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Childhood Seizures - Types of Seizures, Symptoms, Diagnosis, and Management Strategies

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The presentation of childhood seizures keeps changing as the child grows. It can be effectively controlled and prevented with early detection and treatment.

Written by

Dr. Jayasree S

Medically reviewed by

Dr. Prakashkumar P Bhatt

Published At September 14, 2022
Reviewed AtSeptember 8, 2023

Introduction:

Seizure is the body's response to a burst of abnormal electrical impulses produced by the brain cells. The response can be as mild as a moment of stillness in the body or as intense as violent shaking, falls, and loss of consciousness. Brain cells constantly send out electrical impulses called action potentials to control and regulate the body’s functions. When a set of nerve cells malfunction to cause a seizure, the individual experiences strange involuntary body movements, loss of general awareness, and changes in behavior. When a child gets two or more seizure attacks on different occasions, it is tagged as epilepsy. A seizure can be effectively controlled and prevented with medication, but if left untreated, it might damage the brain further.

What Causes Childhood Seizures?

Seizures in children can be due to several reasons. Sometimes a seizure starts without any apparent reason too. The following conditions may induce seizure attacks in infants, children, and young adults:

  • In Infants: A newborn child up to the age of six months may suffer a seizure attack due to trauma to the brain at the time of delivery, prolonged high fever (febrile seizures), and infections like meningitis. Also, when born with neurological disorders featuring seizures or when certain chemical or metabolic changes occur in the baby’s body.

  • In Children and Adolescents: If epilepsy runs in the family, chances are, the child may inherit the tendency to develop seizures. Head injuries due to various trauma, infections such as meningitis or encephalitis, and neurological disorders acquired by birth are the other reasons. In young adults, alcohol and drug abuse may also provoke seizure attacks.

  • In Others: There may be other possible causes like a brain tumor, degenerative nerve diseases, adverse reactions to medications, and drug withdrawal.

What Are the General Signs and Symptoms to Recognize the Child Is Undergoing a Seizure Attack?

Depending on the type of seizure, the symptoms can range from mild to intense. Some types of seizures start after a phase called ‘aura.’ This may include a feeling of de javu, unknown fears, sickness in the stomach, tingling or numbness in the body, and change in vision, smell, and taste.

The following are the warning signs one may be able to recognize at the onset of a seizure attack:

  1. The child tends to stay sleepy and irritated in the morning.

  2. May remain still and stare at a point afar.

  3. Body going stiff and rigid.

  4. A pause in breathing.

  5. Goes into a haze or a confused state of mind.

  6. Nodding the head.

  7. Jerky movements of hands and legs.

  8. Unable to respond to the words or commands of those standing nearby.

  9. Repeated rapid blinking of the eye.

  10. Fall down without any reason.

  11. Loose bowel control and bladder control.

  12. Loss of consciousness.

  13. Lips turn blue, and face turns pale.

  14. After the seizure attack, the child tends to stay disoriented and prefers to sleep.

What Are the Types of Seizures Seen in Children?

If abnormal electrical activity occurs in one or more areas of one side of the brain, it is called a focal or partial seizure. Whereas, if both sides of the brain malfunction to send out abnormal electrical impulses, it is called a generalized seizure.

  1. Focal Seizure - The child may experience an ‘aura’ before having a seizure attack. The seizures can be:

    1. Simple Focal Seizures: Depending on which area of the brain is involved, the child may experience changes in vision, jerking of fingers, arms, and legs on one side. It normally lasts for less than one minute with no apparent loss of consciousness. One may go pale, get sweaty, and be nauseated.

    2. Complex Focal Seizures: They last for one to two minutes, and the child usually loses consciousness. One may cry out, scream, run, smack the lips, keep gagging, or laugh without reason before passing out. After the seizure attack, the child may be exhausted and sleepy.

  2. Generalized Seizures - In this, the seizure attack always ends up in loss of consciousness. As the child grows, the signs and symptoms of the attack keep changing. They can be:
    1. Absence Seizures: Also called petit mal seizure, absence seizures start around the age of four to twelve years, and each attack persists for about thirty seconds. The child may not fall, but the face, mouth, and eyes (rapid blinking) show abnormal movements at the time of the attack. The child will not have any recollection of what happened then.
    2. Atonic Seizure: The child goes limp, unresponsive, loses muscle tone, and falls down from a standing position.
    3. Generalized Tonic-Clonic Seizure: It is an extensive type of seizure attack also called grand mal seizure. One may undergo five phases of the attack where the body parts will contract first, straighten out, shake violently, undergo alternate contraction and relaxation of muscles, and the seizure gradually subsides towards the last phase. This may be accompanied by foamy saliva drooling from the mouth and upward rolling of the eyes. The attack results in body aches, headache, speech and vision issues, and fatigue, leaving the child sleepy.
    4. Myoclonic Seizure: Happens in clusters, meaning repeated episodes of quick jerking movements of the muscles occurring several times a day and lasting for a few days.
  3. The other types of seizures found in children are:

    1. Infantile Spasms - This is a condition requiring immediate attention. The infant shows abnormal movements of the head, neck, body, and legs for a few seconds after waking up from sleep or while going to sleep. The child may get around a hundred such attacks in a day.

