epilepsy, since the seizures occur so frequently. A very characteristic electrical discharge
appears on the EEG, and is usually correlated with a staring spell. Absence seizures respond
very well to medication, and can make an enormous difference in the child’s school
performance and learning. Usually, these seizures resolve spontaneously by adolescence
and the child can gradually be weaned from the medication. In some cases, the seizures
persist longer, and may develop into other forms of epilepsy in adolescence and adulthood.
Neurological development is variable; many affected children do well, but some have subtle
difficulties that persist into adulthood.
There are many other seizure syndromes that affect children. A pediatrician and/or a
pediatric neurologist should be consulted whenever a seizure disorder is suspected.
http://www.webmd.com/epilepsy/epilepsy-in-children
Seizures in Children
What happens inside your child's brain during a seizure? Here is a simplified explanation: Your brain is
made up of millions of nerve cells called neurons, and these cells communicate with one another through
tiny electrical impulses. A seizure occurs when a large number of the cells send out an electrical charge at
the same time. This abnormal and intense wave of electricity overwhelms the brain and results in a
seizure, which can cause muscle spasms, a loss of consciousness, strange behavior, or other symptoms.
Anyone can have a seizure under certain circumstances. For instance, a fever, lack of oxygen, head
trauma, or illness could bring on a seizure. People are diagnosed with epilepsy when they have seizures
that occur more than once without such a specific cause. In most cases -- about seven out of 10 -- the
cause of the seizures can't be identified. This type of seizure is called "idiopathic" or "cryptogenic",
meaning that we don't know what causes them. There may be a problem in the way the brain is wired, or
with high levels of specific brain chemicals called neurotransmitters.
Genetic research is teaching doctors more and more about what causes different types of seizures.
Traditionally, seizures have been categorized according to how they look from the outside and what the
EEG (electroencephalogram) pattern looks like. The research into the genetics of seizures is helping
experts discover the particular ways different types of seizures occur. Eventually, this may lead to tailored
treatments for each type of seizure that causes epilepsy.
Diagnosing a Seizure in a Child
Diagnosing a seizure can be tricky. Seizures are over so quickly that your doctor probably will never see
your child having one. The first thing a doctor needs to do is rule out other conditions, such as
nonepileptic seizures. These may resemble seizures, but are often caused by other factors such as drops
in blood sugar or pressure, changes in heart rhythm, or emotional stress.
Your description of the seizure is important to help your doctor with the diagnosis. You should also
consider bringing the entire family into the doctor's office. The siblings of children with epilepsy, even very
young kids, may notice things about the seizures that parents may not. Also, you may want to keep a
video camera handy so that you can tape your child during a seizure. This may sound like an insensitive
suggestion, but a video can help the doctor enormously in making an accurate diagnosis.
Some kinds of seizures, such as absence seizures, are especially difficult to catch because they may be
mistaken for daydreaming.
"Nobody misses a grand mal (generalized tonic-clonic) seizure," says William R. Turk, MD, Chief of the
Neurology Division at the Nemours Children's Clinic in Jacksonville, Florida. "You can't help but notice
when a person falls to the ground, shakes, and sleeps for three hours." But absence or staring seizures
may go unnoticed for years.
Diagnosing a Seizure in a Child continued...
Turk says you shouldn't worry if your child gazes open-mouthed at cartoons on TV, or stares out the
window in the car. Most kids who appear to be daydreaming really are just daydreaming. Instead, watch
for spells that come at inappropriate times, such as when your child is in the middle of speaking or doing
something, and suddenly stops.
Other kinds of seizures, such as simple or complex partial seizures, can be mistaken for different
conditions, such as migraines, psychological illness, or even drug or alcohol intoxication. Medical tests
are an important part of diagnosing seizures. Your child's doctor will certainly do a physical exam and
blood tests. The doctor may also order an EEG to check the electrical activity in the brain, or request a
brain scan such as an MRI with a specific epilepsy protocol.
The Risks of Seizures in Children
Although they may look painful, seizures don't really cause pain. But they may be frightening for children
and the people around them. Simple partial seizures, in which a child may have a sudden, overwhelming
sense of terror, are especially frightening. One of the problems with complex partial seizures, for instance,
is that people have no control of their actions. They may wind up doing inappropriate or bizarre things that
upset people around them. It's also possible for children to injure themselves during a seizure if they fall
to the ground or hit other things around them. But the seizures themselves are usually not harmful.
Experts don't yet understand the long-term effects of seizures on the brain very well. In the past, most
scientists thought that seizures did not cause any damage to the brain. They attributed any brain damage
to an underlying illness. Now, however, some doubts are beginning to emerge.
Solomon L. Moshe, MD, Director of Clinical Neurophysiology and Child Neurology at the Albert Einstein
College of Medicine in New York, is researching the subject and remains cautious. "I don't think it's good
to say one way or another whether seizures do long-term damage," he says. "I think it all depends on the
individual case."
Moshe notes that the brains of children are very flexible. They are perhaps the least likely people with
epilepsy to suffer any brain damage from a seizure.
Dangerous Seizures in Kids
Although the majority of seizures aren't dangerous and don't require immediate medical attention, one
kind does. Status epilepticus is a life-threatening condition in which a person has a prolonged seizure or
one seizure after another without regaining consciousness in between them. Status epilepticus is more
common among people with epilepsy, but about one-third of the people who develop the condition have
never had a seizure before. The risks of status epilepticus increase the longer the seizure goes on, which
is why you should always get emergency medical help if a seizure lasts more than five minutes.
You may also hear about a condition called Sudden Unexplained Death, in which a person dies for no
known reason. It can happen to anyone, but it's more likely to happen in a person with epilepsy. The
causes aren't known, but parents of children with epilepsy should know that it's a very rare occurrence.
Controlling seizures, especially those that occur in sleep, is the most effective plan for helping to prevent
this tragedy from occurring.
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What is a seizure?
The brain is the center that controls and regulates all voluntary and involuntary responses in the body. It
consists of nerve cells that normally communicate with each other through electrical activity.
A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily
interrupts normal electrical brain function. The incidence of seizures is high before the child's first birthday.
Approximately 3 to 5 percent of all children may experience a seizure.
What are the different types of seizures?
There are several different types of seizures in children, including the following:
Focal seizures - Focal seizures take place when abnormal electrical brain function occurs in one or
more areas of one side of the brain. Focal seizures may also be called partial seizures. With focal
seizures, particularly with complex focal seizures, the child may experience an aura before the
seizure occurs. An aura is a strange feeling, either consisting of visual changes, hearing
abnormalities, or changes in the sense of smell. Two types of focal seizures include the following:
o
Simple focal seizures - The seizures typically last less than one minute. The child may
show different symptoms depending upon which area of the brain is involved. If the
abnormal electrical brain function is in the occipital lobe (the back part of the brain that is
involved with vision), the child's sight may be altered. The child's muscles are typically
more commonly affected. The seizure activity is limited to an isolated muscle group, such
as fingers or to larger muscles in the arms and legs. Consciousness is not lost in this type of
seizure. The child may also experience sweating, nausea, or become pale.
o
Complex focal seizures - This type of seizure commonly occurs in the temporal lobe of
the brain, the area of the brain that controls emotion and memory function. This seizure
usually lasts between one to two minutes. Consciousness is usually lost during these
seizures and a variety of behaviors can occur in the child. These behaviors may range from
gagging, lip smacking, running, screaming, crying, and/or laughing. When the child regains
consciousness, the child may complain of being tired or sleepy after the seizure. This is
called the postictal period.
