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Seizure disorder in child: Seizures and Epilepsy in Children


Seizures and Epilepsy in Children

What is epilepsy in children?

Epilepsy is a brain condition that causes a child to have seizures. It
is one of the most common disorders of the nervous system. It affects
children and adults of all races and ethnic backgrounds.

The brain consists of nerve cells that communicate with each other
through electrical activity. A seizure occurs when one or more parts of
the brain has a burst of abnormal electrical signals that interrupt
normal brain signals. Anything that interrupts the normal connections
between nerve cells in the brain can cause a seizure. This includes a
high fever, high or low blood sugar, alcohol or drug withdrawal, or a
brain concussion. But when a child has 2 or more seizures with no known
cause, this is diagnosed as epilepsy.

There are different types of seizures. The type of seizure depends on
which part and how much of the brain is affected and what happens
during the seizure. The 2 main categories of epileptic seizures are
focal (partial) seizure and generalized seizure.

Focal (partial) seizures

Focal seizures take place when abnormal electrical brain function
occurs in one or more areas of one side of the brain. Before a focal
seizure, your child may have an aura, or signs that a seizure is about
to occur. This is more common with a complex focal seizure. The most
common aura involves feelings, such as deja vu, impending doom, fear,
or euphoria. Or your child may have visual changes, hearing
abnormalities, or changes in sense of smell. The 2 types of focal
seizures are:

  • Simple focal seizure.
    The symptoms depend on which area of the brain is affected. If
    the abnormal electrical brain function is in the part of the
    brain involved with vision (occipital lobe), your child’s sight
    may be altered. More often, muscles are affected. The seizure
    activity is limited to an isolated muscle group. For example,
    it may only include the fingers, or larger muscles in the arms
    and legs. Your child may also have sweating, nausea, or become
    pale. Your child won’t lose consciousness in this type of

  • Complex focal seizure.
    This type of seizure often occurs in the area of the brain that
    controls emotion and memory function (temporal lobe). Your
    child will likely lose consciousness. This may not mean he or
    she will pass out. Your child may just stop being aware of
    what’s going on around him or her. Your child may look awake,
    but have a variety of unusual behaviors. These may range from
    gagging, lip smacking, running, screaming, crying, or laughing.
    Your child may be tired or sleepy after the seizure. This is
    called the postictal period.

Generalized seizure

A generalized seizure occurs in both sides of the brain. Your child
will lose consciousness and be tired after the seizure (postictal
state). Types of generalized seizures include:

  • Absence seizure


    This is also called petit mal seizure. This seizure causes a
    brief changed state of consciousness and staring. Your child
    will likely maintain posture. His or her mouth or face may
    twitch or eyes may blink rapidly. The seizure usually lasts no
    longer than 30 seconds. When the seizure is over, your child
    may not recall what just occurred. He or she may go on with
    activities as though nothing happened. These seizures may occur
    several times a day. This type of seizure is sometimes mistaken
    for a learning or behavioral problem. Absence seizures almost
    always start between ages 4 to 12.

  • Atonic seizure.
    This is also called a drop attack. With an atonic seizure, your
    child has a sudden loss of muscle tone and may fall from a
    standing position or suddenly drop his or her head. During the
    seizure, your child will be limp and unresponsive.

  • Generalized tonic-clonic seizure (GTC).
    This is also called grand mal seizure. The classic form of this
    kind of seizure has 5 distinct phases. Your child’s body, arms,
    and legs will flex (contract), extend (straighten out), and
    tremor (shake). This is followed by contraction and relaxation
    of the muscles (clonic period) and the postictal period. During
    the postictal period, your child may be sleepy. He or she may
    have problems with vision or speech, and may have a bad
    headache, fatigue, or body aches. Not all of these phases occur
    in everyone with this type of seizure.

  • Myoclonic seizure.
    This type of seizure causes quick movements or sudden jerking
    of a group of muscles. These seizures tend to occur in
    clusters. This means that they may occur several times a day,
    or for several days in a row.

What causes a seizure in a child?

A seizure can be caused by many things. These can include:

A seizure may be caused by a combination of these. In most cases, the
cause of a seizure can’t be found.

What are the symptoms of a seizure in a child?

Your child’s symptoms depend on the type of seizure. General symptoms
or warning signs of a seizure can include:

  • Staring

  • Jerking movements of the arms and legs

  • Stiffening of the body

  • Loss of consciousness

  • Breathing problems or stopping breathing

  • Loss of bowel or bladder control

  • Falling suddenly for no apparent reason, especially when
    associated with loss of consciousness

  • Not responding to noise or words for brief periods

  • Appearing confused or in a haze

  • Nodding head rhythmically, when associated with loss of
    awareness or consciousness

  • Periods of rapid eye blinking and staring

During the seizure, your child’s lips may become tinted blue and his or
her breathing may not be normal. After the seizure, your child may be
sleepy or confused.

The symptoms of a seizure may be like those of other health conditions.
Make sure your child sees his or her healthcare provider for a

How are seizures diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health
history. You’ll be asked about other factors that may have caused your
child’s seizure, such as:

Your child may also have:

  • A neurological exam

  • Blood tests to check for problems in blood sugar and other

  • Imaging tests of the brain, such as an



    CT scan

  • Electroencephalogram

    , to test the electrical activity in your child’s brain

  • Lumbar puncture (spinal tap)

    , to measure the pressure in the brain and spinal canal and
    test the cerebral spinal fluid for infection or other problems

How are seizures treated in a child?

The goal of treatment is to control, stop, or reduce how often seizures
occur. Treatment is most often done with medicine. Many types of
medicines used to treat seizures and epilepsy. Your child’s healthcare
provider will need to identify the type of seizure your child is
having. Medicines are selected based on the type of seizure, age of the
child, side effects, cost, and ease of use. Medicines used at home are
usually taken by mouth as capsules, tablets, sprinkles, or syrup. Some
medicines can be given into the rectum or in the nose. If your child is
in the hospital with seizures, medicine may be given by injection or
intravenously by vein (IV).

It is important to give your child medicine on time and as prescribed.
The dose may need to be adjusted for the best seizure control. All
medicines can have side effects. Talk with your child’s healthcare
provider about possible side effects. If your child has side effects,
talk to the healthcare provider. Do not stop giving medicine to your
child. This can cause more or worse seizures.

While your child is taking medicine, he or she may need tests to see
how well the medicine is working. You may have:

  • Blood tests.
    Your child may need blood tests often to check the level of
    medicine in his or her body. Based on this level, the
    healthcare provider may change the dose of medicine. Your child
    may also have blood tests to check the effects of the medicine
    on his or her other organs.

  • Urine tests.
    Your child’s urine may be tested to see how his or her body is
    reacting to the medicine.

  • Electroencephalogram (EEG).
    An EEG is a procedure that records the brain’s electrical
    activity. This is done by attaching electrodes to the scalp.
    This test is done to see how medicine is helping the electrical
    problems in your child’s brain.

Your child may not need medicine for life. Some children are taken off
medicine if they have had no seizures for 1 to 2 years. This will be
determined by your child’s healthcare provider.

