Causes of childhood seizures: 5 Common Triggers the Cause Seizures in Children
Causes of Epilepsy in Childhood
Seizures in children have many causes. Common causes of childhood seizures or epilepsy include
- fever (these are called febrile seizures)
- genetic causes
- head injury
- infections of the brain and its coverings
- lack of oxygen to the brain
- hydrocephalus (excess water in the brain cavities)
- disorders of brain development
Most seizures in childhood are not associated with a definite cause, however.
Less common causes of childhood epilepsy include brain tumors or cysts and degenerative disorders (progressive and deteriorating conditions, often associated with loss of brain cells). There is an important difference between something that causes seizures, such as a high fever in a young child, and something that causes epilepsy, such as a severe head injury.
Extensive and careful studies have not found any evidence that immunizations cause epilepsy. However, a seizure may occur within 1 or 2 days of an immunization, especially if it is followed by a fever. In such cases, the child probably had an innocent febrile seizure. When the child receives immunizations, the parents should give acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) before a fever develops. Children who have a single seizure following an immunization can usually receive further immunizations.
Many childhood seizures are benign, meaning that they are brief events that will not continue into adulthood, and the child’s development and intellect are usually normal. Other seizures are serious and often are associated with developmental delay or intellectual disability and persistent seizures.
The outlook for seizures only partially depends on their cause. For example, two children may be infected with the same bacteria and both have meningitis, an infection of the membranes covering the brain and spinal cord. One child is left with severe epilepsy, but the other child never has a seizure. How can the different outcomes be explained? The bacterial infection in one child may have been more widespread, involving sensitive areas of the brain. Or the bacteria could have infected a vein in one child and caused a small stroke, which then caused the epilepsy. Or perhaps one child had a genetic (hereditary) tendency to have seizures, and the infection brought this trait to the surface.
All people are capable of having a seizure. It remains uncertain why some children have seizures after incidents such as head injury while most others do not. “Seizure threshold” refers to the conditions necessary for the production of a seizure. In animals, the seizure threshold can be precisely defined by observing their response to certain chemicals or electrical stimulation. In human beings, the term “seizure threshold” is used in a more abstract sense. In persons who have a tendency to have seizures, the threshold is lower than in people who have a greater resistance, or higher threshold, against seizures. Genetic, hormonal, sleep deprivation, and other factors can influence an individual’s seizure threshold.
Childhood Epilepsy: Causes
When a child is diagnosed with epilepsy, parents often ask, “Why did this occur?” They may wonder if their child’s epilepsy resulted from something they did or failed to do. They may also hope that identifying a cause will lead to a way to prevent future seizures.
Although cases of epilepsy in which cause remains unknown can often be managed effectively, determining a cause can sometimes point to a particular course of treatment. To determine the cause, or causes, of a child’s epilepsy, physicians rely, in part, on information from parents and other family members. Some of the content in this section may help with those conversations.
Cause Identification May Lead to Improved Care
Epilepsy is a neurological disorder in which events called seizures disrupt normal brain function. These sudden surges of abnormal electrical activity can have a wide range of effects. Depending upon which brain regions are involved, seizures may influence behavior, sensory perception, motor function, or all of the above. In fact, physicians can often determine the location and extent of abnormal brain activity based solely upon the seizure type and its observed clinical effects.
Accurate diagnosis of seizure type often provides clues about the underlying cause of an individual’s seizures. This information may be helpful in determining the risk of seizures recurring and worsening over time, and may also reveal an appropriate course of treatment.
One of the most difficult aspects of epilepsy diagnosis is that seizures are symptoms that can result from many different causes. Abnormal brain development and/or brain injuries, infection, inflammation, or specific gene mutations can all lead to seizures. Collectively, all cases of epilepsy that have a known cause are called symptomatic.
However, cause is not always easy to identify and remains unknown in 65 to 70 percent of epilepsy cases. These cases are called idiopathic.
Physicians use the term idiopathic to describe medical conditions for which there is no known cause. Despite marked advances in epilepsy research and clinical care in recent decades, idiopathic cases of epilepsy still make up the largest percentage (65 to 70 percent) of epilepsy diagnoses. This does not mean that such cases have no underlying cause, but rather that a cause cannot be determined. Often this is because a diagnostic test sensitive or specific enough to determine the cause does not yet exist.
Although determining the cause of seizures can serve an important role in diagnosis, prognosis, and treatment, it is not essential to finding effective treatments. In fact, idiopathic epilepsies can be successfully treated, and it is common for children with this diagnosis to grow out of their seizures entirely.
Even so, determining the cause of an individual’s seizures can be helpful in identifying an appropriate course of treatment. As described in the Diagnosis section, neurologists rely on eyewitness accounts of the seizures and electroencephalogram (EEG) analysis to determine seizure type, and neuroimaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI) to identify structural abnormalities in the brain. Also, physicians increasingly rely on genetic tests to determine the role that gene mutations might play in an individual’s seizures.
How epilepsy is diagnosed
Of the many known causes of epilepsy all fit into two broad categories: inherited and acquired.
Current research is revealing that many types of epilepsy have a genetic component. It has been recognized for some time that epilepsy tends to run in families, and it is now thought that up to 20 percent of childhood cases are inherited. Studies have found that the risk of epilepsy in siblings and children of individuals with the disorder ranges from 4 to 8 percent, compared to 1 to 2 percent in the general population. This increased risk does not imply that genes alone predetermine epilepsy but suggests that genes play an important role in some cases.
To date, researchers have linked more than 70 genes to disorders that can lead to epilepsy. Although the exact role many of these genes play is unknown, scientists believe that the alteration of any one of them increases an individual’s risk of developing epilepsy. Some researchers estimate that more than 500 genes may ultimately be linked to epilepsy.
Scientists have identified some epilepsy types that are caused by the mutation of a single gene. These relatively rare epilepsy syndromes are caused by mutations that result in abnormal protein function, leading to seizures. A few examples include:
- benign familial neonatal convulsions—a type of epilepsy that usually begins prior to the third day of life and typically goes into remission after two or three weeks
- generalized epilepsy with febrile seizures plus (GEFS+)—an epilepsy type that arises in childhood, with seizures occurring during episodes of fever, and then progresses to generalized seizures
- autosomal dominant nocturnal frontal lobe epilepsy—a seizure type that is caused by a mutation in one of three genes and produces shaking movements mostly during sleep
Learn about kinds of seizures
In addition to these epilepsy syndromes, a number of other genetic disorders with wide-ranging manifestations can also give rise to epilepsy. Some of these disorders are:
- tuberous sclerosis complex—a disorder that can affect most major organs, including the brain, and causes seizures in approximately 80 percent of patients
- Sturge-Weber syndrome—a disorder characterized by a port wine birthmark on one side of the face, glaucoma, and seizures
- Aicardi syndrome—a rare disorder characterized by eye abnormalities, infantile spasms, and the partial or complete absence of the corpus callosum, the structure that links the two hemispheres of the brain
- Angelman syndrome—a disorder characterized by seizures, ataxia, language problems, and cognitive impairment
Although some of the disorders described above are uncommon, the identification of gene or chromosome abnormalities associated with many of them has enabled physicians to use relatively simple genetic tests and diagnostic criteria to diagnose patients and family members suspected of having a given disorder. Having identified some of the genes associated with these epilepsy syndromes, scientists can apply this knowledge in their search for similar genes involved in other types of epilepsy.
The search for genetic causes of epilepsy has not been straightforward. Even in cases where genes have been linked to specific types of epilepsy, they may only be part of the explanation. Researchers believe that the most common types of epilepsy are almost certainly caused or influenced by more than one gene, as well as by a number of environmental factors. Researchers hope that identifying the genetic causes of epilepsy may one day lead to better treatments and potentially a cure for some types of the disorder.
In addition to the role gene mutations play in causing epilepsy, it is also thought that genes may influence the effectiveness of treatment options for some people. A recent study demonstrated that many people with epilepsy have an abnormally active version of a gene that increases their resistance to drugs. This may explain why some individuals develop intractable or refractory epilepsy.
Some of the most common non-idiopathic causes of seizures in children are acquired, as opposed to being present at birth or developing as the result of genetic abnormalities. Acquired causes include, for example, lack of oxygen (hypoxia), head injuries, and infections of the central nervous system. Brain tumors and degenerative disorders are not as common in children as they are in older adults, but in rare cases they can also cause childhood epilepsy. Whatever the cause, it is important, especially with regard to treatment and follow-up, to distinguish between factors and conditions that cause isolated seizures and those that cause the recurrent seizures characteristic of epilepsy.