Generalized seizures - Generalized seizures involve both sides of the brain. There is loss of
consciousness and a postictal state after the seizure occurs. Types of generalized seizures include
the following:
o
Febrile seizures - This type of seizure is associated with fever. Approximately 2 to 5
percent of all children in the United States experience febrile seizures. These seizures are
more commonly seen in children between 6 months and 5 years of age and there may be a
family history of this type of seizure. Febrile seizures that last less than 15 minutes are
called "simple," and typically do not have long-term neurological effects. Seizures lasting
more than 15 minutes are called "complex" and there may be long-term neurological
changes in the child.
o
Absence seizures (also called petit mal seizures) - These seizures are characterized
by a brief altered state of consciousness and staring episodes. Typically the child's posture
is maintained during the seizure. The mouth or face may move or the eyes may blink. The
seizure usually lasts no longer than 30 seconds. When the seizure is over, the child may not
recall what just occurred and may go on with his/her activities, acting as though nothing
happened. These seizures may occur several times a day. This type of seizure is sometimes
mistaken for a learning problem or behavioral problem. Absence seizures almost always
start between ages 4 to 12.
o
Atonic (also called drop attacks) - With atonic seizures, there is a sudden loss of muscle
tone and the child may fall from a standing position or suddenly drop his/her head. During
the seizure, the child is limp and unresponsive.
o
Generalized tonic-clonic seizures (GTC or grand mal seizures) - This seizure is
characterized by five distinct phases that occur in the child. The body, arms, and legs will
flex (contract), extend (straighten out), tremor (shake), a clonic period (contraction and
relaxation of the muscles), followed by the postictal period. During the postictal period, the
child may be sleepy, have problems with vision or speech, and may have a bad headache,
fatigue, or body aches.
o
Myoclonic seizures - This type of seizure refers to quick movements or sudden jerking of
a group of muscles. These seizures tend to occur in clusters, meaning that they may occur
several times a day, or for several days in a row.
o
Infantile spasms - This rare type of seizure disorder occurs in infants from 3 months to
12 months of age. There is a high occurrence rate of this seizure when the child is
awakening, or when they are trying to go to sleep. The infant usually has brief periods of
movement of the neck, trunk, or legs that lasts for a few seconds. Infants may have
hundreds of these seizures a day. This can be a serious problem, and can have long-term
complications.
Sometimes, prolonged or clustered seizures can worsen and develop into non-stop seizures. This is called
status epilepticus. This condition is a medical emergency. The child needs to be hospitalized to receive the
proper treatment to control the seizures.
What is epilepsy?
Epilepsy is a neurological condition involving the brain that makes people more susceptible to having
seizures. It is one of the most common disorders of the nervous system and affects people of all ages, races
and ethnic background. More than 2.3 million Americans live with epilepsy.
When a person has two or more seizures, he or she is considered to have epilepsy. There are many possible
causes of epilepsy, including tumors, strokes, and brain damage from illness or injury. In many cases, there
may be no detectable cause for epilepsy.
What causes epilepsy?
While the exact cause of epilepsy may not be known, it may be caused by the following:
family history
genetic problem
underlying brain problem
What is status epilepticus?
Sometimes, prolonged or clustered seizures can worsen and develop into non-stop seizures. This is called
status epilepticus. This condition is a medical emergency. The child needs to be hospitalized to receive the
proper treatment to control the seizures.
What causes a seizure?
A child may experience one or numerous seizures. While the exact cause of the seizure may not be known,
the more common seizures are caused by the following:
in newborns and infants:
o
birth trauma
o
problems that the infant is born with
o
fever/infection
o
metabolic or chemical imbalances in the body
in children, adolescents, and young adults:
o
alcohol or drugs
o
head trauma
o
infection
o
congenital conditions
o
genetic factors
o
unknown reasons
other possible causes of seizures may include:
o
brain tumor
o
neurological problems
o
drug withdrawal
o
medications
What are the symptoms of a seizure?
The child may have varying degrees of symptoms depending upon the type of seizure. The following are
general symptoms of a seizure or warning signs that your child may be experiencing seizures. Symptoms or
warning signs may include:
staring
jerking movements of the arms and legs
stiffening of the body
loss of consciousness
breathing problems or breathing stops
loss of bowel or bladder control
falling suddenly for no apparent reason
not responding to noise or words for brief periods
appearing confused or in a haze
sleepiness and irritable upon waking in the morning
nodding the head
periods of rapid eye blinking and staring
During the seizure, the child's lips may become bluish and breathing may not be normal. The movements
are often followed by a period of sleep or disorientation.
The symptoms of a seizure may resemble other problems or medical conditions. Always consult your child's
physician for a diagnosis.
How are seizures diagnosed?
The full extent of the seizure may not be completely understood immediately after onset of symptoms, but
may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a seizure
is made with a physical examination and diagnostic tests. During the examination, the physician obtains a
complete medical history of the child and family and asks when the seizures occurred. Seizures may be due
to neurological problems and require further medical follow up.
Diagnostic tests may include:
blood tests
electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by
means of electrodes attached to the scalp.
magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large
magnets, radiofrequencies, and a computer to produce detailed images of organs and structures
within the body
computerized tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure
that uses a combination of x-rays and computer technology to produce cross-sectional images
(often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images
of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed
than general x-rays.
lumbar puncture (spinal tap) - a special needle is placed into the lower back, into the spinal canal.
This is the area around the spinal cord. The pressure in the spinal canal and brain can then be
measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to
determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain
and spinal cord.
Treatment of a seizure:
Specific treatment for a seizure will be determined by your child's physician based on:
your child's age, overall health, and medical history
the extent of the condition
the type of seizure
your child's tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference
The goal of seizure management is to control, stop, or decrease the frequency of the seizures without
interfering with the child's normal growth and development. The major goals of seizure management include
the following:
proper identification of the type of seizure
using medication specific to the type of seizure
using the least amount of medication to achieve adequate control
maintaining good medicating levels
Treatment may include:
Medications - There are many types of medications used to treat seizures and epilepsy.
Medications are selected based on the type of seizure, age of the child, side effects, the cost of the
medication, and the adherence with the use of the medication.
Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles, or syrup),
but some can be given rectally (into the child's rectum). If the child is in the hospital with seizures,
medication by injection or intravenous (IV) may be used.
It is important to give your child his/her medication on time and as prescribed by your child's
physician. Different people use up the medication in their body differently, so adjustments (schedule
and dosage) may need to be made for good control of seizures.
All medications can have side effects, although some children may not experience side effects.
Discuss your child's medication side effects with his/her physician.
While your child is taking medications, different tests may be done to monitor the effectiveness of
the medication. These tests may include the following:
o
Blood work - frequent blood draws testing is usually required to check the level of the
medication in the body. Based on this level, the physician may increase or decrease the
dose of the medication to achieve the desired level. This level is called the "therapeutic
level" and is where the medication works most efficiently. Blood work may also be done to
monitor the affects of medications on body organs.
o
Urine tests - these tests are performed to see how the child's body is responding to the
medication.
o
Electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical
activity by means of electrodes attached to the scalp. This test is done to monitor how the
medication is helping the electrical problems in the brain.
