Childhood Seizures: How to Recognize the Signs and Symptoms

We have all heard of seizures and it’s likely that you know someone who has had a seizure or who has been diagnosed with epilepsy. But what exactly is a seizure and how common are seizures in children?

According to the American Association of Neurological Surgeons, epilepsy affects more than 300,000 children under the age of 15. And while most cases of childhood epilepsy are manageable, it can be frightening for kids and parents.

Unfortunately, it is not always easy to recognize a seizure. Not all seizures include convulsions or unusual muscle movements and having a seizure doesn’t mean your child will be diagnosed with epilepsy. A child may seem to be daydreaming or not paying attention. A seizure may not even last a full minute, but over time, if a child keeps having them, untreated seizures can be dangerous. Read on to learn about the different types of childhood seizures and what can trigger them.

What is a seizure?

A seizure is a sudden, uncontrolled electrical disturbance in the brain. Normally, your brain continuously generates small electrical impulses in an orderly pattern. These impulses travel along neurons (a network of nerve cells in the brain) and throughout the body through chemical messengers called neurotransmitters. In a person with epilepsy, the brain's electrical rhythms can become imbalanced or irregular, resulting in seizures. This can briefly affect their consciousness, movements or sensations.

The American Association of Neurological Surgeons says that children and adolescents are more likely to have epilepsy of “unknown or genetic origin.” The reasons why epilepsy begins are different for people of different ages. Children may be born with a defect in the structure of their brain, or they may suffer a head injury or infection that causes their epilepsy.

What causes a seizure?

Seizures in children can have many causes. Common causes of childhood seizures can include:

• Genetic causes
• Fever
• Head injury
• Infections of the brain such as meningitis or encephalitis
• Lack of oxygen to the brain
• Disorders of brain development
• Premature birth
• Hydrocephalus (excess water on the brain)

Less common causes of seizures include brain tumors or cysts.

What types of seizures are seen in children?

The kind of seizure a child has depends on whether their whole brain is affected or just a certain part of it. Generalized seizures affect the whole brain, while focal seizures affect only one part of the brain. Many childhood seizures are benign, meaning that they are brief events that do not typically continue into adulthood, and the child's development and intellect are usually normal.

Generalized seizures

• Generalized tonic-clonic seizures: This type of seizure is also known as a convulsion and is the most common and easily recognized kind of generalized seizure. A child will suddenly cry or scream, become stiff or may fall and begin to move their arms or legs up-and-down or side-to-side movement. Their skin may appear blue, breathing can be shallow and their teeth are usually clenched. The seizure usually lasts a minute or two. Afterward, the child is often confused and may complain of sore muscles or a bitten tongue. Sometimes they will fall into a deep sleep.

• Absence seizures: These seizures can easily be confused with daydreaming or not paying attention. However, the child is unconscious and cannot be alerted or woken up. This type of seizure usually lasts only a few seconds. Your child might stare blankly, blink rapidly, or appear to be chewing. After it's over, the child will often seem completely normal.

• Atonic and tonic seizures: These seizures are when a child suddenly collapses and falls. It can be from the body stiffening or a complete loss of muscle tone. These seizures can cause injuries, including head injuries, because of the force of the fall. After an atonic or tonic seizure is over, usually in less than a minute, the child regains consciousness and awareness.

• Myoclonic seizures: These are sudden, brief muscle jerks, usually affecting a child's neck, shoulders and upper arms. They can be mild or strong enough to make a child fall. These seizures are most common in the morning and often occur in clusters (more than one). They can be frustrating, causing children to drop what they are holding, spill drinks, etc.

Focal seizures

• Focal aware seizures: During these seizures, the child is aware of what is happening, but can't control it. The seizure can cause uncontrolled movement of the body, things smell or taste strange, stomach pain, or sudden fear or anger.

• Focal impaired awareness seizures: This type of seizure will often vary depending upon where in the brain it occurs. The child may stare, chew, make odd movements, mumble, run, scream or even see things. These seizures sometimes occur when the child is sleeping. During a focal impaired awareness seizure, a child is unconscious and won't remember it afterward. Also called “automatisms,” they usually last one or two minutes, after which the child is often frightened or confused.

• Focal to bilateral generalized tonic-clonic seizures: These seizures may begin in one focal area on one side of the brain, but then spread to become generalized tonic-clonic seizures that involve both sides of the brain.

Febrile seizures

Children ages 3 months to 6 years may have seizures when they have a high fever. These are called febrile seizures and occur in 2% to 5% of all children. The National Epilepsy Foundation says there is a slight tendency for them to run in families. If a child's parents, brothers or sisters, or other close relatives have had febrile seizures, the child is a bit more likely to have them. These types of seizures are classified as simple or complex. Most children who have febrile seizures do not require daily treatment with seizure medication.

A pediatric neurologist will diagnose seizures in your child based on symptoms, physical signs and the results of tests such as an electroencephalogram, CT (computed tomography) scan or MRI (magnetic resonance imaging). Your doctor may also perform a blood test or spinal tap. This is usually done if your doctor is worried about meningitis. This is done more commonly in children under 12 months of age but is rarely needed in older children. Epilepsy is usually diagnosed after a person has had at least two seizures that were not caused by some known medical condition.

How are seizures in children treated?

It’s important to know what types of treatments are available for your child. Your child’s doctor will likely recommend medication first. They often need to try a few different antiepileptic (seizure-preventing) drugs before the right one is found. Medications treat the symptoms of epilepsy by reducing the frequency of seizures. The medication will not work properly until it reaches a certain level in the body, and that level must be maintained by taking the medication regularly. If medication doesn't work, or causes difficult side effects, other treatments may include surgery or vagus nerve stimulation. This form of treatment sends regular, mild pulses of electrical energy to the brain through a device that is similar to a pacemaker.

For some children, surgery may be necessary and is similar to many surgeries available for adults who suffer from seizures. Depending on the specifics of the child, the National Epilepsy Foundation says the chances of being seizure-free after surgery may be between 50% and 80% in children. However, particularly in younger children, surgical procedures can be more extensive. This means that larger areas of the brain may need to be operated on.

Another treatment option to control pediatric seizures is dietary therapy. Your child’s doctor may recommend a low glycemic index diet that limits carbohydrates and includes foods that do not raise their blood sugar. Other dietary options may include trying a ketogenic diet that involves limiting calories and food with carbohydrates and protein, or a modified Atkins diet. This is a less restrictive version of the ketogenic diet. It mostly includes food with fat but, does not limit carbohydrates, protein, or calories as much.

While all seizures are caused by electrical disturbances in the brain, there are many different kinds of seizures. Some children have just one type, while others have a combination. It’s important to work closely with your child’s neurologist to determine the best plan of care.