Lack of Oxygen (Hypoxia)
An insufficient supply of oxygen to the brain can cause seizures. Brain cells are extremely sensitive to oxygen deprivation and begin to function abnormally or die just minutes after oxygen supply has been cut off. Drowning, choking, suffocation, cardiac arrest, head trauma, and complications during birth can all lead to hypoxia and seizures. Treatment depends on the underlying cause of the hypoxia but typically involves basic life-support procedures, including ventilation, medications to support blood pressure and heart rate, and medications to suppress seizures.
Seizures resulting from head injuries are uncommon among infants and children. Because the skull offers a great deal of protection, these incidents seldom result in brain injury and subsequent epilepsy. Studies suggest that head injuries resulting in hematomas, wherein blood collects in a mass on the surface of the brain, are more likely to result in seizures and epilepsy.
Infections of the Central Nervous System
Brain infections can cause seizures during acute stages of the infection. In some cases, infections cause injury to the brain significant enough to cause recurrent seizures. The most common central nervous system infections are encephalitis and meningitis. Encephalitis is a brain inflammation often caused by a viral infection. Meningitis is an inflammation or infection of membranes covering the brain or spinal cord.
Both cancerous and benign brain tumors and other lesions can cause seizures. Researchers are unsure exactly why such growths cause seizures. It may be that they are made up of abnormal cells that affect the neuronal network and cause abnormal neuronal firing.
Seizure Threshold, Neurons, and Cell Membranes
A seizure can potentially occur in any individual. However, the conditions that lead to seizures vary from one individual to another. For example, a fever of 104 degrees Fahrenheit that leads to seizures in one child may not have that effect on another child. This is because of variability from one person to another in what doctors call seizure threshold, defined as the minimal conditions required to produce a seizure.
Key elements in understanding seizure threshold, and therefore finding good treatments, are the neurons themselves—in particular, the membranes of these neurons. Research has shown that neuronal cell membranes play a critical role in epilepsy, as they regulate the flow of electrical impulses between neurons. For this reason, researchers are investigating details of the membrane structure, focusing on how molecules cross these membranes and how the cell nourishes and repairs this semi-permeable boundary. A disruption in either of these processes may lead to epilepsy.
Normal brain activity relies on communication between networks of neurons and other types of cells in the body. This communication takes place via electrochemical signals. In essence, chemical messages passed from one neuron to another either turn on or turn off electrical activity in the target neuron. More specifically, these chemicals, including neurotransmitters and ions, either stimulate or inhibit the target neuron to fire its own electrochemical signals. Thus, neurons do their work by exciting or inhibiting the activity of other neurons.
Normal brain function generally requires a balance between excitation and inhibition. A balance of these influences enables the brain to send coordinated messages along networks of neurons that control behavior, learning, primary senses, motor function, and other vital functions.
One of the most studied epilepsy-related neurotransmitters is an inhibitory neurotransmitter called GABA, or gamma-aminobutyric acid. Research has led to drugs that alter the amount of GABA in the brain or change how the brain responds to it. Researchers also are studying excitatory neurotransmitters, such as glutamate.
Some environmental and metabolic conditions can trigger seizures by effectively lowering seizure threshold. These conditions include fever, stress, sleep deprivation, and others. The lower an individual’s seizure threshold, the fewer the stimuli required to cause neurons in the brain to misfire.
Scientists think that many of the genes linked to epilepsy are involved in mechanisms that regulate the flow of electrical charges into and out of nerve cells, thereby affecting their electrical excitability and overall seizure threshold. A likely place for a gene mutation to affect neuron function in such a way as to cause epilepsy is at the level of the neurotransmitters, chemicals that act as messengers between nerve cells, as well as the ion channels that maintain the neuron’s firing threshold.
An understanding of these regulatory mechanisms in the brain and how they malfunction in people with epilepsy has led to the development of medications that can help restore electrochemical balance and greatly reduce or eliminate seizures.
About treatments for epilepsy
Seizures in children: Signs to look for and what to do
Approximately 4-5% of all children will experience a seizure at some point during their childhood. About 1% of children are diagnosed with epilepsy, and 1 in 26 people develop this neurological condition during their lifetime.
Given these statistics, Susan Arnold, M.D., Director of the Level 4 Epilepsy Center at Children’s Medical Center Dallas and Associate Professor at UT Southwestern, says it’s vital for everyone to know what steps to take if they see a person having a seizure.
“Seizures are common, and while a seizure may never happen to you or to a member of your family, it’s good for everybody to know what to do in case of a seizure,” Dr. Arnold says.
What causes seizures in children?
A seizure is an abnormal electrical discharge in the brain. There are many different types of seizures and many different reasons this can occur in a child. Not all seizures are caused by epilepsy. Other causes of seizures in children can include high fever (called febrile seizures), infection or traumatic head injury.
For other kids, when they get very upset and hold their breath, they have an event that looks like a seizure where they pass out or have some stiffening or shaking. This is not considered an epileptic seizure but rather a response to the child holding their breath.
Epileptic seizures occur when sudden electrical discharges in the brain happen without another cause provoking it. Anyone at any age can develop epilepsy, but young children and older adults are at greatest risk. People with epilepsy may identify triggers that increase chance of seizure. Common seizure triggers can include illness, not taking epilepsy medication, stress, flashing lights, certain times of day, dehydration or lack of sleep.
What does a seizure look like in a child?
A seizure can look like lots of different things in a child. The most commonly recognized signs of a seizure are when the body stiffens and shakes. These types of convulsive seizures (generalized tonic-clonic or “grand mal” seizures) can cause a person to fall and injure themselves, bite their tongue or lose control of the bladder or bowel.
Other seizures are not as obvious. Some children may have a seizure but only stare into space, blank out or not respond to a parent – these are sometimes called “absence” or petit mal (staring) seizures. Often when this happens, parents might think their child is not paying attention. This type of seizure can go undiagnosed for months or even years.
Depending on the type of seizure, a child can experience many different symptoms. Common signs of a seizure include:
- Blank staring
- Confused speech
- Loss of consciousness
- Uncontrollable shaking or jerking movements
What to do if a child has a seizure
Seizures can be frightening for a parent or loved one. But when a child has a seizure, it’s important to remain calm and to focus on keeping the child safe.
“The most important thing, and the hardest, is not to panic,” says Dr. Arnold. “Seizures can be scary to watch, but many times they will stop on their own, and seizures that stop in less than five minutes are not usually dangerous to the child.”
Follow the recommendations below to help your child through the seizure safely.
First aid for convulsive seizures
If your child has a convulsion (a seizure where they lose consciousness with stiffening and shaking), follow these steps for seizure first aid:
- Stay calm and stay with your child
- Turn your child on their side
- Make your child as comfortable as possible, cushion the head and remove glasses
- Loosen any tight clothing
- Do not ever put anything in your child’s mouth
- Do not try to “stop” the convulsions or restrain your child
- Pay attention to the length of the seizure – when the seizure started and stopped
- Call 911 for any seizure lasting more than 5 minutes, or if the child is injured during the seizure
First aid for absence seizures
When a child experiences an absence or staring seizure, the most important thing to do is to stay with the child to ensure they stay safe. Make sure they are fully conscious and aware before being left on their own.
If your child has an absence seizure, follow these steps for seizure first aid:
- Stay calm and stay with your child
- Time the seizure
- Don’t grab or hold your child
- Explain to others what is happening
- Protect child from any hazards
When to seek emergency help for seizures in children
Many seizures in children will resolve on their own, and in those cases, children often do not require emergency care. However, if your child is experiencing their first seizure, you must take them to the emergency room or to your doctor to determine why it happened.
Call for emergency medical assistance if the seizure:
- Lasts more than 5 minutes
- Is the child’s first seizure
- Causes an injury due to a fall
- Causes breathing difficulty
- Is convulsive and changes to a staring seizure and the parent isn’t sure if the child is still having a seizure
If your child does not return to full awareness, seek medical assistance or call 911.
Safety precautions for children who have seizures
The biggest risk to children who have seizures is where they occur. If a child is walking down the stairs or is in the bathroom and has a seizure, the child risks falling and hurting themselves.
“Most importantly, especially here in Texas in the summertime, if a child is in the water and has a seizure, they can fall under the water and drown,” says Dr. Arnold. “We tell parents to be very careful about watching kids anywhere around water, including lakes, pools, the bathtub or shower.”
Take these seizure precautions to ensure your child remains safe.
- Avoid tub baths; showers are safer than baths
- Make sure the bathroom door is not locked
- No swimming without constant adult supervision
- Wear a life jacket at all times when boating or on a jet ski
- No climbing higher than 10 feet including ladders, trees and bunk beds
- Wear a helmet at all times when bike riding and horseback riding
- For children with frequent seizures, avoid bike riding on streets
- No cooking over an open stove (use microwave instead) or using an iron
- Teenagers with uncontrolled seizures shouldn’t drive, including ATVs, mini-motor cycles, 4-wheelers
- Do not allow the handling of firearms
As a parent, it will be helpful to develop a plan and to share your plan with others to help keep your child safe during a seizure. Talk to your child’s school or anyone who may be in contact with your child about seizure first aid and safety.