Ketogenic diet - Certain children who are having problems with medications, or whose seizures are
not being well controlled, may be placed on a special diet called the ketogenic diet. Certain children
who are having problems with medications, or whose seizures are not being well controlled, may be
placed on a special diet called the ketogenic diet. This type of diet is low in carbohydrates and high
in protein and fat.
What is a ketogenic diet?
The ketogenic diet is sometimes offered to those children who continue to have seizures while on seizure
medication. When the medications do not work, a ketogenic diet may be considered. No one knows exactly
how the diet works, but some children do become seizure-free when put on the diet. However, the diet does
not work for everyone.
What does the diet consist of?
The ketogenic diet is very high in fat (about 90 percent of the calories come from fat). Protein is given in
amounts to help promote growth. A very small amount of carbohydrate is included in the diet. This very
high- fat, low- carbohydrate diet causes the body to make ketones. Ketones are made by the body from
protein. They are made for energy when the body does not get enough carbohydrates for energy. If your
child eats too many carbohydrates, then his/her body may not make ketones. The presence of ketones is
important to the success of the diet
High-fat foods:
butter
heavy cream
oil
mayonnaise
cream cheese
bacon
cheese
cheese
High-carbohydrate foods:
fruit and fruit juice
breads and cereals
vegetables (corn, peas, and potatoes)
beans
milk
soda
snack foods (chips, snack cakes, crackers)
sweets
Your child's physician will determine if this diet is right for your child. When the ketogenic diet is started,
your child will be admitted to the hospital. It may take four to five days in the hospital to get the diet started
and for you to learn how to plan the diet.
While in the hospital, your child may not be able to eat for one to two days until ketones are measured in
the urine. Once ketones are present in the urine, special high-fat, low-carbohydrate shakes may be started.
These are sometimes called "keto shakes." After several meals of keto shakes, your child will be started on
solid foods.
You may also be taught how to check your child's urine for ketones. The dietitian will help determine how
much fat, protein, and carbohydrate your child is allowed to have, usually divided into three meals a day.
The ketogenic diet can by very challenging to prepare and requires that all foods be weighed using a food
scale. The ketogenic diet is not nutritionally balanced, therefore, vitamin and mineral supplements are
needed.
Some medications and other products, such as toothpaste and mouthwash, contain carbohydrates. It is
important to avoid these products if your child is on the ketogenic diet. Your child may not make ketones in
their urine if too many carbohydrates are included in the diet. Your child's physician and dietitian can give
you a list of medications, and other products, that are free of carbohydrates.
How long is the diet used?
Children usually stay on the diet about two years. The diet is then slowly changed back to a regular diet.
Additional treatment options:
vagus nerve stimulation (VNS) - Some children, whose seizures are not being well-controlled with
seizure medications, may benefit from a procedure called vagus nerve stimulation (VNS). VNS is
currently only used for children over the age of 12 who have partial seizures that are not controlled
by other methods.
VNS attempts to control seizures by sending small pulses of energy to the brain from the vagus
nerve, which is a large nerve in the neck. This is done by surgically placing a small battery into the
chest wall. Small wires are then attached to the battery and placed under the skin and around the
vagus nerve. The battery is then programmed to send energy impulses every few minutes to the
brain. When the child feels a seizure coming on, he/she may activate the impulses by holding a
small magnet over the battery. In many people, this will help to stop the seizure.
There are some side of the effects that may occur with the use of VNS. These may include, but are
not limited to, the following:
o
hoarseness
o
pain or discomfort in the throat
o
change in voice
surgery - Another treatment option for seizures is surgery. Surgery may be considered in a child
who:
o
has seizures that are unable to be controlled with medications.
o
has seizures that always start in one area of the brain.
o
has a seizure in a part of the brain that can be removed without disrupting important
behaviors such as speech, memory, or vision.
Surgery for epilepsy and seizures is a very complicated surgery performed by a specialized surgical team.
The operation may remove the part of the brain where the seizures are occurring, or, sometimes, the
surgery helps to stop the spread of the bad electrical currents through the brain.
A child may be awake during the surgery. The brain itself does not feel pain. With the child awake and able
to follow commands, the surgeons are better able to make sure that important areas of the brain are not
damaged.
Surgery is not an option for everyone with seizures. Discuss this with your child's physician for more
information.
More information regarding the child with seizures or epilepsy:
Make sure you and your child (if age appropriate) understand the type of seizure that is occurring
and the type of medication(s) that are needed.
Know the dose, time, and side effects of all medications.
Consult your child's physician before giving your child other medications. Medications for seizures
can interact with many other medications, causing the medications to work improperly and/or
causing side effects.
Young women of childbearing age, who are on seizure medications, need to be informed that seizure
medications are harmful to a fetus, and the medication may also decrease the effectiveness of oral
contraceptives.
Check with your state to understand any laws about people with epilepsy or seizures operating a
motor vehicle.
If a child has good control over the seizures, only minimal restrictions need to be placed on the
child's activities. The child should always wear a helmet with sports and bike riding (including in-line
roller-skating, hockey, and skateboards). The child should also always have a buddy or adult
supervision while swimming.
Specific follow-up will be determined by your child's physician.
Medications for seizures may not be needed for the entire life of the child. Some children may be
taken off their medications if they have been seizure-free for one to two years. This will be
determined by your child's physician.
http://www.emedicinehealth.com/seizures_in_children/article_em.htm
Seizures in Children Overview
A seizure occurs when the brain functions abnormally, resulting in a change in movement, attention, or
level of awareness. Different types of seizures may occur in different parts of the brain and may be
localized (affect only a part of the body) or widespread (affect the whole body). Seizures may occur for
many reasons, especially in children. Seizures in newborns may be very different than seizures in
toddlers, school-aged children, and adolescents. Seizures, especially in a child who has never had one,
can be frightening to the parent or caregiver.
Around 3% of all children have a seizure when younger than 15 years, half of which are febrile
seizures (seizure brought on by a fever). One of every 100 children has epilepsy-recurring seizures.
A febrile seizure occurs when a child contracts an illness such as an ear infection, cold, or
chickenpox accompanied by fever. Febrile seizures are the most common type of seizure seen in
children. Two to five percent of children have a febrile seizure at some point during their childhood.
Why some children have seizures with fevers is not known, but several risk factors have been
identified.
o
Children with relatives, especially brothers and sisters, who have had febrile seizures
are more likely to have a similar episode.
o
Children who are developmentally delayed or who have spent more than 28 days in a
neonatal intensive care unit are also more likely to have a febrile seizure.
o
o
One of 4 children who have a febrile seizure will have another, usually within a year.
Children who have had a febrile seizure in the past are also more likely to have a
second episode.
Neonatal seizures occur within 28 days of birth. Most occur soon after the child is born. They
may be due to a large variety of conditions. It may be difficult to determine if a newborn is actually
seizing, because they often do not have convulsions. Instead, their eyes appear to be looking in
different directions. They may have lip smacking or periods of no breathing.
