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.
- A low percentage 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.
- Children with relatives, especially brothers and sisters, who have had febrile seizures are more likely to have a similar episode.
- 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.
- 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.
- 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.
- 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.
- 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.
- Tonic seizures result in continuous muscle contraction and rigidity, while tonic-clonic seizures involve alternating tonic activity with rhythmic jerking of muscle groups.
- 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.
- 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 most 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:
- Metabolic disorders
- Disordered blood vessels
- Bleeding inside the brain
- 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.
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.