About 4-5% of children will have a seizure at some point during childhood. @Childrens shares signs of a seizure and how to keep your child safe during a seizure.
Designated as a Level 4 Epilepsy Center by the National Association of Epilepsy Centers, Children’s Medical Center Dallas provides the highest level of treatment for the most complex cases of pediatric epilepsy, with additional advanced epilepsy treatment options available at our Level 3 Epilepsy Center in Plano. Learn more about our program and services.
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Epilepsy in childhood | Epilepsy Society
Information about the diagnosis and treatment of childhood epilepsy and how epilepsy may affect a child’s life.
In the UK, epilepsy affects around 60,000 children and young people under 18. Epilepsy can start at any age including childhood. Epilepsy can start at any age, including in childhood. If your child develops epilepsy you may have questions or concerns.
What is epilepsy?
Epilepsy is a neurological condition (affecting the brain and nervous system) where a person has a tendency to have seizures that start in the brain.
The brain is made up of millions of nerve cells that use electrical signals to control the body’s functions, senses and thoughts. If the signals are disrupted, the person may have an epileptic seizure.
Not all seizures are epileptic. Other conditions that can look like epilepsy include fainting (syncope) due to a drop in blood pressure, and febrile convulsions due to a sudden rise in body temperature when a young child is ill. These are not epileptic seizures because they are not caused by disrupted brain activity.
See more about what is epilepsy?
What happens during a seizure?
There are many different types of epileptic seizure. The type of epileptic seizure a child has depends on which area of their brain is affected.
There are two main types of seizure: focal seizures (previously called partial seizures) and generalised seizures. Focal seizures affect only one side of the brain and generalised seizures affect both sides of the brain. Generally, adults and children have the same types of seizure. However, some may be more common in childhood than adulthood (for example, absence seizures which can be very brief and are often mistaken for ‘daydreaming’ or not paying attention).
Different seizures include:
- jerking of the body
- repetitive movements
- unusual sensations such as a strange taste in the mouth or a strange smell, or a rising feeling in the stomach.
In some types of seizure, a child may be aware of what is happening. In other types, a child will be unconscious and have no memory of the seizure afterwards.
Some children may have seizures when they are sleeping (sometimes called ‘asleep’ or ‘nocturnal’ seizures). Seizures during sleep can affect sleep patterns and may leave a child feeling tired and confused the next day.
See more about seizures.
Why does my child have epilepsy?
Some children develop epilepsy as a result of their brain being injured in some way. This could be due to a severe head injury, difficulties at birth, or an infection which affects the brain such as meningitis. Epilepsy with a known structural cause like this is sometimes called symptomatic epilepsy.
Some researchers now believe that the chance of developing epilepsy is probably always genetic to some extent, in that anyone who starts having seizures has always had some level of genetic tendency to do so. This level can range from high to low and anywhere in between.
Even if seizures start after a brain injury or other structural change, this may be due to both the structural change and the person’s genetic tendency to have seizures combined. This makes sense if we consider that many people might have a similar brain injury but not all of them develop epilepsy afterwards.
See more about causes of epilepsy.
How is epilepsy diagnosed?
A diagnosis of epilepsy may be considered if your child has had more than one seizure. The GP will usually refer them to a paediatrician (a doctor who specialises in treating children). You (and your child if they can) may be asked to describe in detail what happened before, during and after the seizure.
Having a video recording of the seizure can help the paediatrician understand what is happening.
The paediatrician may also suggest a few tests to help with the diagnosis. The tests alone cannot confirm or rule out epilepsy, but they can give extra information to help find out why your child is having seizures.
See more about how epilepsy is diagnosed.
What is a childhood epilepsy syndrome?
If your child is diagnosed with a childhood epilepsy syndrome, this means their epilepsy has specific characteristics. These can include the type of seizure or seizures they have, the age when the seizures started and the specific results of an electroencephalogram (EEG).
An EEG test is painless, and it records the electrical activity of the brain.
Syndromes follow a particular pattern, which means that the paediatrician may be able to predict how your child’s condition will progress. Syndromes can vary greatly. Some are called ‘benign’ which means they usually have a good outcome and usually go away once the child reaches a certain age. Other syndromes are severe and difficult to treat. Some may include other disabilities and may affect a child’s development.
Treatment for children
Your child’s GP is normally responsible for their general medical care. The GP may refer your child to a paediatrician or paediatric neurologist (a children’s doctor who specialises in the brain and nervous system). An epilepsy specialist nurse may also be involved in their care.
Young people usually start to see a specialist in adult services (a neurologist) from around 16 years old.
Most people with epilepsy take anti-epileptic drugs (AEDs) to control their seizures. The paediatrician can discuss with you whether AEDs are the best option for your child. Although AEDs aim to stop seizures from happening, they do not stop seizures while they are happening, and they do not cure epilepsy.
Most children stop having seizures once they are on an AED that suits them. Like all drugs, AEDs can cause side effects for some children. Some side effects go away as the body gets used to the medication, or if the dose is adjusted. If you are concerned about your child taking AEDs you can talk to their paediatrician, epilepsy nurse, GP or pharmacist. Changing or stopping your child’s medication without first talking to the doctor can cause seizures to start again or make seizures worse.
Although AEDs work well for many children, this doesn’t happen for every child. If AEDs don’t help your child, their doctor may consider other ways to treat their epilepsy.
For some children who still have seizures even though they have tried AEDs, the ketogenic diet may help to reduce the number or severity of their seizures. The diet is a medical treatment, often started alongside AEDs and is supervised by trained medical specialists and dietitians.
It may be possible for some children to have epilepsy surgery depending on the type of epilepsy they have and where in the brain their seizures start. Epilepsy surgery involves removing a part of the brain to stop or reduce the number of seizures a child has.
Will epilepsy affect my child’s life?
You may not be able to predict how epilepsy will affect your child’s life. However helping your child to manage their seizures and be open about their feelings can make a positive difference. Help your child’s school understand their condition to ensure they get the most out of their school and education.
Triggers for seizures
Some children’s seizures happen in response to triggers such as stress, excitement, boredom, missed medication, or lack of sleep. Keeping a diary of their seizures can help to see if there are any patterns to when seizures happen. If you recognise triggers, avoiding them as far as possible may help to reduce the number of seizures your child has.
Getting enough sleep, and well-balanced meals, will help keep your child healthy and may help to reduce their seizures.
See more about triggers.
Some parents are nervous about immunisation, whether or not their child has epilepsy. The Department of Health recommends that every child is immunised against infectious diseases. This includes children who have epilepsy. If you are concerned about immunisations, your child’s GP or paediatrician can give you more information.
For some children, having epilepsy and taking AEDs will not affect their behaviour. However, some people may notice a change in their child’s mood or behaviour such as becoming irritable or withdrawn. Some children may be responding to how they feel about having epilepsy and how it affects them. They may also want to be treated the same as their siblings or friends and to feel that epilepsy isn’t holding them back. Encouraging your child to talk about their epilepsy may help them feel better.
Behaviour changes and problems can happen for all children regardless of having epilepsy and for many, may just be part of growing up. In a few children, irritable or hyperactive behaviour may be a side effect of AEDs. If you have concerns about changes in your child’s behaviour, you may want to talk to their doctor or epilepsy specialist nurse.
Most children with epilepsy can take part in the same activities as other children. Simple measures can help make activities such as swimming and cycling safer. For example, making sure there is someone with your child who knows how to help if a seizure happens.
See more about leisure and safety.
Can epilepsy change as children get older?
Seizures may change over time, either in type or frequency. Some children outgrow their epilepsy by their mid to late teens. This is called ‘spontaneous remission’. If they are taking AEDs and have been seizure-free for over two years, their doctor may suggest slowly stopping medication.
How might my child feel?
Having epilepsy can affect a child in different ways. Depending on their age and the type of seizures your child has, the impact may vary.
For some children having a diagnosis of epilepsy will not affect their day-to-day lives. For others it may be frightening or difficult to understand. They may feel embarrassed, isolated or different in front of their peers. Encouraging your child to talk about their concerns may help them to feel more positive.
Most children with epilepsy will have the same hopes and dreams as other children and seizures may not necessarily prevent them from reaching their goals.
See also Epilepsy in adolescence.
Your feelings as a parent
If your child is diagnosed with epilepsy you may have mixed emotions – for your child and for yourself. It can take time to come to terms with a diagnosis and how it may affect family life. You may feel worried or relieved. How you feel about the diagnosis may also change over time.
Our confidential helpline can offer you emotional support, information and time to talk through your feelings.