Partial seizures involve only a part of the brain and therefore only a part of the body.
o
Simple partial (Jacksonian) seizures have a motor (movement) component that is
located in one portion of the body. Children with these seizures remain awake and alert. Movement
abnormalities can "march" to other parts of the body as the seizure progresses.
o
Complex partial seizures are similar, except that the child is not aware of what is going
on. Frequently, children with this type of seizure repeat an activity, such as clapping, throughout the
seizure. They have no memory of this activity. After the seizure ends, the child is often disoriented
in a state known as the postictal period.
Generalized seizures involve a much larger portion of the brain. They are grouped into 2 types:
convulsive (muscle jerking) and nonconvulsive with several subgroups.
o
Convulsive seizures are noted by uncontrollable muscle jerking lasting for a few
minutes-usually less than 5-followed by a period of drowsiness that is called the postictal period.
The child should return to his or her normal self except for fatigue within around 15 minutes. Often
the child may have incontinence (lose urine or stool), and it is normal for the child not to remember
the seizure. Sometimes the jerking can cause injury, which may range from a small bite on the
tongue to a broken bone.
o
Tonic seizures result in continuous muscle contraction and rigidity, while tonic-clonic
seizures involve alternating tonic activity with rhythmic jerking of muscle groups.
o
Infantile spasms commonly occur in children younger than 18 months. They are often
associated with mental retardation and consist of sudden spasms of muscle groups, causing the
child to assume a flexed stature. They are frequent upon awakening.
o
Absence seizures, also known as petit mal seizures, are short episodes during which
the child stares or eye blinks, with no apparent awareness of their surroundings. These episodes
usually do not last longer then a few seconds and start and stop abruptly; however, the child does
not remember the event at all. These are sometimes discovered after the child's teacher reports
daydreaming, if the child loses his or her place while reading or misses instructions for
assignments.
Status epilepticus is either a seizure lasting longer than 30 minutes or repeated seizures
without a return to normal in between them. It is most common in children younger than 2 years, and
most of these children have generalized tonic-clonic seizures. Status epilepticus is very serious. With
any suspicion of a long seizure, you should call 911.
Epilepsy refers to a pattern of chronic seizures of any type over a long period. Thirty percent of
children diagnosed with epilepsy continue to have repeated seizures into adulthood, while
others improve over time.
Seizures in Children Causes
Although seizures have many known causes, for 3 out of 4 children, the cause remains unknown. In many
of these cases, there is some family history of seizures. The remaining causes include infections such as
meningitis, developmental problems such as cerebral palsy, head trauma, and many other less common
causes.
About one fourth of the children who are thought to have seizures are actually found to have some other
disorder after a complete evaluation. These other disorders include fainting, breath-holding spells, night
terrors, migraines, and psychiatric disturbances.
The most common type of seizure in children is the febrile seizure, which occurs when an
infection associated with a high fever develops.
Other reasons for seizures are these:
o
Infections
o
Metabolic disorders
o
Drugs
o
Medications
o
Poisons
o
Disordered blood vessels
o
Bleeding inside the brain
o
Many yet undiscovered problems
Seizures in Children Symptoms
Seizures in children have many different types of symptoms. A thorough description of the type of
movements witnessed, as well as the child's level of alertness, can help the doctor determine what type of
seizure your child has had.
The most dramatic symptom is generalized convulsions. The child may undergo rhythmic jerking
and muscle spasms, sometimes with difficulty breathing and rolling eyes. The child is often sleepy and
confused after the seizure and does not remember the seizure afterward. This symptom group is
common with grand mal (generalized) and febrile seizures.
Children with absence seizures (petit mal) develop a loss of awareness with staring or blinking,
which starts and stops quickly. There are no convulsive movements. These children return to normal
as soon as the seizure stops.
Repetitive movements such as chewing, lip smacking, or clapping, followed by confusion are
common in children suffering from a type of seizure disorder known as complex partial seizures.
Partial seizures usually affect only one group of muscles, which spasm and move convulsively.
Spasms may move from group to group. These are called march seizures. Children with this type of
seizure may also behave strangely during the episode and may or may not remember the seizure itself
after it ends.
When to Seek Medical Care
All children who seize for the first time and many with a known seizure disorder should be evaluated by a
doctor.
Most children with first seizures should be evaluated in a hospital's emergency department.
However, if the seizure lasted less than 2 minutes, if there were no repeated seizures, and if the child
had no difficulty breathing, it may be possible to have the child evaluated at the pediatrician's office.
After the seizure has stopped and the child has returned to normal, contact your child's doctor for
further advice. Your pediatrician may recommend either an office or an emergency department visit. If
you do not have a pediatrician or none is available, bring the child to the emergency department. If you
are worried about possible absence seizures, evaluation at the pediatrician's office is appropriate.
Caregivers of children with epilepsy should contact the child's pediatrician if there is something
different about the type, duration, or frequency of the seizure. The doctor may direct you to the office or
to the emergency department.
Take the child to the emergency department or call 911 if you are concerned that your child was
injured during the seizure or if you think that he or she may be in status epilepticus (seizures of any
kind that do not stop).
Most children who have seized for the first time should be taken to the emergency department for an
immediate evaluation.
Any child with repeated or prolonged seizures, trouble breathing, or who has been significantly
injured should go to the hospital by ambulance.
If the child has a history of seizures and there is something different about this one, such as
duration of the seizure, part of body moving, a long period of sleepiness, or any other concerns, the
child should be seen in the emergency department.
Exams and Tests
For all children, a thorough interview and examination should occur. It is important for the caregiver to tell
the doctor about the child's medical history, birth history, any recent illness, and any medications or
chemicals that the child could have been exposed to. Additionally, the doctor asks for a description of the
event, specifically to include where it occurred, how long any abnormal movements lasted, and the period
of sleepiness afterward. A wide variety of tests can be performed on a child who is thought to have
seizures. This testing depends on the child's age and suspected type of seizures.
Febrile seizures
o
Children should receive medication for the fever such as acetaminophen (for example,
Tylenol) or ibuprofen (for example, Advil).
o
Depending on the age of the child, the doctor may order blood or urine tests or both,
looking for the source of the fever.
o
If the child has had his or her first febrile seizure, then the doctor may want to perform a
lumbar puncture (spinal tap) to test for possible meningitis. The lumbar puncture should be
performed in children younger than 6 months, and some doctors perform them in children as old as
18 months.
o
Most children do not get a CT scan of the head, unless there was something unusual
about the febrile seizures, such as the child not returning to his or her normal self shortly afterward.
o
Very few children with febrile seizures are admitted to the hospital. The treatment for
febrile seizures is keeping the temperature down, and possibly a medication if a specific infection is
found such as an ear infection. Follow up with the child's doctor in a few days.
Movement seizures
o
Movement seizures, which include partial seizures and generalized (grand mal)
seizures, can be very dramatic. If the child is having a seizure in the emergency department, he or
she is given medications to stop the seizure.
o
If the child has returned to normal in the hospital, then the child will probably have a few
tests performed. Blood is drawn to check the child's sugar, sodium, and some other blood
chemicals.
o
If the child is on antiseizure medications, then the medication's levels in the blood are
checked (if possible).
o
Most children undergo a CT scan or MRI (studies looking at the structure of the brain),
but this may be scheduled for several days later rather than in the emergency department. In
children, these imaging studies are usually normal but are performed to look for unusual causes of
seizure such as bleeding or tumor.
o
Most children eventually undergo an EEG, which is a study looking at the brain waves
or electrical activity of the brain. An EEG is almost never performed in the emergency
department but is performed later.
o
The child will probably be admitted if he or she is very young, has another seizure,
has abnormal physical examination findings or lab test results, or if you live far from a hospital.