Other treatments

If medicine doesn’t work well enough for your child to control seizures
or your child has problems with side effects, the healthcare provider
may advise other types of treatment. Your child may be treated with any
of the below:

Ketogenic diet

A ketogenic diet is a type of diet is very high in fat, and very low in
carbohydrates. Enough protein is included to help promote growth. The
diet causes the body to make ketones. These are chemicals made from the
breakdown of body fat. The brain and heart work normally with ketones
as an energy source. This special diet must be strictly followed. Too
many carbohydrates can stop ketosis. Researchers aren’t sure why the
diet works. But some children become seizure-free when put on the diet.
The diet doesn’t work for every child.

Vagus nerve stimulation (VNS)

This treatment sends small pulses of energy to the brain from one of
the vagus nerves. This is a pair of large nerves in the neck. If your
child is age 12 or older and has partial seizures that are not
controlled well with medicine, VNS may be an option. VNS is done by
surgically placing a small battery into the chest wall. Small wires are
then attached to the battery and placed under the skin and around one
of the vagus nerves. The battery is then programmed to send energy
impulses every few minutes to the brain. When your child feels a
seizure coming on, he or she may activate the impulses by holding a
small magnet over the battery. In many cases, this will help to stop
the seizure. VNS can have side effects such as hoarse voice, pain in
the throat, or change in voice.


Surgery may be done to remove the part of the brain where the seizures
are occurring. Or the surgery helps to stop the spread of the bad
electrical currents through the brain. Surgery may be an option if your
child’s seizures are hard to control and always start in one part of
the brain that doesn’t affect speech, memory, or vision. Surgery for
epilepsy seizures is very complex. It is done by a specialized surgical
team. Your child may be awake during the surgery. The brain itself does
not feel pain. If your child is awake and able to follow commands, the
surgeons are better able to check areas of his or her brain during the
procedure. Surgery is not an option for everyone with seizures.

How can I help my child live with epilepsy?

You can help your child with epilepsy manage his or her health. Make
sure to:

  • If age-appropriate, make sure your child understands the type
    of seizure he or she has, and the type of medicine that is

  • Know the dose, time, and side effects of all medicines. Give
    your child medicine exactly as directed.

  • Talk with your child’s healthcare provider before giving your
    child other medicines. Medicines for seizures can interact with
    many other medicines. This can cause the medicines to not work
    well, or cause side effects.

  • Help your child avoid anything that may trigger a seizure. Make
    sure your child gets enough sleep, as lack of sleep can trigger
    a seizure.

  • Make sure your child visits his or her healthcare provider
    regularly. Have your child tested as often as needed.

Keep in mind that your child may not need medicine for life. Talk with
the healthcare provider if your child has had no seizures for 1 to 2

If your child’s seizures are controlled well, you may not need many
restrictions on activities. Make sure your child wears a helmet for
sports such as skating, hockey, and bike riding. Make sure your child
has adult supervision while swimming.

When should I call my child’s healthcare provider?

Call the healthcare provider if:

Key points about epilepsy and seizures in children

  • A seizure occurs when one or more parts of the brain has a
    burst of abnormal electrical signals that interrupt normal

  • There are many types of seizures. Each can cause different
    kinds of symptoms. These range from slight body movements to
    loss of consciousness and convulsions.

  • Epilepsy is when a person has 2 or more seizures with no known

  • Epilepsy is treated with medicine. In some cases, it may be
    treated with VNS or surgery.

  • It’s important to avoid anything that triggers seizures. This
    includes lack of sleep.

Seizures in Children: Diagnosis, Causes, Signs, Treatments

What happens inside your child’s brain during a seizure? Here is a simplified explanation: Your brain is made up of billions of nerve cells called neurons, which communicate with one another through tiny electrical impulses. A seizure occurs when a large number of the cells send out an electrical charge at the same time. This abnormal and intense wave of electricity overwhelms the brain and results in a seizure, which can cause muscle spasms, a loss of consciousness, strange behavior, or other symptoms.

Anyone can have a seizure under certain circumstances. For instance, a fever, lack of oxygen, head trauma, or illness could bring on a seizure. People are diagnosed with epilepsy when they have seizures that occur more than once without such a specific cause. In most cases — about seven out of 10 — the cause of the seizures can’t be identified. This type of seizure is called “idiopathic” or “cryptogenic,” meaning that we don’t know what causes them. The problem may be with an uncontrolled firing of neurons in the brain that triggers a seizure.

Genetic research is teaching doctors more and more about what causes different types of seizures. Traditionally, seizures have been categorized according to how they look from the outside and what the EEG (electroencephalogram) pattern looks like. The research into the genetics of seizures is helping experts discover the particular ways different types of seizures occur. Eventually, this may lead to tailored treatments for each type of seizure that causes epilepsy.

Diagnosing a Seizure in a Child

Diagnosing a seizure can be tricky. Seizures are over so quickly that your doctor probably will never see your child having one. The first thing a doctor needs to do is rule out other conditions, such as nonepileptic seizures. These may resemble seizures, but are often caused by other factors such as drops in blood sugar or pressure, changes in heart rhythm, or emotional stress.

Your description of the seizure is important to help your doctor with the diagnosis. You should also consider bringing the entire family into the doctor’s office. The siblings of children with epilepsy, even very young kids, may notice things about the seizures that parents may not. Also, you may want to keep a video camera handy so that you can tape your child during a seizure. This may sound like an insensitive suggestion, but a video can help the doctor enormously in making an accurate diagnosis.


Some kinds of seizures, such as absence seizures, are especially difficult to catch because they may be mistaken for daydreaming.


“Nobody misses a grand mal (generalized tonic-clonic) seizure,” says William R. Turk, MD, chief of the Neurology Division at the Nemours Children’s Clinic in Jacksonville, Florida. “You can’t help but notice when a person falls to the ground, shakes, and sleeps for three hours.” But absence or staring seizures may go unnoticed for years.

Turk says you shouldn’t worry if your child gazes open-mouthed at cartoons on TV, or stares out the window in the car. Most kids who appear to be daydreaming really are just daydreaming. Instead, watch for spells that come at inappropriate times, such as when your child is in the middle of speaking or doing something, and suddenly stops.

Other kinds of seizures, such as simple or complex partial seizures, can be mistaken for different conditions, such as migraines, psychological illness, or even drug or alcohol intoxication. Medical tests are an important part of diagnosing seizures. Your child’s doctor will certainly do a physical exam and blood tests. The doctor may also order an EEG to check the electrical activity in the brain, or request a brain scan such as an MRI with a specific epilepsy protocol.

The Risks of Seizures in Children

Although they may look painful, seizures don’t really cause pain. But they may be frightening for children and the people around them. Simple partial seizures, in which a child may have a sudden, overwhelming sense of terror, are especially frightening. One of the problems with complex partial seizures, for instance, is that people have no control of their actions. They may wind up doing inappropriate or bizarre things that upset people around them. It’s also possible for children to injure themselves during a seizure if they fall to the ground or hit other things around them. But the seizures themselves are usually not harmful.