Joining one of our membership schemes provides you with a wealth of information and support to help manage epilepsy. And it helps forward our world-class research and medical services. Make a difference and join today.
Join one of our membership schemes
- Contact a Family – provides support groups, and information for parents and families of children with disabilities or medical conditions.
Epilepsy Society is grateful to Christine Bennett, Senior Children’s Epilepsy Nurse, for her guidance on this information.
Information updated: May 2021
Epilepsy in Children: Diagnosis & Treatment
Epilepsy is the most common childhood brain disorder in the United States – nearly 3 million Americans have this condition (450,000 of which are under age 17).
About two-thirds of all children with epilepsy outgrow their
seizures by the time they are teenagers. However, it is important for parents to help their child maintain a healthy lifestyle and ensure regular medical visits.
About Epilepsy & Seizures
Epilepsy is a brain disorder where a person has recurring seizures. The seizures are triggered by changes in the electrical and chemical activity in the brain. Seizures can be caused by anything that injures the brain, including head injuries, infections, poisoning or even brain development problems prior to birth. Often a cause for the seizures and epilepsy cannot be found.
There are many different
types of seizures. Some are very short, lasting only a few seconds, while others can last a few minutes. The type of seizure a person has depends on where the seizure occurs in the brain and how much of the brain is involved. A doctor will typically diagnose a child with epilepsy (also called a seizure disorder) if:
- The child has one or more seizures
- The doctor thinks the child is likely to have a seizure again
- The seizure was not directly caused by another medical condition, like diabetes or a severe infection
How is Epilepsy Diagnosed?
Making a diagnosis involves identifying a condition or disease based on signs and symptoms. An epilepsy diagnosis is generally made when seizures occur more than once without an identifiable reason, such as
Any child without a known diagnosis of epilepsy who experiences an unprovoked seizure needs immediate emergency medical attention and then have follow-up with her primary care pediatrician soon thereafter. If seizures reoccur, children should see a
pediatric neurologist, a specialist who manages seizures and epilepsy.
While every child’s diagnostic process will vary, the major steps in the process typically include:
Detailed medical history: May include questions regarding the mother’s pregnancy and delivery,
any relatives with epilepsy, and if the child had a high fever, serious head injury and/or periods of staring, inattention or breath-holding.
Detailed account of the seizure: The person(s) who were present at the time of the child’s seizure should communicate with the doctor.
Physical examination: Assessment of cardiac, neurological, and mental status.
Blood test: To identify potential causes and or other significant illnesses.
Computerized Axial Tomography (CAT) or CT Scan: Can be used to determine whether a seizure was caused by an acute neurological lesion or illness.
Electroencephalogram (EEG): Can be used to assess the risk of seizure recurrence and may help determine seizure type and epilepsy syndrome.
Magnetic Resonance Image (MRI): Preferred brain picture when evaluating children with new onset seizures or seizures that may have started in a particular part of the brain.
After the exam, tests, and a period of observation, a doctor determines whether a child has epilepsy.
If a child is diagnosed with epilepsy:
After a diagnosis of epilepsy is made, it is important for parents to work with the doctor to classify what type(s) of seizures the child is having, and what type of epilepsy the child has, and discuss treatment options. As seizures do not often happen in the doctor’s office, parents and caregivers must observe and track any unusual behavior and report it to their child’s doctor.
Doctors will assess whether a child’s symptoms and characteristics
(age, seizure frequency, family history, etc.) fit a certain kind of epilepsy syndrome or pattern. Classifying the epilepsy syndromes depends on the type of seizure, test results, the child’s behavior during the seizure, and the expectations for a child’s response to treatment.
Click here for a list of additional questions to ask the doctor to help take care of a child’s epilepsy.
How is Epilepsy Treated?
Treatment for epilepsy usually begins with medication. However, it is important to remember that epilepsy is a complex condition and every child is different. Not every child responds to treatment in the same way, so there is no one “right treatment.”
There are many seizure-prevention drugs, called anti-epilepsy drugs (AEDs) or anticonvulsant drugs, on the market and new ones in development. However, it sometimes takes a while to find the one that works best for each child.
These drugs do not change the brain’s underlying susceptibility to produce seizures. They only 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 has to be maintained. For this reason, it is especially important to follow the doctor’s specific medication instructions.
How long a child needs to take medication for epilepsy:
If a child does not have a seizure for a few years while taking medication, it may be possible to stop taking it. This is different for every child.
A child should never stop taking medication unless it is recommended and closely supervised by a doctor.
Risks for other medical issues:
Epilepsy can increase a child’s chance of having a mood or
Headaches, ulcers, and other physical conditions are also common. It is important for parents to know about possible “co-morbidities” and talk to their child’s doctor about any concerns.
Additional Information & Resources:
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
Seizures and Epilepsy in Children
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.
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.
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
For more detailed information on specific seizures
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
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.
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.
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
Absence seizure – Symptoms and causes
Absence seizures involve brief, sudden lapses of consciousness. They’re more common in children than in adults.
Someone having an absence seizure may look like he or she is staring blankly into space for a few seconds. Then, there is a quick return to a normal level of alertness. This type of seizure usually doesn’t lead to physical injury.
Absence seizures usually can be controlled with anti-seizure medications. Some children who have them also develop other seizures. Many children outgrow absence seizures in their teens.
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An indication of simple absence seizure is a vacant stare, which may be mistaken for a lapse in attention that lasts about 10 seconds, though it may last as long as 20 seconds, without any confusion, headache or drowsiness afterward. Signs and symptoms of absence seizures include:
- Sudden stop in motion without falling
- Lip smacking
- Eyelid flutters
- Chewing motions
- Finger rubbing
- Small movements of both hands
Afterward, there’s no memory of the incident. Some people have many episodes daily, which interfere with school or daily activities.
A child may have absence seizures for some time before an adult notices the seizures, because they’re so brief. A decline in a child’s learning ability may be the first sign of this disorder. Teachers may comment about a child’s inability to pay attention or that a child is often daydreaming.
When to see a doctor
Contact your doctor:
- The first time you notice a seizure
- If this is a new type of seizure
- If the seizures continue to occur despite taking anti-seizure medication
Contact 911 or emergency services in your area:
- If you observe prolonged automatic behaviors lasting minutes to hours — activities such as eating or moving without awareness — or prolonged confusion, possible symptoms of a condition called absence status epilepticus
- After any seizure lasting more than five minutes
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Many children appear to have a genetic predisposition to absence seizures.
In general, seizures are caused by abnormal electrical impulses from nerve cells (neurons) in the brain. The brain’s nerve cells normally send electrical and chemical signals across the synapses that connect them.
In people who have seizures, the brain’s usual electrical activity is altered. During an absence seizure, these electrical signals repeat themselves over and over in a three-second pattern.
People who have seizures may also have altered levels of the chemical messengers that help the nerve cells communicate with one another (neurotransmitters).
Certain factors are common to children who have absence seizures, including:
- Age. Absence seizures are more common in children between the ages of 4 and 14.
- Sex. Absence seizures are more common in girls.
- Family members who have seizures. Nearly half of children with absence seizures have a close relative who has seizures.
While most children outgrow absence seizures, some:
- Must take anti-seizure medications throughout life to prevent seizures
- Eventually have full convulsions, such as generalized tonic-clonic seizures
Other complications can include:
- Learning difficulties
- Behavior problems
- Social isolation
Feb. 24, 2021
90,000 Convulsive syndrome in children – causes of seizures, symptoms, prevention methods
Convulsive syndrome – a nonspecific reaction of the child’s body to external and internal stimuli, characterized by sudden attacks of involuntary muscle contractions. The smaller the child, the more convulsive readiness he has. This is due to the immaturity of some structures of the brain and nerve fibers, a high degree of permeability of the blood-brain barrier and a tendency to generalize any processes, as well as some other reasons.
All causes of seizures can be divided into epileptic (epilepsy) and non-epileptic.
- Encephalitis, meningitis, brain trauma and infections.
- Metabolic disorders, primarily potassium and calcium metabolism, for one reason or another.
- For newborns – hemolytic disease, congenital lesions of the nervous system, asphyxia.
- Various hormonal disorders.
- In acute infectious diseases, especially with a rise in temperature to febrile numbers.
- Intoxication and poisoning.
- Hereditary metabolic diseases.
- Pathology of the cardiovascular and hematopoietic systems.
- Tonic cramps (muscle spasm).
- Pose with the upper limbs bent at all joints, extended lower limbs and thrown back head.
- Breathing and pulse are slowed down. Contact with the outside world is lost or significantly weakened.
- Clonic convulsions (involuntary muscle twitching).