Children in status epilepticus are admitted to an intensive care unit.
o
If the child is doing well, doesn't have recurring seizures, and has a normal physical
examination findings and blood test results, then the child will most likely be sent home to follow up
with a pediatrician in a few days to continue the evaluation and arrange other tests, such as the
EEG.
Absence seizures (petit mal)
o
These can be evaluated without going to an emergency department. Most likely, the
doctor will only order an EEG. If the EEG tells the doctor that the child is having absence seizures,
then the child will most likely be placed on medications to control them.
Neonatal seizures and infantile spasms
o
Seizures of this type occur in young children and are often associated with other
problems such as mental retardation. Children suspected of having these seizures may have
multiple lab tests done in the emergency department. They would include blood and urine samples,
lumbar puncture, and possibly a CT scan of the head. These children are usually admitted to the
hospital and may even be referred to a pediatric specialty hospital. In the hospital, these children
undergo several days of testing to look for the many possible causes of the seizures.
Self-Care at Home
Your initial efforts should be directed first at protecting the child from additionally injuring himself or
herself.
Help the child to lie down.
Remove glasses or other harmful objects in the area.
Do not try to put anything in the child's mouth. In doing so, you may injure the child or yourself.
Immediately check if the child is breathing. Call 911 to obtain medical assistance if the child is
not breathing.
After the seizure ends, place the child on one side and stay with the child until he or she is fully
awake. Observe the child for breathing. If he or she is not breathing within 1 minute after the seizure
stops, then start mouth-to-mouth rescue breathing (CPR). Do not try to do rescue breathing for the
child during a convulsive seizure, because you may injure the child or yourself.
If the child has a fever, acetaminophen (such as Tylenol) may be given rectally.
Do not try to give food, liquid, or medications by mouth to a child who has just had a seizure.
Children with known epilepsy should also be prevented from further injury by moving away solid
objects in the area of the child. If you have discussed use of rectal medication (for example, Valium)
with your child's doctor, give the child the correct dose.
Medical Treatment
Treatment of children with seizures is different than treatment for adults. Unless a specific cause is found,
most children with first-time seizures will not be placed on medications.
Important reasons for not starting medications
o
During the first visit, many doctors cannot be sure if the event was a seizure or
something else.
Many seizure medications have side effects including damage to your child's liver or
o
teeth.
Many children will have only one, or very few, seizures.
o
If medications are started
o
The doctor will follow the drug levels, which require frequent blood tests, and will watch
closely for side effects. Often, it takes weeks to months to adjust the medications, and sometimes
more than one medicine is needed.
o
If your child has status epilepticus, he or she will be treated very aggressively with
antiseizure medications, admitted to the intensive care unit, and possibly be placed on a breathing
machine.
Next Steps
Prevention
Most seizures cannot be prevented. There are some exceptions, but these are very difficult to control,
such as head trauma and infections during pregnancy.
Children who are known to have febrile seizures should have their fevers well controlled when
sick.
The biggest impact caretakers can have is to prevent further injury if a seizure does occur.
The child can participate in most activities just as other children do. Parents and other caretakers
must be aware of added safety measures, such as having an adult around if the child is swimming or
participating in any other activities that could result in harm if a seizure occurs.
One common area for added caution is in the bathroom. Showers are preferred because they
reduce the risk of drowning more than baths.
Outlook
The prognosis for children with seizures depends on the type of seizures. Most children do well, are able
to attend regular school, and have no limitations. The exceptions occur with children who have other
developmental disorders such as cerebral palsy and in children with neonatal seizures and infantile
spasms. It is important to talk with your child's doctor about what to expect with your child.
Many children "outgrow" seizures as their brains mature. If several years pass without any
seizures, doctors often stop the child's medications and see if the child has outgrown the seizures.
A seizure in general is not harmful unless an injury occurs or status epilepticus develops.
Children who develop status epilepticus have a 3-5% risk of dying from the prolonged seizure.
Children with febrile seizures "outgrow" them, but they often have repeated seizures when they
develop fevers while they are young. Some children with febrile seizures go on to have epilepsy, but
most doctors believe the epilepsy was not caused by the febrile seizures.
http://www.healthscout.com/ency/68/675/main.html
Definition of Seizures In Children
Article updated and reviewed by Peter B. Kang, MD, Assistant in Neurology, Children's Hospital Boston, and Instructor in
Neurology, Harvard Medical School, Boston, MA. Editorial review provided by VeriMed Healthcare Network on April 18,
2005.
Seizures are characterized by abnormal electrical activity in the brain, usually causing
changes in behavior such as rhythmic movements or confusion. An individual with epilepsy
is someone who has recurrent spontaneous seizures, that is, seizures that are not
associated with triggers such as fevers or head trauma.
Description of Seizures In Children
Please see the “Epilepsy (Seizure Disorders)” section for basic information about seizure
types, emergency management, and medications.
There are a number of seizure syndromes that affect children, not all of which meet the
criteria for epilepsy. Three common seizure syndromes are febrile seizures, Rolandic
epilepsy, and absence epilepsy.
Febrile seizures are seizures that are triggered by fevers, and typically occur in children
from the age of six months to five years. Simple febrile seizure are ones in which the
seizure is brief (up to several minutes in duration), generalized (stiffening and shaking of all
limbs), limited to one seizure for the duration of the illness, and occur in children who are
developmentally normal and have no known chronic neurological disorders. Simple febrile
seizures, barring injury during the seizures themselves, are generally benign, with no
significant long term consequences for neurological development known to date and only a
slightly increased risk for epilepsy in the long term. Simple febrile seizures are not generally
regarded as a form of epilepsy since the seizures are not spontaneous. If there are features
that mark the seizures as being complex (or “atypical”) rather than simple, there may be a
higher risk of epilepsy and serious long term consequences for neurological development.
Many children with complex febrile seizures still do fairly well. Simple febrile seizures often
do not require specialized testing such as electroencephalography (EEG, an electrical
brainwave test like an EKG) or an MRI scan, but complex febrile seizures may require such
an evaluation. If a child has seizures both with and without fever, the child meets the
criteria for epilepsy. An important concern to keep in mind, especially with an infant who has
a seizure with fever, is that such a seizure may be the first sign of meningitis, so any child
with a first time febrile seizure should be evaluated at the nearest hospital emergency
department. Depending on the circumstances, subsequent seizures may require evaluation
also, especially if the seizure is prolonged or if the child does not recover afterwards in the
same manner as in previous events. Febrile seizures sometimes run in families.
Rolandic epilepsy is a common form of childhood epilepsy that is characterized by partial
seizures. This disorder begins between infancy and puberty. The most common seizure type
is the simple partial seizure, characterized by abnormal motor activity of a specific part of
the body (for example, one arm or one leg). The face may be affected, leading to difficulty
speaking. These seizures generally occur at night. Sometimes one of these partial seizures
will generalize (spread to the rest of the brain) and develop into a generalized tonic-clonic
(“grand mal”) seizure. This form of epilepsy can be diagnosed based on the description of
the events and a characteristic pattern of abnormalities (centrotemporal spikes) on EEG.