Experts don’t fully understand the long-term effects of seizures on the brain. In the past, most scientists thought that seizures did not cause any damage to the brain, attributing brain damage in an individual to an underlying illness. Now, however, some doubts are beginning to emerge.


Solomon L. Moshe, MD, director of Clinical Neurophysiology and Child Neurology at the Albert Einstein College of Medicine in New York, is researching the subject and remains cautious. “I don’t think it’s good to say one way or another whether seizures do long-term damage,” he says. “I think it all depends on the individual case.”

Moshe notes that the brains of children are very flexible. They are perhaps the least likely people with epilepsy to suffer any brain damage from a seizure.

Dangerous Seizures in Kids

Although the majority of seizures aren’t dangerous and don’t require immediate medical attention, one kind does. Status epilepticus is a life-threatening condition in which a person has a prolonged seizure or one seizure after another without regaining consciousness in between them. Status epilepticus is more common among people with epilepsy, but about one-third of the people who develop the condition have never had a seizure before. The risks of status epilepticus increase the longer the seizure goes on, which is why you should always get emergency medical help if a seizure lasts more than five minutes.

You may also hear about a condition called Sudden Unexplained Death, in which a person dies for no known reason. It can happen to anyone, but it’s more likely to happen in a person with epilepsy. The causes aren’t known, but parents of children with epilepsy should know that it’s a very rare occurrence. Controlling seizures, especially those that occur in sleep, is the most effective plan for helping to prevent this tragedy from occurring.

Neurology | Types of Seizures In Children

There are several different types of seizures in children. Pediatric seizures can be categorized as two broad types, focal and generalized:

Focal seizures

Pediatric focal seizures take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. Focal seizures may also be called partial seizures. With focal seizures, particularly with complex focal seizures, the child may experience an aura before the seizure occurs. An aura is a strange feeling, either consisting of visual changes, hearing abnormalities, or changes in the sense of smell. There are two sub-types of focal seizures to be aware of.

Simple focal seizures in children typically last less than one minute. The child may show different symptoms depending upon which area of the brain is involved. If the abnormal electrical brain function is in the occipital lobe (the back part of the brain that is involved with vision), the child’s sight may be altered. The child’s muscles are typically more commonly affected. The seizure activity is limited to an isolated muscle group, such as fingers or to larger muscles in the arms and legs. Consciousness is not lost in this type of seizure. The child may also experience sweating, nausea, or become pale.

Complex focal seizures in children commonly occur in the temporal lobe of the brain, the area of the brain that controls emotion and memory function. This seizure usually lasts between one to two minutes. Consciousness is usually lost during these seizures and a variety of behaviors can occur in the child. These behaviors may range from gagging, lip smacking, running, screaming, crying, and/or laughing. When the child regains consciousness, the child may complain of being tired or sleepy after the seizure. This is called the postictal period.

Generalized seizures

Generalized pediatric seizures involve both sides of the brain. There is loss of consciousness and a postictal state after the seizure occurs. There are multiple sub-types of generalized seizures, each common during different ages of adolescence and occurring with different symptoms.

Absence seizures

Pediatric absence seizures (also called petit mal seizures) are characterized by a brief altered state of consciousness and staring episodes. Typically the child’s posture is maintained during the seizure. The mouth or face may move or the eyes may blink. The seizure usually lasts no longer than 30 seconds. When the seizure is over, the child may not recall what just occurred and may go on with his/her activities, acting as though nothing happened. These seizures may occur several times a day. This type of seizure is sometimes mistaken for a learning problem or behavioral problem. Absence seizures almost always start between ages 4 to 12 years.

Atonic Seizures

With atonic seizures in children (also called drop attacks) there is a sudden loss of muscle tone and the child may fall from a standing position or suddenly drop his/her head. During the seizure, the child is limp and unresponsive.

Generalized tonic-clonic seizures

This seizure (GTC or also called grand mal seizures) is characterized by five distinct phases that occur in the child. The body, arms, and legs will flex (contract), extend (straighten out), tremor (shake), a clonic period (contraction and relaxation of the muscles), followed by the postictal period. During the postictal period, the child may be sleepy, have problems with vision or speech, and may have a bad headache, fatigue, or body aches.

Myoclonic seizures

This type of seizure refers to quick movements or sudden jerking of a group of muscles. These seizures tend to occur in clusters, meaning that they may occur several times a day, or for several days in a row.

Infantile spasms

This rare type of seizure disorder occurs in infants from before six months of age. There is a high occurrence rate of this seizure when the child is awakening, or when they are trying to go to sleep. The infant usually has brief periods of movement of the neck, trunk, or legs that lasts for a few seconds. Infants may have hundreds of these seizures a day. This can be a serious problem, and can have long-term complications.

Febrile seizures

Pediatric febrile seizures are associated with fever. These seizures are more commonly seen in children between 6 months and 5 years of age and there may be a family history of this type of seizure. Febrile seizures that last less than 15 minutes are called “simple,” and typically do not have long-term neurological effects. Seizures lasting more than 15 minutes are called “complex” and there may be long-term neurological changes in the child.

Seizures in Children | Boston Children’s Hospital

What are the symptoms of a seizure?

A child may have a wide variety of symptoms depending on their type of seizures. Some seizures are easy to recognize through signs like shaking or temporarily losing consciousness. Other seizures are so mild that you might not even recognize them as seizures: They might involve only a visual hallucination, for example, or a moment of very strong emotions. In some cases, seizures have no outward signs at all.

Some signs that your child may be experiencing seizures include:

  • staring
  • tremors, convulsions, or jerking movements in the arms and legs
  • stiffening of the body
  • loss of consciousness
  • breathing problems
  • loss of bowel or bladder control
  • falling suddenly for no apparent reason
  • not responding to noise or words for short periods of time
  • appearing confused or in a haze
  • extreme sleepiness and irritability when waking up in the morning
  • head nodding
  • periods of rapid eye blinking and staring
  • vomiting
  • changes in vision, speech, or both

Sometimes these symptoms can have a cause other than seizures. Further testing will help doctors confirm suspected seizures or find another condition that is causing the symptoms.

Seizures don’t necessarily harm the brain, but some seizures do cause damage. The side effects of seizures, such as dramatic changes in behavior and personality, may remain even when your child isn’t actually having a seizure. In some cases, seizures are associated with long-term neurological conditions and problems with learning and behavior.

During the seizure itself, children may fall or get injured. It’s important to stay with your child during a seizure. Gently ease the child to the floor if sitting or standing, turn them on their side in case of vomiting and remove any surrounding hard objects. Seizures may leave your child exhausted. Unfortunately, just as troubling as the physical complications, seizures can also cause embarrassment and social isolation.

What are the different types of seizures?

Focal seizures

Focal seizures, formerly called partial seizures, happen when abnormal electrical activity has its onset in a particular area of the brain, known as the “seizure focus.” They can occur in any lobe of the brain. Before a focal seizure, your child may experience an aura — a strange feeling that involves changes in hearing, vision, or sense of smell.

Focal seizures may last less than a minute and have different symptoms depending on which area of the brain is involved. They usually affect the muscles, causing a variety of abnormal movements that are limited to one muscle group, such as the fingers or the larger muscles in the arms and legs. If the abnormal activity is in the brain’s occipital lobe, your child may experience changes in vision. Your child may experience sweating or nausea or become pale but will not lose consciousness.