    2. Febrile Seizures - This happens to children from the age of six months to five years of age while they are running a high fever. A simple febrile seizure lasting for less than fifteen minutes may not cause any harm. Whereas complex febrile seizures lasting more than fifteen minutes may cause persistent neurological disorders in the child.

How to Diagnose a Seizure Disorder?

As the symptoms of seizures match with many other intellectual disabilities and learning disorders in children, a conclusive diagnosis requires a thorough medical evaluation. The doctor tries to understand the pattern, duration, frequency, and types of symptoms expressed at the time of each seizure attack, along with the medical history. This is followed by physical examination and diagnostic tests such as:

  • Electroencephalogram (EEG) - To locate the malfunctioning area of the brain by attaching electrodes to the scalp and recording the patterns of electrical activity.

  • Imaging Studies - Such as; computed tomography (CT) scan and magnetic resonance imaging (MRI) to identify structural abnormalities and underlying causes of seizure disorder.

  • Lumbar Puncture (Spinal Tapping) - This procedure may be conducted to test the cerebrospinal fluid (CSF) for infections and signs of inflammation.

What Is the Treatment to Control and Prevent Seizures in Children?

Doctors aim to stop, control, or reduce the frequency of seizure attacks in children. The treatment is specific to the type of seizure; it should not interfere with the child’s natural growth and development. One may suggest:

  1. Anti-seizure Drugs - Several drugs are available in this category, such as; Carbamazepine, Lamotrigine, Levetiracetam, Eslicarbazepine, and more.

  2. Vagus Nerve Stimulation - Where a stimulating device is attached under the skin to send electrical pulses to the brain and thereby control seizure attacks.

  3. Surgical Correction - Rarely a surgical correction may be conducted where the malfunctioning area of the brain is removed to eliminate the underlying cause of the seizure.

  4. Dietary Modifications - Certain special diet plans such as the ketogenic diet and Atkins diet were seen to help regulate seizures.

Conclusion:

Children with a tendency for seizures should not be left to bathe or swim alone as a part of safety precautions. For an epileptic teenager, there is always a risk of accidents while driving. Many children outgrow their tendency to get seizure attacks as they grow up. And the majority of the affected kids show good improvement with preventive medicines. With early detection and proper medical management, living with seizures is not as bad as it used to be anymore.

Frequently Asked Questions

1.

Are Febrile Seizures Common in Children?

Febrile seizures happen to children from six months to five years of age while they are running a high fever. A simple febrile seizure lasting less than fifteen minutes may not cause harm. Whereas complex febrile seizures lasting more than fifteen minutes may cause persistent neurological disorders in children.

2.

What Are the Types of Seizures Seen in Children?

If abnormal electrical activity occurs in one or more areas of one side of the brain, it is called a focal or partial seizure. Whereas, if both sides of the brain malfunction to send out abnormal electrical impulses, it is called a generalized seizure. The other types of seizures in children are infantile spasms and febrile seizures.

3.

What Is the Prognosis of Childhood Seizures?

Many children outgrow their tendency to get seizure attacks as they grow up. And the majority of the affected kids show good improvement with preventive medicines. So with early detection and proper medical management, living with seizures is not as bad as it used to be anymore.

4.

What Are the Signs of Childhood Seizures?

Depending on the type of seizure, the symptoms can range from mild to intense. Some types of seizures start after a phase called ‘aura.’ This may include a feeling of de javu, unknown fears, sickness in the stomach, tingling or numbness in the body, and change in vision, smell, and taste.

5.

What Are the Causes of Childhood Seizures?

In children and adolescents, if epilepsy runs in the family, the child may inherit the tendency to develop seizures. Other reasons are head injuries due to various trauma, infections such as meningitis or encephalitis, and neurological disorders acquired by birth. In young adults, alcohol and drug abuse may also provoke seizure attacks.

6.

What Does a Child Look Like After the Seizures?

 - Fall without any reason.
 - Loose bowel control and bladder control.
 - Loss of consciousness.
 - Lips turn blue, and face turns pale.
 - After the seizure attack, the child tends to stay disoriented and prefers to sleep.

7.

What Is a Grand Mal Seizure?

An extensive type of seizure attack is also called a grand mal seizure. One may undergo five phases of the episode where the body parts will contract first, straighten out, shake violently, undergoing alternate contraction and relaxation of muscles. The seizure gradually subsides towards the last phase.

8.

What Type of Seizure Needs Immediate Care?

 
Infantile spasm is a condition requiring immediate attention. The infant shows abnormal head, neck, body, and leg movements for a few seconds after waking up or while going to sleep. The child may get around a hundred such attacks in a day.

9.

What Is the Treatment to Control Seizures in Children?

 
Doctors aim to stop, control, or reduce the frequency of seizure attacks in children. The treatment is specific to the type of seizure; it should not interfere with the child’s natural growth and development. Anti-seizure drugs are available in this category, such as; Carbamazepine, Lamotrigine, Levetiracetam, Eslicarbazepine, and more.

10.

How Long Do Seizures Usually Last?

Absence seizures also called petit mal seizures, absence seizures start around four to twelve years, and each attack persists for about thirty seconds. The child may not fall, but the face, mouth, and eyes (rapid blinking) show abnormal movements at the time of the attack. The child will not have any recollection of the particulars.
Dr. Prakashkumar P Bhatt
Dr. Prakashkumar P Bhatt

Neurology

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