There may be variants with slightly different forms of seizures or slightly different
abnormalities on EEG. The seizures are usually easy to control with medication, and by
adolescence they typically resolve and the medication can gradually be weaned off. This is a
benign form of childhood epilepsy, and affected children generally have normal neurological
development.
Absence (“petit mal”) epilepsy typically begins in the first decade of life (after infancy). The
seizures are mild generalized events characterized primarily by brief staring spells that last
a few seconds, followed by a resumption of the interrupted activity. To others, including
teachers and parents, they may appear only as a brief pause in activity. There are no
convulsions (stiffening or shaking), but occasionally there may be other mild manifestations
such as lip smacking or drooling. These seizures may happen dozens of times per day. Some
children with absence epilepsy are thought by their parents or teachers to be daydreamers
or to have attention deficit hyperactivity disorder because the spells interrupt schoolwork
and make them appear distracted and unfocused. The description of the spells may be
subtle, and are often not sufficient for diagnosis. Two aids to diagnosis include
hyperventilation and an EEG. Hyperventilation is known to trigger these seizures, so a
neurologist may ask the child to blow at a fan or other object during the office visit for
several minutes. If the child stares off while hyperventilating, the neurologist may call out a
color or other word, and then when the child stops staring, ask him or her what word was
spoken. If the staring spell was a true seizure, the child should not have any recollection of
hearing that word. In some cases, the child has the episodes so frequently that this test can
be done without hyperventilation. The EEG is very accurate in diagnosing this form of
epilepsy, since the seizures occur so frequently. A very characteristic electrical discharge
appears on the EEG, and is usually correlated with a staring spell. Absence seizures respond
very well to medication, and can make an enormous difference in the child’s school
performance and learning. Usually, these seizures resolve spontaneously by adolescence
and the child can gradually be weaned from the medication. In some cases, the seizures
persist longer, and may develop into other forms of epilepsy in adolescence and adulthood.
Neurological development is variable; many affected children do well, but some have subtle
difficulties that persist into adulthood.
There are many other seizure syndromes that affect children. A pediatrician and/or a
pediatric neurologist should be consulted whenever a seizure disorder is suspected.
http://www.webmd.com/epilepsy/epilepsy-in-children
Seizures in Children
What happens inside your child's brain during a seizure? Here is a simplified explanation: Your brain is
made up of millions of nerve cells called neurons, and these cells communicate with one another through
tiny electrical impulses. A seizure occurs when a large number of the cells send out an electrical charge at
the same time. This abnormal and intense wave of electricity overwhelms the brain and results in a
seizure, which can cause muscle spasms, a loss of consciousness, strange behavior, or other symptoms.
Anyone can have a seizure under certain circumstances. For instance, a fever, lack of oxygen, head
trauma, or illness could bring on a seizure. People are diagnosed with epilepsy when they have seizures
that occur more than once without such a specific cause. In most cases -- about seven out of 10 -- the
cause of the seizures can't be identified. This type of seizure is called "idiopathic" or "cryptogenic",
meaning that we don't know what causes them. There may be a problem in the way the brain is wired, or
with high levels of specific brain chemicals called neurotransmitters.
Genetic research is teaching doctors more and more about what causes different types of seizures.
Traditionally, seizures have been categorized according to how they look from the outside and what the
EEG (electroencephalogram) pattern looks like. The research into the genetics of seizures is helping
experts discover the particular ways different types of seizures occur. Eventually, this may lead to tailored
treatments for each type of seizure that causes epilepsy.
Diagnosing a Seizure in a Child
Diagnosing a seizure can be tricky. Seizures are over so quickly that your doctor probably will never see
your child having one. The first thing a doctor needs to do is rule out other conditions, such as
nonepileptic seizures. These may resemble seizures, but are often caused by other factors such as drops
in blood sugar or pressure, changes in heart rhythm, or emotional stress.
Your description of the seizure is important to help your doctor with the diagnosis. You should also
consider bringing the entire family into the doctor's office. The siblings of children with epilepsy, even very
young kids, may notice things about the seizures that parents may not. Also, you may want to keep a
video camera handy so that you can tape your child during a seizure. This may sound like an insensitive
suggestion, but a video can help the doctor enormously in making an accurate diagnosis.
Some kinds of seizures, such as absence seizures, are especially difficult to catch because they may be
mistaken for daydreaming.
"Nobody misses a grand mal (generalized tonic-clonic) seizure," says William R. Turk, MD, Chief of the
Neurology Division at the Nemours Children's Clinic in Jacksonville, Florida. "You can't help but notice
when a person falls to the ground, shakes, and sleeps for three hours." But absence or staring seizures
may go unnoticed for years.
Diagnosing a Seizure in a Child continued...
Turk says you shouldn't worry if your child gazes open-mouthed at cartoons on TV, or stares out the
window in the car. Most kids who appear to be daydreaming really are just daydreaming. Instead, watch
for spells that come at inappropriate times, such as when your child is in the middle of speaking or doing
something, and suddenly stops.
Other kinds of seizures, such as simple or complex partial seizures, can be mistaken for different
conditions, such as migraines, psychological illness, or even drug or alcohol intoxication. Medical tests
are an important part of diagnosing seizures. Your child's doctor will certainly do a physical exam and
blood tests. The doctor may also order an EEG to check the electrical activity in the brain, or request a
brain scan such as an MRI with a specific epilepsy protocol.
The Risks of Seizures in Children
Although they may look painful, seizures don't really cause pain. But they may be frightening for children
and the people around them. Simple partial seizures, in which a child may have a sudden, overwhelming
sense of terror, are especially frightening. One of the problems with complex partial seizures, for instance,
is that people have no control of their actions. They may wind up doing inappropriate or bizarre things that
upset people around them. It's also possible for children to injure themselves during a seizure if they fall
to the ground or hit other things around them. But the seizures themselves are usually not harmful.
Experts don't yet understand the long-term effects of seizures on the brain very well. In the past, most
scientists thought that seizures did not cause any damage to the brain. They attributed any brain damage
to an underlying illness. Now, however, some doubts are beginning to emerge.
Solomon L. Moshe, MD, Director of Clinical Neurophysiology and Child Neurology at the Albert Einstein
College of Medicine in New York, is researching the subject and remains cautious. "I don't think it's good
to say one way or another whether seizures do long-term damage," he says. "I think it all depends on the
individual case."
Moshe notes that the brains of children are very flexible. They are perhaps the least likely people with
epilepsy to suffer any brain damage from a seizure.
Dangerous Seizures in Kids
Although the majority of seizures aren't dangerous and don't require immediate medical attention, one
kind does. Status epilepticus is a life-threatening condition in which a person has a prolonged seizure or
one seizure after another without regaining consciousness in between them. Status epilepticus is more
common among people with epilepsy, but about one-third of the people who develop the condition have
never had a seizure before. The risks of status epilepticus increase the longer the seizure goes on, which
is why you should always get emergency medical help if a seizure lasts more than five minutes.