The diagnosis of convulsive syndrome in children is made on the basis of the clinic, which in most cases does not cause difficulties. After making this diagnosis, it is necessary to clarify the nature of the convulsive syndrome, for which the child’s life and illness history, X-ray examination of the skull, echoencephalography, electroencephalography, angiography and other methods can be used. Laboratory tests can be quite indicative.
Febrile seizures (at a high body temperature, above 38 C) usually stop with age. To prevent their recurrence, severe hyperthermia should not be allowed when an infectious disease occurs in a child. The risk of transformation of febrile seizures into epileptic seizures is 2-10%.
In other cases, the prevention of convulsive syndrome in children includes the prevention of perinatal fetal pathology, therapy of the underlying disease, supervision by pediatric specialists.If the convulsive syndrome in children does not disappear after the cessation of the underlying disease, it can be assumed that the child has developed epilepsy.
More about pediatric neurology at the YugMed clinic
90,000 Convulsions in children – diagnosis and treatment in the medical center “St. Andrew’s hospitals
Convulsions – a sudden disorder of the brain, manifested by various disorders of the motor, psychoemotional, sensitive and autonomic spheres. Convulsions can occur with loss of consciousness, as well as against the background of preserved or partially preserved consciousness.
Seizures in children can occur at any age, but it is generally accepted that up to two thirds of seizures occur in the first 3 years of life. Being a typical manifestation of epilepsy, seizures do not always indicate the presence of this disease in a child. Seizures are recorded in 5-10% of children, epilepsy is diagnosed in 0.5-1% of the population.
The causes of seizures in children can be:
- Perinatal disorders – birth trauma, previous hypoxia / cerebral ischemia, intracranial hemorrhage, intrauterine infections (intrauterine infection of the fetus with rubella, cytomegalovirus (CMV) viruses or the causative agent of toxoplasmosis).
- Infections – meningitis, encephalitis, brain abscess.
- Brain trauma – brain contusion, less often a concussion.
- Metabolic disorders – a decrease in the level of calcium, sodium, magnesium, blood sugar (respectively, hypocalcemia, hyponatremia, hypomagnesemia, hypoglycemia), an increase in the level of sodium in the blood (hypernatremia), renal failure.
- Increased body temperature (febrile convulsions)
- Neurological diseases – epilepsy, congenital malformations of the central nervous system, hereditary metabolic diseases (disorders of amino acid metabolism, mitochondrial diseases, glycogenosis, etc.)), phakomatosis (neurofibromatosis, tuberous sclerosis, etc.), brain tumors.
- Drug withdrawal syndrome – seizures in newborns born to mothers who use drugs.
The main clinical types of seizures in children:
- tonic (synchronous / asynchronous tension of the muscles of the trunk, limbs)
- clonic (synchronous / asynchronous rhythmic contractions of all muscles)
- tonic-clonic (combination of tonic and clonic seizures with a predominance of one or another component)
- myoclonic (repeated, often symmetrical contractions of individual muscles or muscle groups)
- atonic (sudden decrease in muscle tone)
- infantile spasms (short-term successive symmetrical flexion / extension contractions of the muscles of the neck, limbs and trunk)
- absences (sudden short-term cessation of motor and speech activity with “fading” of the gaze).
The volume of necessary examination of children with seizures is determined by the doctor individually, it depends on the nature, conditions of occurrence, frequency of seizures; general condition of the patient, features of his somatic and neurological status and may include EEG, if necessary, EEG video monitoring, CT or MRI of the brain, lumbar puncture, biochemical studies of blood, cerebrospinal fluid, urine, etc. establishing a diagnosis that allows you to form the correct approaches to the treatment of a child.
Convulsive episodes in newborns and young children are in most cases isolated and do not require further treatment. Recurrent seizures, most commonly associated with various types of epilepsy, require carefully selected and long-term anticonvulsant therapy under the supervision of a pediatric neurologist (epileptologist).
Convulsions in a child | Convulsions at a temperature in a child
Febrile seizures in children: causes, complications, treatment methods
Convulsions in a child – causes of
High fever (over 38 ° C) in children under 5 years of age can lead to serious complications. One of them is febrile seizures – characterized by muscle spasms, can lead to temporary loss of consciousness.
Convulsive syndrome is an individual feature of the central nervous system with an increased threshold of sensitivity. It occurs between the ages of six months and five years, often associated with a hereditary predisposition. Convulsions are often manifested in a child at temperatures above 38 ° C. If predisposing factors are absent, a convulsive state is not observed with an increase in temperature.
Convulsions at a temperature in a child – main varieties
The causes of febrile seizures are not fully understood. They can be triggered by acute viral infections, colds, overheating, and teething. One of the key factors is the underdevelopment of the children’s nervous system.
Convulsions at a temperature in a child are as follows:
- Tonic – there is a prolonged contraction of large muscles. There is a throwing back of the head, cramps in the legs of the child, twitching and straightening of the limbs. The muscles are constantly contracting, there is no relaxation period.
- Clonic – short-term contraction alternating with muscle relaxation. What cramps look like in children at high temperatures – arms, legs are bent, the body is arched.
- Tonic-clonic – both types appear.
It is worth paying particular attention to the following symptoms: frothing at the mouth, profuse salivation, frequent uncontrolled urination and stool.
Sleep cramps in a child are especially dangerous. Blocked airways may stop breathing. Sometimes spasms are accompanied by vomiting, there is a threat that the baby may drown.
How to determine seizures in a child at a temperature and how to treat them
When a child has a seizure – without a fever or with a fever – it is important for parents to remain calm. The main thing is to call an ambulance, and before her arrival, provide first aid. Remember: a convulsive state, on average, lasts no longer than half an hour, it is impossible to stop a seizure.
Before the arrival of the doctor, the following steps must be taken:
- Take off tight clothing, unbutton collar;
- put the child on a flat surface with his left side, turn his head to the side, fix;
- provide fresh air access, ventilate the room;
- in order to avoid biting the tongue, place a dense roller of a handkerchief between the teeth;
- watch your breathing – if the baby stops breathing, the muscles are tense, wait until the spasm stops and give artificial respiration;
- during a seizure, do not try to drink, give medications, after – antipyretic drugs are allowed;
- before the ambulance arrives, do not leave the baby alone.
What to do in case of seizures in a child – consult a neurologist MOC Fortis
To find out why a child has seizures – consult a neurologist. The febrile type may indicate disorders of the central nervous system, first of all, such serious diseases: tumors, epilepsy. For their timely detection, make an appointment with a pediatric neurologist at Fortis Medical Wellness Center. In order to make a diagnosis, the doctor will send you for examination, prescribe the optimal treatment.Make an appointment for a consultation by filling out the online appointment form or by calling the contact numbers. Check out the schedule of appointments with medical specialists in advance. It is convenient to clarify information on issues of interest by writing a message through the feedback form.
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90,000 Limb cramps – symptoms, causes, treatment, first aid, what to do in case of convulsions
Seizures are familiar to most people, an unpleasant sensation that is caused by involuntary muscle contraction. As a rule, it does not last long, but it brings a lot of negative emotions.
What are seizures?
This is a sharp muscle contraction that is beyond the control of a simple relaxing effort. The spasm is accompanied by pain, it can last from several seconds to ten minutes. With a strong muscle contraction, a large amount of decay products are released, this is the biological mechanism of convulsions.
What are the causes of seizures
This condition can occur in both sick and completely healthy people.Muscle contraction can be localized or generalized when entire muscle groups are affected. In children, such convulsions occur at high temperatures, and in adults, a similar condition is a sign of a serious illness of the nervous system.
Among the causes of seizures:
- Deficiency of certain vitamins and minerals, most often calcium or magnesium;
- Sedentary lifestyle or too intense stress;
- Pregnancy and related changes in the female body;
- Taking certain medications that remove potassium salts from the body;
- Various diseases, including diabetes mellitus, varicose veins, overweight and flat feet.
If you are worried about frequent cramps in the limbs, contact a specialist who will find out the cause of the unpleasant phenomena.
What to do with night cramps?
If a muscle has cramped, it will be impossible to consciously relax it. The only way is to use physical force: straighten the toes with your hands or pull the toe towards you. After the cramp has passed, the limb can be massaged to help restore normal circulation.
How to prevent seizures?
Prevention of seizures exists if you understand the risk of their occurrence and the cause that may lead to it. For example, with flat feet, it is important to choose the right shoes and use orthopedic insoles. With varicose veins – avoid excessive physical exertion. During pregnancy, observe the regimen and take the necessary vitamins. In any case, if you want to avoid night cramps, you need to adjust your diet to include foods rich in potassium, calcium and magnesium.Instead of sweets, give preference to dried apricots and dates.
