What is a Seizure?
Seizures are sudden events that cause temporary changes in physical movement, sensation, behavior or consciousness. They are caused by abnormal electrical and chemical changes in the brain.
There are many different types of seizures. Some last for only a few seconds, while others may last a few minutes. The specific type of seizure a person has depends on where in the brain the seizure starts, how the seizure spreads and how much (and what part) of the brain is involved. Seizures might include:
- Loss of consciousness
- Convulsions (whole body shaking)
- Brief periods of staring
- A sudden feeling of fear or panic
- Uncontrolled shaking of an arm or leg
- Flexing, stiffening, jerking, or twitching of the upper body
Nodding of the head
What is Epilepsy?
The term epilepsy is used to describe seizures that occur repeatedly over time without an acute illness (like fever) or an acute brain injury. Sometimes, the cause of the recurring seizures is known (symptomatic epilepsy), and sometimes it is not (idiopathic epilepsy).
A doctor would likely diagnose a child with epilepsy if the following were true:
- The child has had one or more unprovoked seizures.
- The doctor thinks the child is likely to have a seizure again
- The child's seizures are not directly caused by another medical condition, like diabetes, a severe infection or an acute brain injury.
Let's Look at Some Common Seizure Types
Doctor's divide seizures into two basic categories based on how much of the brain is involved. These include:
Generalized seizures that involve the whole brain.
Focal seizures that start in one specific part of the brain.
For more detailed information on specific seizures types.
Common Generalized Seizures:
Convulsive seizures (also called generalized tonic-clonic seizures) involve the whole body. These seizures used to be called "grand mal" seizures. They are the most dramatic type of seizure, causing rapid, rhythmic and sometimes violent shaking movements, often with loss of consciousness. These can sometimes start in one part of the brain, causing one part of the body to move, and then progress to the entire brain and movements on both sides of the body. These seizures usually last for 2 or 3 minutes and will almost always end on their own.
Convulsive seizures occur in about 5 out of every 100 people at some time during childhood. It is important to note that not everyone who has a single convulsive seizure will go on to develop epilepsy.
Absence seizures (previously called "petit mal" seizures) are very short episodes with a vacant stare or a brief (few seconds) lapse of attention. They may be accompanied by other subtle symptoms like eyelid fluttering, rapid eye blinking, lip smacking. These occur mainly in young children and may be so subtle that they aren't noticed until they begin affecting schoolwork.
Common Focal Seizures:
Focal seizures (previously called complex partial seizures) involve abnormal electrical activity in one part of the brain. During these seizures a person can be confused and consciousness is impaired. They often engage in random, repetitive and purposeless activities like wringing the hands or walking slowly in circles. The person is unaware of what is going on around them and may be unable to talk normally. This type of seizure typically lasts 1 to 2 minutes.
Focal seizures can involve jerking of one or more parts of the body, or sensory changes like smells or tingling feelings that may not be obvious to onlookers. During the seizure the person is fully aware of what is going on. These seizures where consciousness is not impaired have been called Simple Partial Seizures
Focal seizures can start in one area of the brain, and spread to involve both sides of the brain. In some instances a focal seizure can progress to a convulsive seizure.
Other Disorders That Can Look Like Seizures:
Some children experience sudden episodes that might masquerade or imitate seizures, but are really not. Examples include:
- Breath holding
- Facial or body twitching (myoclonus)
- Sleep disorders (night terrors, sleepwalking, and cataplexy)
They may occur just once or may recur over a limited time period. Again, although these episodes may resemble epilepsy, they are not, and they require quite different diagnostic tests and treatment.
If Your Child is Having a Convulsion:
Most seizures will stop on their own and do not require immediate medical treatment. If your child is having a convulsion, protect her from injuring herself by laying her on her side with her hips higher than her head, so she will not choke if she vomits. Do not put anything in the mouth.
If the convulsion does not stop within five minutes or is unusually severe (difficulty breathing, choking, blueness of the skin, having several in a row), call 911 for emergency medical help. Do not leave your child unattended, however. After the seizure stops, call the pediatrician immediately and arrange to meet in the doctor's office or the nearest emergency department. Also call your doctor if your child is on an anticonvulsant medication, since this may mean that the dosage must be adjusted.
If your child has diabetes, is injured or has a seizure in the water, this is always an emergency and 911 should be called immediately.
If your child has a fever, the pediatrician will check to see if there is an infection. If there is no fever and this was your child's first convulsion, the doctor will try to determine other possible causes by asking if there is a family history of seizures or if your child has had any recent head injury. He will examine your child and also may order blood tests, pictures of the brain using computed tomography (CAT scan) or magnetic resonance imaging (MRI), or testing with an electroencephalogram (EEG), which measures the electrical activity of the brain. Sometimes a spinal tap will be performed to obtain a specimen of spinal fluid that can be examined for some causes of convulsions such as meningitis, an infection of the lining of the brain. If no explanation or cause can be found for the seizures, the doctor may consult a pediatric neurologist, a pediatrician who specializes in disorders of the nervous system.
If your child has had a febrile convulsion, some parents may try controlling the fever using acetaminophen and sponging. However, these approaches do not prevent future febrile seizures, but only make the child more comfortable. If a bacterial infection is present, your doctor will probably prescribe an antibiotic. If a serious infection such as meningitis is responsible for the seizure, your child will have to be hospitalized for further treatment. Also, when seizures are caused by abnormal amounts of sugar, sodium, or calcium in the blood, hospitalization may be required so that the cause can be found and the imbalances corrected.
If epilepsy is diagnosed, your child usually will be placed on an anticonvulsant medication. When the proper dosage is maintained, the seizures can almost always be completely controlled. Your child may need to have her blood checked periodically after starting some medications to make certain there is an adequate amount present. She also may need periodic EEGs. Medication usually is continued until there have been no seizures for a year or two.
As frightening as seizures can be, it's encouraging to know that the likelihood that your child will have another one drops greatly as she gets older. (About 1 in 100 adults 18 and older have active epilepsy). Unfortunately, a great deal of misunderstanding and confusion about seizures still exists, so it is important that your child's friends and teachers become educated about her condition.
If you need additional support or information, consult with your pediatrician or contact your local or state branch of the Epilepsy Foundation of America.