You may also hear about a condition called Sudden Unexplained Death, in which a person dies for no
known reason. It can happen to anyone, but it's more likely to happen in a person with epilepsy. The
causes aren't known, but parents of children with epilepsy should know that it's a very rare occurrence.
Controlling seizures, especially those that occur in sleep, is the most effective plan for helping to prevent
this tragedy from occurring.
http://www.childrenshospital.org/az/Site1967/mainpageS1967P0.html
What is a seizure?
The brain is the center that controls and regulates all voluntary and involuntary responses in the body. It
consists of nerve cells that normally communicate with each other through electrical activity.
A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily
interrupts normal electrical brain function. The incidence of seizures is high before the child's first birthday.
Approximately 3 to 5 percent of all children may experience a seizure.
What are the different types of seizures?
There are several different types of seizures in children, including the following:
Focal seizures - Focal seizures take place when abnormal electrical brain function occurs in one or
more areas of one side of the brain. Focal seizures may also be called partial seizures. With focal
seizures, particularly with complex focal seizures, the child may experience an aura before the
seizure occurs. An aura is a strange feeling, either consisting of visual changes, hearing
abnormalities, or changes in the sense of smell. Two types of focal seizures include the following:
o
Simple focal seizures - The seizures typically last less than one minute. The child may
show different symptoms depending upon which area of the brain is involved. If the
abnormal electrical brain function is in the occipital lobe (the back part of the brain that is
involved with vision), the child's sight may be altered. The child's muscles are typically
more commonly affected. The seizure activity is limited to an isolated muscle group, such
as fingers or to larger muscles in the arms and legs. Consciousness is not lost in this type of
seizure. The child may also experience sweating, nausea, or become pale.
o
Complex focal seizures - This type of seizure commonly occurs in the temporal lobe of
the brain, the area of the brain that controls emotion and memory function. This seizure
usually lasts between one to two minutes. Consciousness is usually lost during these
seizures and a variety of behaviors can occur in the child. These behaviors may range from
gagging, lip smacking, running, screaming, crying, and/or laughing. When the child regains
consciousness, the child may complain of being tired or sleepy after the seizure. This is
called the postictal period.
Generalized seizures - Generalized seizures involve both sides of the brain. There is loss of
consciousness and a postictal state after the seizure occurs. Types of generalized seizures include
the following:
o
Febrile seizures - This type of seizure is associated with fever. Approximately 2 to 5
percent of all children in the United States experience febrile seizures. These seizures are
more commonly seen in children between 6 months and 5 years of age and there may be a
family history of this type of seizure. Febrile seizures that last less than 15 minutes are
called "simple," and typically do not have long-term neurological effects. Seizures lasting
more than 15 minutes are called "complex" and there may be long-term neurological
changes in the child.
o
Absence seizures (also called petit mal seizures) - These seizures are characterized
by a brief altered state of consciousness and staring episodes. Typically the child's posture
is maintained during the seizure. The mouth or face may move or the eyes may blink. The
seizure usually lasts no longer than 30 seconds. When the seizure is over, the child may not
recall what just occurred and may go on with his/her activities, acting as though nothing
happened. These seizures may occur several times a day. This type of seizure is sometimes
mistaken for a learning problem or behavioral problem. Absence seizures almost always
start between ages 4 to 12.
o
Atonic (also called drop attacks) - With atonic seizures, there is a sudden loss of muscle
tone and the child may fall from a standing position or suddenly drop his/her head. During
the seizure, the child is limp and unresponsive.
o
Generalized tonic-clonic seizures (GTC or grand mal seizures) - This seizure is
characterized by five distinct phases that occur in the child. The body, arms, and legs will
flex (contract), extend (straighten out), tremor (shake), a clonic period (contraction and
relaxation of the muscles), followed by the postictal period. During the postictal period, the
child may be sleepy, have problems with vision or speech, and may have a bad headache,
fatigue, or body aches.
o
Myoclonic seizures - This type of seizure refers to quick movements or sudden jerking of
a group of muscles. These seizures tend to occur in clusters, meaning that they may occur
several times a day, or for several days in a row.
o
Infantile spasms - This rare type of seizure disorder occurs in infants from 3 months to
12 months of age. There is a high occurrence rate of this seizure when the child is
awakening, or when they are trying to go to sleep. The infant usually has brief periods of
movement of the neck, trunk, or legs that lasts for a few seconds. Infants may have
hundreds of these seizures a day. This can be a serious problem, and can have long-term
complications.
Sometimes, prolonged or clustered seizures can worsen and develop into non-stop seizures. This is called
status epilepticus. This condition is a medical emergency. The child needs to be hospitalized to receive the
proper treatment to control the seizures.
What is epilepsy?
Epilepsy is a neurological condition involving the brain that makes people more susceptible to having
seizures. It is one of the most common disorders of the nervous system and affects people of all ages, races
and ethnic background. More than 2.3 million Americans live with epilepsy.
When a person has two or more seizures, he or she is considered to have epilepsy. There are many possible
causes of epilepsy, including tumors, strokes, and brain damage from illness or injury. In many cases, there
may be no detectable cause for epilepsy.
What causes epilepsy?
While the exact cause of epilepsy may not be known, it may be caused by the following:
family history
genetic problem
underlying brain problem
What is status epilepticus?
Sometimes, prolonged or clustered seizures can worsen and develop into non-stop seizures. This is called
status epilepticus. This condition is a medical emergency. The child needs to be hospitalized to receive the
proper treatment to control the seizures.
What causes a seizure?
A child may experience one or numerous seizures. While the exact cause of the seizure may not be known,
the more common seizures are caused by the following:
in newborns and infants:
o
birth trauma
o
problems that the infant is born with
o
fever/infection
o
metabolic or chemical imbalances in the body
in children, adolescents, and young adults:
o
alcohol or drugs
o
head trauma
o
infection
o
congenital conditions
o
genetic factors
o
unknown reasons
other possible causes of seizures may include:
o
brain tumor
o
neurological problems
o
drug withdrawal
o
medications
What are the symptoms of a seizure?
The child may have varying degrees of symptoms depending upon the type of seizure. The following are
general symptoms of a seizure or warning signs that your child may be experiencing seizures. Symptoms or
warning signs may include:
staring
jerking movements of the arms and legs
stiffening of the body
loss of consciousness
breathing problems or breathing stops
loss of bowel or bladder control
falling suddenly for no apparent reason
not responding to noise or words for brief periods
appearing confused or in a haze
sleepiness and irritable upon waking in the morning
nodding the head
periods of rapid eye blinking and staring
During the seizure, the child's lips may become bluish and breathing may not be normal. The movements
are often followed by a period of sleep or disorientation.
The symptoms of a seizure may resemble other problems or medical conditions. Always consult your child's
physician for a diagnosis.
How are seizures diagnosed?
The full extent of the seizure may not be completely understood immediately after onset of symptoms, but
may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a seizure
is made with a physical examination and diagnostic tests. During the examination, the physician obtains a
complete medical history of the child and family and asks when the seizures occurred. Seizures may be due
to neurological problems and require further medical follow up.
Diagnostic tests may include:
blood tests
electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by
means of electrodes attached to the scalp.
magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large
magnets, radiofrequencies, and a computer to produce detailed images of organs and structures
within the body
computerized tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure
that uses a combination of x-rays and computer technology to produce cross-sectional images
(often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images
of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed
than general x-rays.
lumbar puncture (spinal tap) - a special needle is placed into the lower back, into the spinal canal.