Focal seizures may be associated with altered consciousness. Your child can experience a variety of behaviors, such as gagging, lip smacking, running, screaming, crying, or laughing. After the seizure, during what’s called the postictal period, your child may feel tired.

Generalized seizures

Generalized seizures involve both sides of the brain. Children lose consciousness and have a postictal period (a recovery phase) after the seizure. The types of generalized seizures include:

  • Absence seizures (also called petit mal seizures) involve episodes of staring and an altered state of consciousness. They usually last no longer than 30 seconds but can happen several times a day. Your child’s mouth or face may move, or eyes may blink. Afterward, your child may not recall the seizure and may act as if nothing happened. Absence seizures almost always start between ages 4 and 12 and are sometimes mistaken for a learning or behavioral problem.
  • Atonic seizures involve a sudden loss of muscle tone and may cause drop attacks: Your child may fall from a standing position or suddenly drop their head. During the seizure, your child is limp and unresponsive.
  • Tonic seizures involve a sudden stiffening of parts of the body or the entire body. Brief tonic seizures may also cause drop attacks.
  • Generalized tonic-clonic seizures (also called GTC or grand mal seizures) are characterized by five distinct phases:
  1. flexing of your child’s body, arms, and legs
  2. straightening out of their body
  3. tremors (shakes)
  4. contraction and relaxing of the muscles (the clonic period)
  5. a postictal period in which your child may be tired and sleepy, have problems with vision or speech, or have a bad headache or body aches

Myoclonic seizures

Myoclonic seizures involve sudden jerking in a group of muscles. These seizures tend to occur in clusters, happening several times a day or for several days in a row.

Infantile spasms

Infantile spasms are a rare type of seizure disorder that occurs in the first year of life. They usually involve brief periods of movement in the neck, trunk, or legs, often when a child is waking up or trying to go to sleep. They usually last only a few seconds, but infants may have hundreds of these seizures a day. This can be a serious problem and can be associated with long-term complications. Spasms may also occur throughout life and can also cause drop attacks.

Status epilepticus

Status epilepticus is a situation in which seizures develop into a prolonged seizure of 30 minutes or longer duration. This condition is a medical emergency and may require hospitalization.

Febrile seizures

Febrile seizures are triggered by fever and usually happen in children between 6 months and 5 years of age. They involve muscle contractions — either mild (such as stiffening of the limbs) or severe (convulsions). Febrile seizures are fairly common, affect about 2 to 5 percent of children in the U.S., and often run in families. Febrile seizures that last less than 15 minutes are called “simple”; those lasting longer are called “complex.”

What causes seizures in children?

Seizures can take a wide variety of forms, depending in part on what part of the brain has the abnormal electrical activity. Many different diseases and injuries can cause children to have seizures. These include:

  • head injuries
  • birth trauma
  • congenital conditions (conditions that your child is born with)
  • poisoning
  • fever or infection
  • brain tumors
  • maternal illness during pregnancy
  • heredity
  • degenerative brain disorders
  • stroke
  • metabolic problems and chemical imbalances in the body
  • alcohol or drugs
  • medications

Often, however, the exact cause of seizures cannot be determined.

How we care for seizures

Treatments for seizures have expanded greatly in recent years and include a variety of medications, specialized diets, or, in serious cases, a variety of brain surgeries. At Boston Children’s Hospital, we care for children who have epilepsy or who have experienced seizures through the Epilepsy Center, Fetal-Neonatal Neurology Program, and many other programs that are dedicated to caring for children with disorders that may cause seizures.

Our areas of innovation for seizures

Physicians and researchers at Boston Children’s Hospital are constantly looking for safer, more effective treatments to help children live seizure-free. We typically have several clinical trials going on at any time. Our doctors are:

  • searching for and testing new anti-seizure drugs
  • developing better methods for diagnosing and treating seizures
  • looking for ways to prevent other conditions from triggering seizures
  • evaluating new imaging techniques that help surgeons avoid damaging functional brain tissue

Seizures in Children – Children’s Health Issues

When a child has a convulsion, parents or other caregivers should do the following to try to protect the child from harm:

  • Lay the child down on one side.

  • Keep the child away from potential hazards (such as stairs or sharp objects).

  • Do not put anything in the child’s mouth and do not try to hold the child’s tongue.

After the seizure ends, parents or other caregivers should do the following:

  • Stay with the child until the child is fully awake.

  • Check whether the child is breathing and, if breathing is not apparent, start mouth-to-mouth rescue breathing (if the child is having convulsions, attempting rescue breathing is unnecessary and can injure the child or the rescuer) and alert emergency medical services.

  • Do not give any food, liquid, or drug by mouth until the child is fully awake.

  • Check for fever and, if present, treat it.

Fever can be lowered by giving the child acetaminophen by suppository placed in the rectum if the child is unconscious or too young to take drugs by mouth or by giving acetaminophen or ibuprofen by mouth if the child is conscious. Also, warm clothing should be removed.

An ambulance should be called if any of the following occur:

  • This is the child’s first seizure.

  • The seizure lasts more than 5 minutes.

  • The child is injured during the seizure or has difficulty breathing after the seizure.

  • Another seizure occurs immediately.

All children should be taken to the hospital emergency department the first time they have a seizure. For children who are already known to have a seizure disorder, parents should discuss in advance with the doctor when, where, and how urgently evaluation is required if another seizure occurs.

Doctors usually give drugs to end a seizure that lasts 5 minutes or more to prevent status epilepticus. Drugs to end seizures include the sedative lorazepam or the antiseizure drugs phenobarbital, fosphenytoin or levetiracetam by vein (intravenously). If a drug cannot be given intravenously, diazepam gel may be applied to the rectum, or midazolam liquid may be given into the nose (intranasally). Diazepam and midazolam are sedatives similar to lorazepam that can help stop seizures. Children who have received these drugs or with status epilepticus are carefully monitored for problems with breathing and blood pressure.

If children continue to have seizures after the cause is treated, they are given antiseizure drugs intravenously. They are then closely observed to check for possible side effects, such as slowed breathing.

If antiseizure drugs control the seizures, they may be stopped before children are discharged from the nursery or hospital. Whether antiseizure drugs are stopped depends on the cause of the seizures, their severity, and the results of the EEG.

Childhood epilepsy syndromes | Epilepsy Society

How childhood epilepsy syndromes are diagnosed, details of some specific syndromes and sources of further support.

What is a syndrome?

A syndrome is a group of signs or symptoms that happen together and help to identify a unique medical condition.

What is a ‘childhood epilepsy syndrome’?

If your child is diagnosed with an epilepsy syndrome, it means that their epilepsy has some specific signs and symptoms. These include:

An EEG test is painless and it records patterns of electrical activity in the brain. Some epilepsy syndromes have a particular pattern so the test can be helpful in finding the correct diagnosis. An epilepsy syndrome can only be diagnosed by looking at all the signs and symptoms together.

If your child is diagnosed with an epilepsy syndrome it may help the paediatrician (doctor who specialises in treating children) to plan their care. For example, choosing treatment options or deciding whether further tests are needed.