Diagnosis of the cause of seizures
In case of an unpleasant condition, it is first of all recommended to contact a therapist who will prescribe a number of tests and carry out the necessary diagnostics. These are blood and urine tests, which will show the presence of concomitant pathologies, as well as ultrasound of the veins of the lower extremities. After the cause of the seizures is found, the patient is recommended to be examined by a specialized narrow specialist or to take vitamins and a diet that can help with a banal lack of trace elements.
Treatment of night cramps
Seizures can be a sign of the development of serious diseases, it is extremely important to diagnose them in a timely manner. Depending on the cause, appropriate treatment is also selected. In any case, you can reduce the risk of painful leg cramps by practicing a daily contrast shower. It is also important to change your diet. Include foods rich in potassium, calcium and magnesium, and reduce the amount of carbohydrates and fats that interfere with the absorption of beneficial micronutrients.
In most cases, frequent calf cramps will subside if you balance your diet and begin to engage in moderate physical activity.
You can consult about the causes of seizures and make an appointment with a specialist by calling our clinic or through the form on the website.
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90,000 Convulsive syndrome, useful articles of the medical clinic Neuro-Med
In children of the first year of life, convulsions are observed in various diseases of the nervous system.They can appear against the background of already existing neurological disorders and delayed psychomotor development, or they appear as the first symptom indicating brain damage. The clinical picture of convulsive syndrome depends on both the nature of the disease and the age of the child. In newborns, seizures often begin with local twitching of the facial muscles, eyes, then they spread to the arm, leg on the side of the same name and (or) move to the opposite. Clonic twitches can follow randomly from one part of the body to another.Such roads are called generalized fragmented, as they represent a fragment of generalized seizures [Rose A. L., Lambroso S. T. 1970; Lacy J. R., Penry J. K., 1976].
Newborns may also have focal clonic seizures affecting one half of the body. Sometimes they resemble Jacksonian ones or proceed in the form of adversive turns of the head, eyes, tonic abduction of the hands in the direction of turning the head (like ASHTR), opercular paroxysms (grimaces, sucking, chewing, smacking).The motor component of a seizure is often accompanied by vasomotor disorders in the form of pallor, cyanosis, facial redness, and salivation. Less common in newborns, myoclonic-type seizures are observed, which are characterized by single or frequent twitching of the upper or lower extremities with a tendency to bend them. They can also be manifested by general tremors with subsequent large-spreading tremors of the hands. Sometimes these convulsions are accompanied by screaming, vegetative-vascular disorders.In mild cases, the pathological movements that occur with seizures can be mistaken for spontaneous movements of the newborn and miss the true onset of the seizure syndrome. Metabolic disorders (hypoglycemia, hypocalcemia, hypomagnesemia, hyperbilirubinemia, pyridoxine dependence), abnormalities in brain development, hypoxia, intracranial birth trauma, and less often neuroinfections (meningitis, encephalitis) are often the cause of convulsive syndrome during the neonatal period. Some early manifested forms of hereditary metabolic disorders of amino acids (leucinosis, hypervalinemia, argininemia, histidinemia, isovalerian acidemia, phenylketonuria), carbohydrates (galactosemia, glycogenosis), lipids (Norman-Wood and Norman-Landing diseases, Gaucher disease), vitamins (methylmalonic aciduria Lee’s disease, hyperglycemia), occurring with the acute development of neurological symptoms after birth, are also accompanied by convulsive syndrome.In infants, in contrast to newborns, the motor component of the convulsive syndrome becomes more pronounced. In generalized seizures, a tendency towards alternation of tonic and clonic phases can already be noted, but it still remains weakly expressed in comparison with older children. The structure of the seizure is dominated by a tonic component, often convulsions (accompanied by vegetative symptoms (pain in vomiting, vomiting, fever). Involuntary urination is rare.After a seizure, the child is often agitated, but may be lethargic, drowsy. Partial convulsions in children of the first year of life are manifested by clonic twitching of the facial muscles, muscles of the tongue, distal extremities, turning the head and eyes to the side.
Convulsive syndrome can also proceed according to the type of absences, which are characterized by a short stop of gaze. Sometimes at the time of a seizure there are so-called motor automatisms in the form of sucking, chewing movements, smacking.The attack is often accompanied by vascular disorders and easy retraction towards the eyeballs. It should be noted that absences in infants are observed much less frequently than other types of seizures.
For infants, seizures of the myoclonic type (infantile spasms) are characteristic [Jeavons P. M Bower B. D., Dimitracoudi M., 1973]. In children over one year old, seizures are rare. Due to the fact that seizures of this type have a malignant course and cause severe retardation of psychomotor development, it is necessary to dwell on them in more detail.Small propulsive seizures occur in the form of bilateral symmetrical muscle contractions, resulting in sudden bending of the trunk and limbs (“salaam seizures”).
In case of extensor spasm, the head and trunk are sharply unbend, the arms and legs are abducted. Along with the classical clinical picture, there can be partial forms – general flinching, nodding, turning the head, flexion and extension of the arms and legs, sometimes predominant contraction of the muscles of one side of the body is observed. A feature of small seizures is their tendency to seriality.Their frequency per day ranges from single to several hundred and more. Loss of consciousness is short-term. Convulsions can be accompanied by a cry, a grimace of a smile, dilated pupils, nystagmus, rolling eyes, trembling of the eyelids, and vascular disorders. Convulsions occur more often before falling asleep or after waking up.
In infancy, the cause of convulsive sivdroids can be organic lesions of the nervous system as a result of pre- and perinatal pathology, hereditary metabolic diseases, phakomatosis, leukodystrophy, neuroinfection, post-vaccination complications.In the first year of life, febrile and affective-respiratory convulsions are also often observed.
Febrile convulsions occur in acute respiratory infections: flu, otitis media, pneumonia. These are usually typical generalized or localized tonic-clonic seizures occurring at the height of the fever. More often, febrile seizures are single, sometimes repeated for 1-2 days. The risk of recurrent febrile paroxysm increases with the early onset of the primary seizure, its recurrence and an unfavorable neurological background [Aicardi J.C., Chevrie J. J., 1977; Nelson K. B., Ellenberg J. H. 1978].
Affective-respiratory convulsions are more often observed in children with increased excitability at the age of 7-12 months. Convulsions, as a rule, follow a negative emotional reaction to severe sudden pain, fright. The child begins to scream loudly, then the breath is held on inhalation, the child turns blue, then turns pale, throws his head back, loses consciousness for a few seconds. In this case, muscle hypotonia or, conversely, tonic muscle tension is noted.Following this, as a result of brain hypoxia, a generalized tonic-clonic seizure may develop. If you switch the child’s attention until the moment of loss of consciousness, the development of paroxysm can be interrupted.
The diagnosis of convulsive syndrome in children of the first year of life, especially in newborns, presents certain difficulties. This is due to the atypical course, abortion and short duration of paroxysms. Sometimes the seizures are mistaken for the normal movements of the child and are diagnosed only when they become unfolded and the child loses consciousness.At the same time, seizures are sometimes referred to as pathological motor reactions of non-convulsive genesis (athetoid movements of the hands and forearms, spontaneous Moro reflex, asymmetric cervico-tonic reflex, contraction of individual facial muscles, grimacing, tongue tremor, sweeping arm movements such as hemibalism, hand tremor, etc. .). Sometimes “dystonic attacks” are taken for tonic convulsions, in which there is a sudden increase in muscle tone due to the influence of tonic cervical and labyrinthine reflexes.Unlike convulsive syndrome, with dystonic attacks, the child does not lose consciousness, and muscle tone can be reduced by giving the child a reflex-inhibiting position. In these cases, EEG changes characteristic of convulsive syndrome are not observed either.
When a convulsive syndrome appears in a newborn, a thorough biochemical study should be carried out: blood and urine for the content of calcium, potassium, sodium, phosphorus, glucose, pyridoxine, amino acids, a lumbar puncture should be done to exclude subarachnoid hemorrhage, purulent meningitis.If seizures first occur in infancy, then along with the above studies, an EEG is taken in order to identify paroxysmal brain activity. The EEG can detect various changes in the bioelectrical activity of the brain, depending on the nature of the seizures and changes in the nervous system in which they occurred. So, with infantile spasms on the EEG, changes are noted that are characteristic only for this type of seizure – hypsarrhythmia. Research such as craniography, diaphanoscopy, computed tomography, REG, angiography, also in some cases, can clarify the cause of the convulsive syndrome.
The effect of convulsive syndrome on developmental delay depends on the child’s age, the level of psychomotor development before the onset of seizures, the presence of other neurological disorders, the nature of convulsive seizures, their frequency and duration. The younger the child is at the onset of seizures, the more pronounced the delay in psychomotor development will be. If seizures occurred in a healthy child, were episodic and short-term, then they themselves may not have a significant effect on age-related development and not cause neurological disorders.These are, as a rule, single febrile and affective-respiratory convulsions. In all other cases, paroxysms, especially if they were prolonged and repeated, in turn can cause irreversible changes in the central nervous system. Convulsions that appear against the background of delayed psychomotor development and (or) other neurological disorders complicate the course of the underlying disease, aggravating the developmental delay. The child loses the acquired motor, mental and speech skills.