This is the area around the spinal cord. The pressure in the spinal canal and brain can then be
measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to
determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain
and spinal cord.
Treatment of a seizure:
Specific treatment for a seizure will be determined by your child's physician based on:
your child's age, overall health, and medical history
the extent of the condition
the type of seizure
your child's tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference
The goal of seizure management is to control, stop, or decrease the frequency of the seizures without
interfering with the child's normal growth and development. The major goals of seizure management include
the following:
proper identification of the type of seizure
using medication specific to the type of seizure
using the least amount of medication to achieve adequate control
maintaining good medicating levels
Treatment may include:
Medications - There are many types of medications used to treat seizures and epilepsy.
Medications are selected based on the type of seizure, age of the child, side effects, the cost of the
medication, and the adherence with the use of the medication.
Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles, or syrup),
but some can be given rectally (into the child's rectum). If the child is in the hospital with seizures,
medication by injection or intravenous (IV) may be used.
It is important to give your child his/her medication on time and as prescribed by your child's
physician. Different people use up the medication in their body differently, so adjustments (schedule
and dosage) may need to be made for good control of seizures.
All medications can have side effects, although some children may not experience side effects.
Discuss your child's medication side effects with his/her physician.
While your child is taking medications, different tests may be done to monitor the effectiveness of
the medication. These tests may include the following:
o
Blood work - frequent blood draws testing is usually required to check the level of the
medication in the body. Based on this level, the physician may increase or decrease the
dose of the medication to achieve the desired level. This level is called the "therapeutic
level" and is where the medication works most efficiently. Blood work may also be done to
monitor the affects of medications on body organs.
o
Urine tests - these tests are performed to see how the child's body is responding to the
medication.
o
Electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical
activity by means of electrodes attached to the scalp. This test is done to monitor how the
medication is helping the electrical problems in the brain.
Ketogenic diet - Certain children who are having problems with medications, or whose seizures are
not being well controlled, may be placed on a special diet called the ketogenic diet. Certain children
who are having problems with medications, or whose seizures are not being well controlled, may be
placed on a special diet called the ketogenic diet. This type of diet is low in carbohydrates and high
in protein and fat.
What is a ketogenic diet?
The ketogenic diet is sometimes offered to those children who continue to have seizures while on seizure
medication. When the medications do not work, a ketogenic diet may be considered. No one knows exactly
how the diet works, but some children do become seizure-free when put on the diet. However, the diet does
not work for everyone.
What does the diet consist of?
The ketogenic diet is very high in fat (about 90 percent of the calories come from fat). Protein is given in
amounts to help promote growth. A very small amount of carbohydrate is included in the diet. This very
high- fat, low- carbohydrate diet causes the body to make ketones. Ketones are made by the body from
protein. They are made for energy when the body does not get enough carbohydrates for energy. If your
child eats too many carbohydrates, then his/her body may not make ketones. The presence of ketones is
important to the success of the diet
High-fat foods:
butter
heavy cream
oil
mayonnaise
cream cheese
bacon
cheese
cheese
High-carbohydrate foods:
fruit and fruit juice
breads and cereals
vegetables (corn, peas, and potatoes)
beans
milk
soda
snack foods (chips, snack cakes, crackers)
sweets
Your child's physician will determine if this diet is right for your child. When the ketogenic diet is started,
your child will be admitted to the hospital. It may take four to five days in the hospital to get the diet started
and for you to learn how to plan the diet.
While in the hospital, your child may not be able to eat for one to two days until ketones are measured in
the urine. Once ketones are present in the urine, special high-fat, low-carbohydrate shakes may be started.
These are sometimes called "keto shakes." After several meals of keto shakes, your child will be started on
solid foods.
You may also be taught how to check your child's urine for ketones. The dietitian will help determine how
much fat, protein, and carbohydrate your child is allowed to have, usually divided into three meals a day.
The ketogenic diet can by very challenging to prepare and requires that all foods be weighed using a food
scale. The ketogenic diet is not nutritionally balanced, therefore, vitamin and mineral supplements are
needed.
Some medications and other products, such as toothpaste and mouthwash, contain carbohydrates. It is
important to avoid these products if your child is on the ketogenic diet. Your child may not make ketones in
their urine if too many carbohydrates are included in the diet. Your child's physician and dietitian can give
you a list of medications, and other products, that are free of carbohydrates.
How long is the diet used?
Children usually stay on the diet about two years. The diet is then slowly changed back to a regular diet.
Additional treatment options:
vagus nerve stimulation (VNS) - Some children, whose seizures are not being well-controlled with
seizure medications, may benefit from a procedure called vagus nerve stimulation (VNS). VNS is
currently only used for children over the age of 12 who have partial seizures that are not controlled
by other methods.
VNS attempts to control seizures by sending small pulses of energy to the brain from the vagus
nerve, which is a large nerve in the neck. This is done by surgically placing a small battery into the
chest wall. Small wires are then attached to the battery and placed under the skin and around the
vagus nerve. The battery is then programmed to send energy impulses every few minutes to the
brain. When the child feels a seizure coming on, he/she may activate the impulses by holding a
small magnet over the battery. In many people, this will help to stop the seizure.
There are some side of the effects that may occur with the use of VNS. These may include, but are
not limited to, the following:
o
hoarseness
o
pain or discomfort in the throat
o
change in voice
surgery - Another treatment option for seizures is surgery. Surgery may be considered in a child
who:
o
has seizures that are unable to be controlled with medications.
o
has seizures that always start in one area of the brain.
o
has a seizure in a part of the brain that can be removed without disrupting important
behaviors such as speech, memory, or vision.
Surgery for epilepsy and seizures is a very complicated surgery performed by a specialized surgical team.
The operation may remove the part of the brain where the seizures are occurring, or, sometimes, the
surgery helps to stop the spread of the bad electrical currents through the brain.
A child may be awake during the surgery. The brain itself does not feel pain. With the child awake and able
to follow commands, the surgeons are better able to make sure that important areas of the brain are not
damaged.
Surgery is not an option for everyone with seizures. Discuss this with your child's physician for more
information.
More information regarding the child with seizures or epilepsy:
Make sure you and your child (if age appropriate) understand the type of seizure that is occurring
and the type of medication(s) that are needed.
Know the dose, time, and side effects of all medications.
Consult your child's physician before giving your child other medications. Medications for seizures
can interact with many other medications, causing the medications to work improperly and/or
causing side effects.
Young women of childbearing age, who are on seizure medications, need to be informed that seizure
medications are harmful to a fetus, and the medication may also decrease the effectiveness of oral
contraceptives.
Check with your state to understand any laws about people with epilepsy or seizures operating a
motor vehicle.
If a child has good control over the seizures, only minimal restrictions need to be placed on the
child's activities. The child should always wear a helmet with sports and bike riding (including in-line
roller-skating, hockey, and skateboards). The child should also always have a buddy or adult
supervision while swimming.
Specific follow-up will be determined by your child's physician.
Medications for seizures may not be needed for the entire life of the child. Some children may be
taken off their medications if they have been seizure-free for one to two years. This will be
determined by your child's physician.
