Seizures in Children
A seizure occurs when the electrical signals in the brain become disorganized, causing a sudden temporary change in movement, awareness, behavior, and consciousness. They can occur quickly and without warning. The outward or visible manifestation of a seizure depends on where in the brain the electrical activity has been disrupted and how far it spreads.
Types of seizures
There are many different types of seizures, ranging from mild and short to prolonged and severe. Some can significantly affect quality of life. Generalized seizures involve the whole brain, while focal seizures only affect one specific part of the brain.
Febrile Seizures: this type of seizure is provoked by fever, often caused by illness. These occur in young, healthy children and are not usually associated with epilepsy or underlying neurological disorders. Sometimes parents will attempt to prevent seizure activity by controlling fever with analgesics (acetaminophen or ibuprofen), but this unfortunately does not prevent febrile seizures from occurring.
Absence Seizures: this type of seizure involves a very short episode of staring or lack of attention. Children will not respond to others around them during these episodes, even with attempts to physically move them. Children may have eye fluttering or rapid blinking during the episodes. Children return to normal immediately after an absence seizure. These were previously called “petite mal” seizures. They can be so quick and subtle that they often go unnoticed for a long time.
Focal Seizures (complex partial seizures): this type of seizure involves a specific portion of the brain, leading to outward symptoms that correlate to what that portion of the brain controls. For instance, a focal seizure in the motor area of the brain can cause jerking of the limbs or head, while a focal seizure in the language area of the brain can affect speech. During most of these seizures a person can be confused and unaware of what is going on, but if it is a simple partial seizure consciousness is not affected and the child is aware of what is happening. Focal seizures can start in one area of the brain and spread to involve both sides of the brain, developing into a convulsive seizure.
Convulsive Seizures (generalized tonic-clonic seizures): this type of seizure involves the most physical movement of the body, and therefore appear to be the most severe. These used to be called “grand-mal” seizures. Rapid, repetitive, often violent movements of the entire body can occur. These seizures usually last 2-3 minutes and stop spontaneously. The child affected by concussive seizures will often lose consciousness.
Infantile Spasms: this is a rare but serious type of seizure that begins in the first year of life. They involve a sudden stiffening of the infant’s body followed by a sudden dropping motion of the head and arms. These seizures only last a few seconds but often are clustered together. Infants will appear fine between episodes. Soon after these spasms start, infants will begin to lose developmental milestones that are appropriate for their age. Infants with infantile spasms require extensive medical evaluations to pinpoint the cause.
Epilepsy is a medical term used to describe repeated seizures that are not caused by illness or brain injury.
Children can also experience sudden movement episodes that may cause concern because they look like seizures, but really are other problems These include breath holding spells, fainting spells, muscle twitching, tics, and sleep disorders.
Evaluation of seizure activity
Any child who has seizure activity for the first time should have an immediate emergency medical evaluation and follow up with his or her Pediatrician. If seizures occur more than once a child should be evaluated by a Pediatric Neurologist, a physician who specializes in the brain.
Evaluation can vary widely since there are many different types and presentations of seizure activity in children. However, every evaluation should include a detailed medical and developmental history of the child, a thorough physical examination, and a detailed description of the event. Sometimes blood testing is done to rule out certain diseases or infections. Radiological images of the brain (CT scan or MRI) may be done to look for tumors, bleeding, traumatic injuries or brain abnormalities. An electroencephalogram, or EEG, will measure electrical brain function and help determine the type of seizure affecting a child andhow likely it is that it will happen again.
Treatments
The treatment of seizures depends significantly on the type of seizure the child is experiencing. This can range from watchful monitoring over time without intervention (as in with febrile seizures) to anti-convulsant medications, dietary therapies, holistic or complementary medical treatments, medical device implants and surgical procedures. Pediatric Neurologists work with families to determine the best possible treatment plans for children affected by seizures.
Final thoughts
Experiencing your child having a seizure can be a very scary thing. It is essential to seek medical care immediately if seizure activity does not stop within five minutes, but do not leave your child unattended. Talk with your child’s Pediatrician about the need for specialist evaluation, such as a Pediatric Neurologist. It will be important to discuss the type and potential cause for seizures as well as treatment and prognosis for your child. Knowledge is power, and in these cases can help you feel more in control if your child is likely to continue to have seizure activity. Also, keep in mind that frequency of seizures usually improves as children get older.
Resources
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