The nature of convulsive paroxysms also affects the delay in age-related development.The most unfavorable in this regard are infantile spasms, which primarily cause a deep retardation of mental development. According to J. R. Lacy and J. K. Penru (1976), mental retardation is observed in 75-93% of patients with infantile spasms. The formation of motor skills is also impaired or they are completely lost, depending on the age at which the convulsions began. Regardless of whether seizures appear in the midst of apparent well-being or against the background of an already existing developmental delay, their addition and the lack of effectiveness from the therapy lead to a loss of points on the age-related development scale, and the loss is steadily increasing.Initially, the scores decrease due to mental functions, and then to motor ones as a result of loss of skills, and not a violation of muscle tone or pathological tonic reflexes.
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The main content of the syndrome is increased neuropsychic exhaustion, which manifests itself in the weakness of the active attention function, emotional instability, impaired manipulative-game activity, in the predominance of either hyperdynamic or hypodynamic processes.Secondary lack of perception is also often observed due to increased mental exhaustion. Characterized by the dynamism, unevenness of the severity of clinical manifestations in the same child at different times. Clinical manifestations often intensify towards the end of the day due to unfavorable meteorological conditions and especially under the influence of various intercurrent diseases.
Features of delayed psychomotor development in this syndrome depend on the predominance of hypo- or hyperexcitability processes and are characterized by the same symptoms that were described in these syndromes.
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90,000 Causes of seizures in young children. First aid
Most often in children, this occurs due to high body temperature (39 degrees and above). Also, some infectious diseases, increased intracranial pressure, head injuries, and more can lead to them. In infants, convulsions are explained by an undeveloped central nervous system. Seizures are divided into epileptic and non-epileptic seizures.
Non-epileptic seizures can be caused by the toxic effects of certain viruses in infectious diseases.A seizure can occur in babies in the acute phase of acute respiratory viral infections or influenza with a strong fever. Also, seizures can occur with measles, rubella or chickenpox during a period of intense rash.
With inflammation of the brain with the development of its edema, convulsions occur in the form of tension in the whole body after a decrease in body temperature.
Basically, convulsions in infancy indicate birth trauma or asphyxiation of the child at the time of childbirth, or the presence of brain damage.
At the beginning of the seizures, the child’s head throws back when the arms and legs are convulsively stretched forward, the eyes roll, and the jaws clench tightly, the lips turn blue due to lack of oxygen. Consciousness is most often lost, and foam may appear on the lips. This process can cover both the entire body and some muscle groups, and can last from ten seconds to several minutes.
When a child has such an attack, you first need to relieve the baby of embarrassing clothes, put him on his side, trying to put a rolled handkerchief or a piece of cloth between his teeth in order to prevent biting the tongue.It is necessary to provide an influx of fresh air, so you must immediately open the window. In case of a convulsive seizure, the child should not be left unattended, even for a short time, and, of course, a medical team should be called as soon as possible.
Seizures can go one after one, you need to be prepared for this, and try to record the time of the onset of the seizures and their duration, which may be useful information for the physician. Also, the doctor may need information about what food or medications the child was taking shortly, whether the baby’s body temperature rose, and whether he recently had any diseases.
Treatment of convulsive seizures can only be prescribed by a doctor after establishing the cause that caused it. To establish an accurate diagnosis, the child may be prescribed some examinations.
Source – vseopomoschi.ru.
Author: Advertising INFPOL.RU
90,000 causes, symptoms and treatment in an article by neurologist Cologne O.L.
Date of publication April 2, 2020 Updated April 26, 2021
Definition of the disease. Causes of the disease
Febrile seizures are benign conditions in which, due to high body temperature (38 ° C and above), the electrical activity of neurons in the brain changes, leading to seizures.
The term “febrile seizures” was used in the past. However, over time, it was replaced by “febrile seizures”, since the concept of “seizures” is much broader and not all seizures are manifested by seizures  .
Febrile seizures are not associated with infectious lesions of the central nervous system (meningitis, encephalitis, etc.). It is one of the seizure conditions that does not require a diagnosis of epilepsy.
Such seizures usually occur in children of infancy, early and preschool age: from 6 months of life to 5 years, some sources indicate the age of up to 6 years  .In fact, febrile seizures can develop between the ages of 1 month and 8 years. Outwardly, the clinical picture looks difficult: the child loses consciousness, he has tonic (in the form of tension) and / or clonic (in the form of twitching) motor phenomena. Despite this, in general, this condition has a favorable prognosis.
Convulsions against the background of febrile fever in children occur quite often: in about one child in 30 under the age of 6 years. A second seizure occurs on average in one of three children  .The number of attacks increases in November-January and June-August, which is associated with the highest prevalence of respiratory and gastrointestinal infections, respectively  .
True febrile seizures should be distinguished from febrile-provoked seizures seen in some forms of epilepsy  . In our country, febrile seizures are in the competence of neurologists, but in most other countries of the world, similar conditions are included in the range of activities of pediatricians  .
In the USA and European countries, the average prevalence of febrile seizures among children is currently 2-4%   . In Russia, in recent years, such epidemiological studies have not been carried out, however, there is no reason to believe that the incidence of this pathology in the Russian Federation is somehow different from the average European.
Causes of occurrence
Febrile seizures are a multifactorial condition, i.e.many factors can contribute to their development. As a rule, their occurrence is characterized by a combination of a genetic predisposition and an infectious agent causing fever  . Febrile seizures are associated with a decrease in the seizure threshold and a tendency of the body to develop a high temperature in response to infection  .
Genetic predisposition is implied due to the prevalence of familial cases of febrile seizures.However, the exact type of inheritance has not yet been established  . Several genes have been found whose mutations can contribute to the development of febrile seizures, but in clinical practice these mutations are not detected due to their favorable prognosis  .
Genetic predisposition to febrile seizures depends on age. Before 5-6 months, seizures are rare, in 85% of children they occur before the age of four, with an average of 17-23 months. With the development of febrile seizures in children under 6 months, it is important to exclude neuroinfection in order to avoid diagnostic errors.
The cause of febrile seizures is fever – an increase in temperature to 38 ° C and above. It should be noted that a high temperature can be detected only after the end of the attack   .
An increased temperature can be triggered by any infectious disease. Up to 30% of cases of seizure in children in the first year of life are observed against the background of infections caused by the human herpes simplex virus type 6. In this case, there is a high probability that the virus enters the bloodstream and spreads throughout the body  .
Quite often, an increase in temperature to febrile values is not associated with an infectious process. Non-infectious causes include teething, the action of drugs or toxic substances, diseases of endocrine, psychogenic, reflex or central genesis  .
If you find similar symptoms, consult your doctor. Do not self-medicate – it is dangerous for your health!
Symptoms of febrile seizures
As a rule, seizures occur at the very beginning of a rise in temperature, and in 25-42% of cases they are the first symptom of the disease  .But sometimes febrile seizures develop within 24 hours after the onset of the fever.
Seizures are most often characterized by twitching and / or muscle tension on both sides.
The convulsions do not last long. A feature is the phase of atony (decreased muscle tone), which can be observed at the onset of a motor attack. Parents usually describe the onset of a febrile seizure as a gradual “collapse”, limp with loss of consciousness (like fainting). At the same time, the child is relaxed, does not react to what is happening around.Then the attachment of clonic twitchings or a versatile component (turning the head and / or trunk) is noted. Vomiting during an attack does not occur.
Other types of seizures are much less common, for example, tonic (in the form of tension) occur in 13% of cases. As a rule, these attacks are short-lived. Their duration depends on whether they are typical or atypical. Atonic seizures occur in only 3% of cases  .
Febrile seizures lasting 30 minutes or more are called febrile status.They differ from febrile attacks only in their duration.
Pathogenesis of febrile seizures
Due to a genetic predisposition, the immature membrane of neurons in the cerebral cortex is especially sensitive to the pathological effects of high temperature, which leads to disruption of the structure and functional properties of neurons  . Febrile seizures result from these disorders.
At the moment there is no clear description of the pathogenesis of febrile seizures.However, there are interesting observations related to proinflammatory cytokines. The cytokine interleukin-1 beta (IL-1β) in response to pathogenic factors causes an inflammatory reaction with fever in the body, and its natural antagonist (IL-1ra) suppresses this reaction by blocking IL-1β. Studies have shown a significant increase in the level of IL-1β in the hippocampus (part of the limbic system of the brain) and hypothalamus, while the level of IL-1ra did not change  .