Different types of syndrome

Syndromes can vary greatly. Some are called ‘benign’ which means children become seizure-free (have no seizures) once they reach a certain age. Other syndromes are ‘severe’ and children have seizures which are difficult to control. Anti-epileptic drugs (AEDs) may be tried alone or in combination with each other and some non-drug treatments may also be tried, for example the ketogenic diet. Many children with severe epilepsy syndromes have additional difficulties with learning and behaviour and may need extra support.

Examples of childhood epilepsy syndromes

Benign rolandic epilepsy (BRE)

This syndrome affects 15% of children with epilepsy and can start at any time between the ages of 3 and 10.

Children may have very few seizures and most become seizure-free by the age of 16. They may have focal aware seizures, (previously called simple partial seizures) often at night, which begin with a tingling feeling in the mouth, gurgling or grunting noises and dribbling. Speech can be temporarily affected and symptoms may develop into a generalised tonic clonic seizure. AEDs may not be necessary but they can be helpful to control seizures.

Childhood absence epilepsy (CAE)

This syndrome starts between the ages of 4 and 10 and can affect up to 12% of children with epilepsy under 16. Absence seizures happen frequently and are very brief, lasting only a few seconds. Because of this they often go unnoticed.

During a seizure a child will become unconscious. They may look blank or stare and their eyelids may flutter. They may not respond to what is happening around them or be aware of what they are doing. Seizures respond well to medication. If a child is seizure-free for two years medication is sometimes reduced gradually. Up to 90% of children with CAE will grow out of seizures by the age of 12. Occasionally a child may also have other types of seizure.

Juvenile myoclonic epilepsy (JME)

This syndrome starts between the ages of 12 and 18. Many children have three different types of seizure:

  • myoclonic seizures (brief muscle jerks) in the upper body
  • tonic clonic seizures
  • absence seizures.

These often happen shortly as, or shortly after, the child or young person wakes up. Medication can be successful in controlling seizures, which often continue into adulthood and may become less severe.

Tiredness, stress and alcohol can trigger seizures. Up to 40% of children or young people with JME have seizures that are triggered by flashing or flickering lights (photosensitive epilepsy).

Infantile spasms (or West syndrome)

This syndrome often begins in the first year of life and can affect children who have had a previous brain injury before the age of 6 months. It is identified by brief spasms or jerks which happen in ‘clusters’. Spasms can affect the whole body or just the arms and legs. Each cluster can include between 10 – 100 individual spasms, which often happen when the child is waking up. Ongoing studies are looking at using AEDs and steroids to treat this syndrome, although around 25% of children have spasms that do not respond well to medication. Many children develop problems with learning or behaviour. Some may go on to develop Lennox-Gastaut syndrome.

Lennox-Gastaut syndrome (LGS)

This syndrome usually begins between the ages of 3 and 5, but can start as late as adolescence. Children may have several different types of seizure with this syndrome. These include tonic (where the muscles suddenly become stiff), atonic (where the muscles suddenly relax), myoclonic, tonic clonic and atypical absences. Atypical absences often last longer than normal absences and are different as a child may be responsive and aware of their surroundings.

Many children also develop learning difficulties as well as behaviour problems.

This syndrome can be very difficult to treat with AEDs, and most children need a combination of different drugs. Some non-drug treatments such as the ketogenic diet and vagus nerve stimulation therapy (VNS) can also be helpful. Seizures often continue into adult life.

Who can I talk to?

If your child has been diagnosed with a childhood epilepsy syndrome you may have concerns or questions. You can get information and advice from a paediatrician with an interest in epilepsy or a paediatric neurologist. Support may also be available through an epilepsy specialist nurse, counsellor, support group or helpline.

Some people find it helpful to talk to friends or family about their child’s epilepsy. You might find it helpful to speak to other parents. Support groups and online forums can be a useful way to share your experiences.

You can also talk to someone by calling our confidential helpline. Our helpline offers time to talk, emotional support and information on other support groups.

Further reading and support

Information produced: July 2017

Seizures and Epilepsy in Children

Treatment of a Seizure

Specific treatment for a seizure will be determined by your child’s doctor based on:

  • Your child’s age, overall health, and medical history

  • Extent of the condition

  • Type of seizure

  • Your child’s tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

The goal of seizure management is to control, stop, or decrease the frequency of the seizures without interfering with the child’s normal growth and development. The major goals of seizure management include the following:

  • Proper identification of the type of seizure

  • Using medication specific to the type of seizure

  • Using the least amount of medication to achieve adequate control

  • Maintaining good medicating levels

Treatment may include:

  • Medications
    There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, age of the child, side effects, the cost of the medication, and the adherence with the use of the medication.

    Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles, or syrup), but some can be given rectally (into the child’s rectum). If the child is in the hospital with seizures, medication by injection or intravenous (IV) may be used.

    It is important to give your child his/her medication on time and as prescribed by your child’s physician. Different people use up the medication in their body differently, so adjustments (schedule and dosage) may need to be made for good control of seizures.

    All medications can have side effects, although some children may not experience side effects. Discuss your child’s medication side effects with his/her physician.

    While your child is taking medications, different tests may be done to monitor the effectiveness of the medication. These tests may include the following:

    • Blood work – frequent blood draws testing is usually required to check the level of the medication in the body. Based on this level, the physician may increase or decrease the dose of the medication to achieve the desired level. This level is called the “therapeutic level” and is where the medication works most efficiently. Blood work may also be done to monitor the affects of medications on body organs.

    • Urine tests – these tests are performed to see how the child’s body is responding to the medication.

    • Electroencephalogram (EEG) – a procedure that records the brain’s continuous, electrical activity by means of electrodes attached to the scalp. This test is done to monitor how the medication is helping the electrical problems in the brain.

    • Ketogenic diet – Certain children who are having problems with medications, or whose seizures are not being well controlled, may be placed on a special diet called the ketogenic diet. This type of diet is low in carbohydrates and high in protein and fat.

What is a Ketogenic Diet?

The ketogenic diet is sometimes offered to those children who continue to have seizures while on seizure medication. When the medications do not work, a ketogenic diet may be considered. No one knows exactly how the diet works, but some children do become seizure-free when put on the diet. However, the diet does not work for everyone.

What does the Diet Consist of?

The ketogenic diet is very high in fat (about 90 percent of the calories come from fat). Protein is given in amounts to help promote growth. A very small amount of carbohydrate is included in the diet. This very high- fat, low- carbohydrate diet causes the body to make ketones. Ketones are made by the body from the breakdown of fat. They are made for energy when the body does not get enough carbohydrates for energy. If your child eats too many carbohydrates, then his/her body may not make ketones. The presence of ketones is important to the success of the diet.

High-fat foods:

  • Butter

  • Heavy cream

  • Oil

  • Mayonnaise

  • Cream cheese

  • Bacon

  • Cheese

High-carbohydrate foods:

  • Fruit and fruit juice

  • Breads and cereals

  • Vegetables (corn, peas, and potatoes)

  • Beans

  • Milk

  • Soda

  • Snack foods (chips, snack cakes, crackers)

  • Sweets

Your child’s doctor will determine if this diet is right for your child. When the ketogenic diet is started, your child will be admitted to the hospital. It may take four to five days in the hospital to get the diet started and for you to learn how to plan the diet.