According to another hypothesis, a genetic predisposition to seizures is a consequence of a violation of the metabolism of catecholamines (dopamine, norepinephrine, adrenaline) in the central nervous system.
Studies show that increased excretion of catecholamines in daily urine in children with febrile seizures is a consequence of ergotropic (sympatho-adrenal) hypertonicity. At the heart of this hypertonicity is a violation of the higher suprasegmental autonomic centers, and above all the structures of the limbicoreticular complex. Such a disorder may be genetically determined, or it may arise due to perinatal pathology  .
Classification and stages of development of febrile seizures
A simple (typical) febrile seizure is a single episode (no repetitions within 24 hours) lasting less than 10-15 minutes.The nature of such an attack is generalized, that is, the limbs and / or mimic muscles are involved symmetrically – both sides equally. Parents often describe this seizure as chills  . About 2/3 of all children who have been hospitalized for febrile seizures are diagnosed with a simple febrile seizure  .
Complicated or atypical is a febrile seizure that lasts more than 15 minutes and / or recurs within 24 hours and / or has a focal component  .The focal component refers to unilateral tonic tension or clonic twitching of the limbs and facial muscles on one side  .
In addition to simple and complex attacks, febrile status is also distinguished . These are epileptic seizures against a background of fever that last 30 minutes or more  .
According to the results of observations of hospitalized patients, in 16% of children the seizure is focal, seizures repetitions during the day are observed in 14%, prolonged seizures – in 9%  , febrile status is 5% of all febrile seizures.
Complications of febrile seizures
Simple febrile seizures do not affect the development and behavior of the child  . However, in rare cases, prolonged convulsions and febrile status may further lead to neurological deficits  . It flows differently for everyone. It is usually characterized by insufficient mobility of the limbs, inactivity of the whole body, disorders in the intellectual, sensitive and emotional spheres. There is a direct relationship between the intellectual development of children with febrile seizures and the total number of seizures suffered.Intellectual disabilities are more common in patients with atypical and / or complex febrile seizures  
In general, relapses occur with a probability of 30-40%, and in the case of a simple febrile seizure, the risk does not exceed 10%  . Only 9% of children have more than three episodes  .
The development of pharmacoresistant temporal lobe epilepsy , secondary to mesial temporal lobe sclerosis (characterized by loss of nerve cells and scarring of the deepest part of the temporal lobe), can be a consequence of prolonged seizures.The possibility of a patient developing focal temporal lobe seizures with febrile seizures has been discussed for a long time, since the causal relationship between these diseases has not been fully understood  .
Diagnosis of febrile seizures
In case of febrile seizures, the doctor should examine the child, understand the causes of the fever and indicate the scope of further examination  . The diagnosis of febrile seizures is exclusively clinical, i.e.established only on the basis of the clinical picture: in the presence of seizures against a background of high body temperature.
At the initial stage, it is necessary to exclude neuroinfection and other diseases that may begin with febrile seizures: Dravet’s syndrome, generalized epilepsy with febrile seizures plus (GEFS +). To do this, it is important to ask an eyewitness to the attack and conduct a complete somatic and neurological examination of the child.
During the examination, it is important to assess the level of consciousness, for this sometimes it is necessary to examine the child several times, since after an attack, deafness and drowsiness may remain.It is also necessary to assess the meningeal symptoms (stiff neck, Kernig’s, Brudzinski’s symptoms).
Lumbar puncture is prescribed only if meningeal symptoms are present. It involves inserting a needle into the subarachnoid space of the spinal cord in order to obtain cerebrospinal fluid. In other cases, febrile seizures are not punctured  .
Electroencephalography (EEG) is optional      .It is known that the deceleration of bioelectrical activity on the EEG can persist up to 72 hours after a febrile attack  . It is possible that in complex seizures, the prognostic value of the EEG is higher, but at the moment there are no unequivocal recommendations regarding the need for it  .
There is evidence that children with febrile seizures have a decrease in blood ferritin levels  . Ferritin is a protein that reflects the body’s iron stores.To identify it, you need to do a blood test for ferritin.
CT or MRI of the brain is not prescribed for patients with simple and complex seizures. Previous studies show that these methods show little or no change. Prolonged and focal seizures (especially repeated) can cause hippocampal edema and the development of its sclerosis in the future, but in such cases seizures occur without an increase in body temperature (epilepsy develops)  .That is, CT or MRI can be used when it comes to differential diagnosis.
Differential diagnosis of febrile seizures.
First of all, with febrile seizures, it is necessary to exclude neuroinfection. To do this, the doctor checks the meningeal signs (stiff neck, Kernig and Brudzinsky symptoms), if necessary, performs a lumbar puncture and performs neuroimaging (CT or MRI of the brain).
Some forms of epilepsy may debut with a febrile seizure: generalized epilepsy with febrile seizures plus, Dravet’s syndrome, hemiconvulsive seizure syndrome, hemiplegia and epilepsy (HEE).
However, more often in these diseases, seizures are atypical, and before the development of the entire clinic (the appearance of afebrile seizures, neurological deficit), such diagnoses cannot be made  .
Treatment of febrile seizures
When choosing treatment tactics, two important points should be considered:
- The first is positive: the overall risk of transformation of febrile seizures into epilepsy is no more than 10%  .
- The second is negative: with prolonged febrile seizures, there is an increased likelihood of repeated seizures, the development of epilepsy and severe brain damage.
In most cases, febrile seizures end on their own. If febrile seizures occur, it is recommended to record the time of the episode onset and then inform the doctor about its duration. It is necessary to lay the child on his side so that he does not choke on saliva, unbutton the clothes on the neck and chest. At the time of an attack, in no case should you open your mouth forcibly, put a spoon or other objects in your mouth. Many have heard about this method, but all modern doctors prohibit its use, since attempts to open the jaw can lead to injuries to the teeth and tongue.The use of any medication in the form of tablets or liquids is contraindicated, as the child cannot swallow during an attack.
Short febrile seizures do not require separate treatment. It is necessary to treat the underlying disease that caused the rise in body temperature  . In case of uncomplicated seizures and the possibility of adequate supervision (parental supervision), hospitalization is not required. In case of doubt, the child is hospitalized for 12 hours  .
Emergency care should be provided to patients with prolonged febrile seizure and febrile status.In such cases, the patient is usually hospitalized.
For prolonged or repeated seizures, a healthcare professional should provide oxygen. In addition, diazepam is injected intravenously at a dose of 0.5 mg per 1 kg of body weight at a maximum rate of 5 mg / min. This drug is used to relieve an attack. The therapeutic concentration in the child’s brain is achieved after 10 seconds of administration. If after 10 minutes the attack does not stop, diazepam is administered again at the same dosage  .
In the USA and Europe, there are benzodiazepine preparations, the administration of which does not require special medical training of the parent or the presence of a medical professional:
- rectal diazepam in the form of suppositories is placed in the rectum;
- Buccal solution is placed in the buccal region;
- Intranasal solution of midozolam in the form of drops is instilled into the nose.
However, such forms are not registered in the Russian Federation  .
Simple febrile seizures rarely transform into epilepsy. The risk of such an outcome is only 1.0-1.5% (in the general child population – 0.5-1.0%)  . The development of epilepsy in febrile seizures is possible in the presence of risk factors:
Mortality in febrile seizures is extremely low – even specific figures cannot be given  . To avoid negative consequences, parents need to know where to go in the event of a febrile attack and how to provide first aid.It is also important to remember that in most cases this condition is benign and goes away without any consequences  .
Preventive therapy for febrile seizures has long been a matter of debate. As a result, three main strategies were formed:
- long-term (constant) intake of antiepileptic drugs (AED) – for 2-5 years;
- intermittent (periodic) AED reception mode;
- Absence of any drug prevention of seizures (with the exception of taking antipyretic drugs)  .
Although the use of antiepileptic drugs as prophylaxis has been shown to reduce relapse rates by about one third, this is not recommended. The American Academy of Pediatric Practice has stated that the potential toxicity of antiepileptic drugs is higher than the relatively small risk associated with simple febrile seizures  . According to a systematic review conducted by the international non-profit organization Cochrane, neither continuous nor intermittent antiepileptic medication should be used as prophylaxis in children with febrile seizures  .
Although lowering the high temperature to normal or subfebrile values (37.1-38.0 ° C) does not guarantee the prevention of recurrent seizures, it is necessary to normalize body temperature in children who have previously had febrile seizures  . The use of antipyretics is considered to be preferred over the use of physical methods of cooling  . Therefore, children with seizures are shown the appointment of drugs with antipyretic activity  .
At the same time, no randomized controlled trials have shown a decrease in the risk of developing febrile seizures with targeted temperature reduction. Antipyretic drugs are prescribed mainly to alleviate the general condition of the child, and not to prevent febrile seizures   .