While in the hospital, your child may not be able to eat for one to two days until ketones are measured in the urine. Once ketones are present in the urine, special high-fat, low-carbohydrate shakes may be started. These are sometimes called “keto shakes.” After several meals of keto shakes, your child will be started on solid foods.

You may also be taught how to check your child’s urine for ketones. The dietitian will help determine how much fat, protein, and carbohydrate your child is allowed to have, usually divided into three meals a day. The ketogenic diet can by very challenging to prepare and requires that all foods be weighed using a food scale. The ketogenic diet is not nutritionally balanced, therefore, vitamin and mineral supplements are needed.

Some medications and other products, such as toothpaste and mouthwash, contain carbohydrates. It is important to avoid these products if your child is on the ketogenic diet. Your child may not make ketones in their urine if too many carbohydrates are included in the diet. Your child’s doctor and dietitian can give you a list of medications, and other products, that are free of carbohydrates.

How Long is the Diet Used?

Children usually stay on the diet about two years. The diet is then slowly changed back to a regular diet.

Sample ketogenic meal

Sample ketogenic shake

60 g heavy cream

500 g Ross Carbohydrate-free Formula (concentrate)

21 g strawberries

270 g heavy cream

53 g eggs

13 g Egg Beaters

10 g cheddar cheese


10 g bacon


21 g butter


Additional Treatment Options:

  • Vagus nerve stimulation (VNS)
    Some children, whose seizures are not being well-controlled with seizure medications, may benefit from a procedure called vagus nerve stimulation (VNS). VNS is currently most commonly used for children over the age of 12 who have partial seizures that are not controlled by other methods.
    VNS attempts to control seizures by sending small pulses of energy to the brain from the vagus nerve, which is a large nerve in the neck. This is done by surgically placing a small battery into the chest wall. Small wires are then attached to the battery and placed under the skin and around the vagus nerve. The battery is then programmed to send energy impulses every few minutes to the brain. When the child feels a seizure coming on, he/she may activate the impulses by holding a small magnet over the battery. In many people, this will help to stop the seizure.

    There are some side of the effects that may occur with the use of VNS. These may include, but are not limited to, the following:

  • Surgery
    Another treatment option for seizures is surgery. Surgery may be considered in a child who:

    • Has seizures that are unable to be controlled with medications.

    • Has seizures that always start in one area of the brain.

    • Has a seizure in a part of the brain that can be removed without disrupting important behaviors such as speech, memory, or vision.

    Surgery for epilepsy and seizures is a very complicated surgery performed by a specialized surgical team. The operation may remove the part of the brain where the seizures are occurring, or, sometimes, the surgery helps to stop the spread of the bad electrical currents through the brain.

    A child may be awake during the surgery. The brain itself does not feel pain. With the child awake and able to follow commands, the surgeons are better able to make sure that important areas of the brain are not damaged.

    Surgery is not an option for everyone with seizures. Discuss this with your child’s doctor for more information.

FGBNU NTSPZ. ‹› Lectures on child psychiatry ››

Epilepsy refers to diseases of the brain that begin predominantly in childhood and adolescence. This has been repeatedly written by domestic and foreign psychiatrists and neuropathologists. This is confirmed by our observations.

The frequency of the onset of epilepsy in childhood can be explained by the increased convulsive readiness of the ontogenetically immature brain, especially the incomplete development of its higher parts (lack of cortical control over autonomic functions).Therefore, even minor irritants can cause seizures in a child. Increased convulsive reactivity in children is also explained by the biochemical characteristics of their body: lability of water-salt and calcium metabolism, increased hydrophilicity of tissues. The clinical picture of epilepsy is a complex complex of symptoms, in which mental changes are closely intertwined with neurological and somatic ones.

Manifestations of epileptic disease are expressed both in the form of individual seizures, and in a kind, more or less persistent psychopathological and neurological disorders observed in the post- and interictal period.

The central place in the clinical picture of epilepsy is occupied by epileptic paroxysms, manifested in various forms: a large convulsive seizure, small seizures, mental paroxysms. Each of these forms of epileptic seizures can appear in various forms.

The clinical manifestations of an epileptic seizure depend on: 1) the localization of pathogenic and epileptogenic foci, since different parts of the brain have different chemical structures and varying degrees of excitability; 2) the strength and intensity of the discharge of neurons; 3) the extensiveness of the excitation wave that develops after the nervous discharge.

With the localization of the starting point of epileptogenic excitation in the motor analyzer, the force of the nervous discharge is especially high. A low threshold of excitability is also characteristic of the temporal regions of the brain (mediobasal structures).

The types of epileptic paroxysms observed in patients of mature age and in children are presented in the classification adopted by the International League Against Epilepsy. In the USSR, they use the same classification, somewhat modified by P.M. Sarajishvili. In this classification, two large groups of epileptic seizures are distinguished: a) generalized and b) focal (focal).

In children and adolescents, as in patients of mature age, both generalized and focal epileptic seizures can be observed. Paroxysmal states are also manifested in children in a variety of motor, sensory, vegetative-visceral and psychopathological symptoms and syndromes.

Generalized seizures occur in patients of different ages, but the clinical manifestations of seizures change more or less sharply depending on the patient’s age – on the ontogenetic stage of brain development.In school-age children, paroxysmal states differ little from those observed in adults. In early and preschool age, the clinical picture of paroxysms has a number of features characteristic of this phase of development.

Generalized seizures include a large convulsive seizure, a minor seizure, myoclonic and akinetic seizures, and status epilepticus.

With a large seizure, involuntary tonic and clonic contractions of the muscles of the body and loss of consciousness occur.But in children of early and preschool age, the tonic phase predominates; clonic manifestations are rudimentary, and sometimes absent altogether. A seizure at this age is characterized by pronounced respiratory disorders and cyanosis. Often, in young children, generalized convulsions are not completely symmetrical – in the same patient, they cover the right or left half of the body. In infancy, convulsive seizures are sometimes expressed not in tonic convulsions, but in relaxation of the tone of the muscles of half of the body. Seizures are often atypical: one or the other phase of the seizure may be less pronounced.

A minor seizure, characterized by short-term loss of consciousness, is also observed in preschool children. They often have absences with motor automatisms and small seizures of the pycnoleptic type. The status of minor seizures is not uncommon.

Myoclonic seizures are common in school-aged children (14 to 18 years old). They manifest themselves in the startle of various muscle groups, sometimes occur with loss of consciousness, often in series.

With akinetic seizures, muscle tone is quickly lost (the patient falls, but immediately gets up).

Children of early and preschool age also develop special atypical forms of minor seizures, which do not occur in older children and adults. These clinical forms are described by foreign (Yants and Matesidr.) And domestic authors (S. S. Mnukhin, G. B. Abramovich, I. S. Tets, R. A. Kharitonov, R. V. Ivanova, etc.). Among these seizures are distinguished: a) propulsive, b) impulsive, c) retropulsive.Such seizures occur without an aura, last only a few seconds, and usually proceed in series. In the pathogenesis of these forms, anoxemic conditions in the brain, caused by prenatal or early postnatal harm, occupy a large place. Such a pathogenetic basis of an attack is especially characteristic of propulsive seizures, often developing on the basis of early organic brain damage.

Propulsive seizures occur in children aged 2 months to 4 years and are expressed in a sharp jerk of the muscles and the body’s urge forward.The clinical manifestations of propulsive seizures depend on the age phase of the child’s development: maturation of motor systems and statics. In 2-3-month-old children Propulsive seizures are manifested in a rapid tilt of the head forward – “nodding”; at 6 months, they are already replaced by tilts of the head and trunk, and in the future they can be expressed in forward movements of the entire body.

The worst prognostic type is the type of seizure called “salaam seizures.” The seizures are stereotyped: the patient tilts his head and torso forward, raises his arms up and to the sides.

The group of propulsive seizures includes myoclonic seizures with general flinching; the head leans forward, the arms are thrown apart in a ring-like manner. Sometimes there is a rapid loss of muscle tone and the fall of the patient (akinetic, astatic seizures).

Retropulsive seizures begin in children aged 5–8 years. They are characterized by backward movements of the head and trunk. In terms of clinical manifestations, they are closer to the clinical form called “pycnolepsy”, but they differ in more pronounced movement disorders.Pyknolepsy is characterized by a high frequency of seizures (up to 50 per day) and a shorter-term loss of consciousness, accompanied by a rhythmically repetitive motor component – eye blinking and head tilting back. Despite the high frequency of seizures, the child does not have fatigue and weakness. Such attacks, sometimes lasting for several years, do not affect the patient’s performance and do not cause mental degradation.

Some authors consider pycnolepsy to be one of the forms of epilepsy, others – an independent disease.To resolve this issue, follow-up information is of great importance. According to Pasha, in a third of patients over time, attacks of pycnolepsy completely disappear, in another third they remain and in a third have large convulsive seizures.

As our clinical observations have shown, pycnolepsy often develops in children of a special kind, with increased excitability, reactive lability and a tendency to hysterical reactions. These forms are usually favorable. But among the forms diagnosed as pycnolepsy, there is a certain part of cases when in the future the disease takes on a course characteristic of epilepsy.

Focal seizures in children are not uncommon, but the topic of the lesion and the localization of the epileptogenic focus in children is more difficult to determine than in adults, since with increased irradiation of epileptogenic excitation, focal seizures in children of preschool and primary school age quickly re-generalize.

Of the focal seizures, motor Jacksonian seizures should be noted, arising from irritation of the anterior central gyrus of one of the hemispheres. They are characterized by clonic convulsions of the right or left extremities and facial muscles.In adults, these seizures occur against a background of clear consciousness; in preschool children, they are relatively rare and often accompanied by loss of consciousness.

More often in children, simple adversive seizures are noted, characterized by a sharp turn of the head, eyes and trunk to the side opposite to the affected hemisphere. These paroxysms in children usually generalize into a large seizure.

Opercular seizures, accompanied by chewing, smacking, swallowing and drooling, are relatively common in school-age children; they often occur in preschool age.

Tonic postural seizures, which have an initial focus of irritation in the midbrain (or in the lower regions), can be observed in patients of different ages. But more often they develop at an early and preschool age.

Focal sensory seizures occur in older children and are characterized by different aura – sensitive, visual, auditory, olfactory. Preschoolers often have seizures with an abdominal aura: nausea, gastrointestinal disturbances, abdominal pain, and increased salivation.In older children, the aura in many cases is in the form of dizziness and other vestibular disorders. Sometimes sensory disorders take on the nature of derealization. To patients, everything seems changed, unfamiliar, or, on the contrary, they have a feeling that everything that happens has already been experienced at some point.

The most pronounced age-related differences in the clinical picture of “mental paroxysms” – dysphoria, twilight states, mental automatisms.

The features of dysphoric conditions in children with epilepsy were studied in our clinic by M.I. Lapides. He identified a number of features that distinguish dysphoria from other depressive states: the absence of psychomotor retardation, the predominance of elements of tension, aggression over melancholy, a frequent manifestation of mood disorders in somato-vegetative signs, sometimes – a slight disturbance of consciousness such as dullness, the phenomenon of derealization.

In preschool children, severe dysphoria is rare. They manifest themselves in attacks of unmotivated crying, aggressive actions, often in increased irritability, pugnaciousness.Parents complain that the child becomes stubborn for no reason, gets angry at everyone, accuses and suspects of something unkind, threatens to throw himself under a tram, etc. Such states usually last from several hours to 2-3 days. Euphoric states with excessive mobility are often observed, but in preschool children it is difficult to distinguish them from psychopathic states.

In school-age children, dysphoria is more clearly delineated and is characterized by a depressive-irritable and angry mood.

Vitya, 13 years old. Early development is correct. At the age of 3, convulsive seizures with loss of consciousness were noted 2 times, sometimes night fears arose: he jumped up, screamed, his face expressed fright, then fell asleep. In the morning I didn’t remember anything. In the future, seizures and fears did not recur. The boy was disciplined, obedient. Studied well. At the age of 10, mood disorders appeared, proceeding with emotional tension, pronounced aggression: rushing around the room, tore at his clothes.These episodes of mood disorder lasted for several hours.

The examination revealed an athletic physique, slow, awkward movements, increased vasomotor reactions. Intellectually correct. Only slowness of thinking, insufficient vocabulary, narrowed circle of interests are noted. Extremely stenic, stubborn, persistent. The general background of the mood was calm, but periodically there were states when a headache appeared, melancholy, from which the patient did not know what to do with himself, everything that was happening seemed to him a fog, irritation and anger appeared.At such moments, the patient is tense, dissatisfied with everything, yells at the staff. Then he asks for forgiveness, assures that he could not restrain himself and does not remember much.

Mental paroxysms often manifest themselves in the form of twilight states. In terms of clinical manifestations, twilight states are very diverse, but they have in common: a) the presence of an altered consciousness; b) the suddenness of the beginning and end; c) subsequent amnesia, sometimes incomplete. It is characteristic that in the presence of disorientation in the environment, the actions of the patients are nevertheless interrelated and give the impression of being ordered.But, despite the outwardly ordered nature of actions, the patient performs them unaccountably, therefore his actions can be dangerous for him and those around him.

It is important to note that the structure of the twilight state in patients with epilepsy does not correspond to the content accepted in general psychopathology. As you know, twilight states include disorders of consciousness, characterized by a narrowing of the volume of consciousness, while epileptic twilight states often develop against the background of a dreamy or delirious clouding of consciousness, sometimes deep stunnedness.

The vagueness of the definition of twilight states has long been noted both by Soviet psychiatrists (A.A. Perelman, S.F. Semenov, M.I. Gurevich, V.A. etc.). Depending on the type of clouding of consciousness, various clinical forms of crepuscular states were identified: dreaming, oneiroid forms, delirious, stupor with stupor, crepuscular states with affective-delusional disorders and manic excitement.

In the clinical manifestations of twilight states, mood changes are also often noted: melancholy or an elevated ecstatic state, sometimes hallucinations and delusional ideas.But unlike the twilight states observed in adult patients, psychopathological manifestations in children are more elementary and monotonous.

In our clinic, twilight states in children with epilepsy were studied by K.A. Novlyanskaya. Taking into account the close connection of twilight states with a convulsive seizure, the author singled out pre-epileptic and post-seizure twilight states. The former more often occurred in preschool children and manifested themselves in unaccountable fear, accompanied by pathological sensations, often with abdominal pain.The child runs in fear, screams, seeks help. Such states last for several minutes, then a convulsive seizure begins. The child does not remember the state of fear.

In early school age, twilight states also manifest themselves in the affect of fear, most often as nighttime fears and sleepwalking.

So, Tanya, 10 years old, from 3 years old suffering from large convulsive seizures, at 8 years old had night fears. At the moment of falling asleep, the girl jumped out of bed with an expression of horror, protected her head with her hands, jumped over the headboard, fell to the floor, covering her face with her hands.In a few minutes the attack ended. She got up with tears in her eyes, went to bed in silence. Sometimes she jumped up again, rushed forward swiftly, not seeing obstacles, waved her hands away, as if defending herself, and suddenly stopped on the run.

In older school age, sensory disorders often predominate in the clinical manifestations of the twilight state: objects seem to have changed (large, small), a familiar environment is perceived as being seen for the first time. Symptoms of depersonalization are not uncommon: disturbances in the body scheme with a sense of alienation.For example, 11-year-old Volodya, in a pre-depressive state, felt that his head was coming off his neck and rolling in front of him.

In twilight states, there are often frightening and very vivid visual hallucinations. A 12-year-old boy saw a pensive old man with a beard and a black shawl. He stared at close range, as if foreshadowing something.

Twilight states are also manifested in psychic automatisms.

Vanya, 10 years old, suddenly starts to fuss at the table, grabs objects and then stops talking.Such conditions are repeated periodically, often accompanied by twitching of the facial muscles.

Kolya, 14 years old, suddenly grabbed an inkwell at school and wanted to drink ink. After the attack, I did not remember this. Later, these states were repeated in him in the same form. Large seizures did not develop until 2 years later.

At these moments, patients are completely inaccessible to external influences.

Parents and teachers often regard these manifestations not as painful disorders, but as a prank.Doctors often have diagnostic errors. But the sudden onset and end of an attack, the uniformity of these states, the presence of altered consciousness, amnesia – all this makes it possible to correctly assess conditions such as epileptic seizures.

Fugues are one of the forms of mental paroxysms in epilepsy. In a state of dim consciousness, children suddenly run away from home, wander about.

A clinical example is the case history of 10-year-old Seryozha.

At the age of 3, the boy began seizures with loss of consciousness and subsequent sleep. At the age of 7, they were replaced by small seizures. From that time on, the child became rude and whiny. Academic performance has declined in the last year. He suddenly began to leave home for 2-3 days. He returned thinner, did not remember where he was. Sometimes he was brought in by police officers. He was often found sleeping on a tram. There were no psychogenic motives for this.

There are no signs of organic damage to the nervous system. Intellect is not impaired, but thinking is slow. He says reluctantly about leaving home, that “he himself did not want it.”Only isolated memories of this period were preserved.

Post-seizure twilight states are relatively more common, occur with more complex psychopathological manifestations and against the background of a deeper disorder of consciousness. They usually occur after a series of seizures, usually after large seizures.

In the post-attack state, against the background of deep stunnedness, chaotic motor excitement with aggression and great emotional tension often occurs, and often, on the contrary, stupor is noted.In the post-seizure twilight state, hallucinatory and delusional disorders are more often observed: ideas of persecution, poisoning, refusal to eat. After the end of the twilight state, memories of this are not preserved. Sometimes, after a long twilight state, residual delirium remains, which often takes on the character of delusional fantasies in children and adolescents.

Galya is 13 years old, during a twilight post-attack state that lasted 2 days, it seemed that some stranger came to their apartment and left bottles of medicine.The patient could smell them. At the end of the twilight state, for 2 months, she was convinced that all this really happened, she showed where the bottle stood and the medicine was spilled.

Post-attack twilight states often take a protracted course.

Epileptic psychoses occurring outside of twilight states are rare in children, since they usually occur in the later stages of a difficult disease process.

So, G.B. Abramovich observed conditions, which he qualified as epileptic psychoses, only in 29 out of 1077 children with epilepsy.

MI Lapides studied psychosis in children with epilepsy in our clinic. He divided psychotic states into three groups: 1) dysphoric psychoses; 2) psychotic manifestations against the background of twilight states; 3) delusional disorders.

Among dysphoric psychoses, the following were observed: a) states with low mood, anxiety and suspicion, ideas of attitude, persecution, damage, and sometimes auditory hallucinations; b) a circular form of “epileptic insanity” with depressive-melancholic and hypomanic phases; c) in patients with a low intellectual level – mori-like states, characterized by euphoria, a desire for witticisms, gross uncriticality, reaching the point of absurdity.

As mentioned above, psychotic states that arose against the background of twilight states of consciousness were very diverse. There were states of confusion with psychomotor agitation, delirious and paranoid-hallucinatory pictures, psychopathic states with cruelty and aggressive actions.

Delusional disorders manifested themselves in the form of epileptic paranoid and delusional fantasies. Children between the ages of 7 and 10 developed mainly delusional fantasies.Clinical manifestations characteristic of schizophrenia were noted in 3 patients with a long course of the disease process in the late stage. The patients became less contact, did not answer questions, and refused to eat. Some of them also had catatonic manifestations. In all these cases, there were indications of schizophrenia in relatives in heredity.

From the above data, it can be concluded that the clinical manifestations of epilepsy in children are very polymorphic, as well as in patients of mature age.But depending on what stage of the ontogenetic development of the brain was the onset of epileptic disease, the manifestations of paroxysms always change more or less sharply. In children who become ill at an early and preschool age, the clinical picture of paroxysms is more abortive, often peculiar and atypical.

Therefore, it is clear that the diagnosis of epilepsy in preschool children and the delimitation of epileptic disease from other progressive brain diseases occurring with convulsive seizures are often very difficult.

90,000 Treatment of paroxysmal disorders in children at the MEDSI clinic in St. Petersburg.

Such disorders in children are manifested in the form of neurological attacks against the background of visible health or exacerbations of chronic diseases. In some cases, they are fixed in pathologies not related to the nervous system.

In case of disorders, a special paroxysmal activity of the child’s brain is recorded on the electroencephalogram. It is detected as an altered normal wave and is manifested by peaks, pathological complexes, peaked waves and a slowdown in electrical activity.In fact, it represents an abnormal activity in the brain.

Such activity can be recorded under the following conditions:

  • Acquired dementia
  • Neurotic disorders: social phobia, depression, panic attacks, schizophrenia, etc.
  • Immaturity of the brain
  • Epilepsy
  • Severe intoxication
  • Autonomic disorders
  • Psychopathic personality changes
  • Increased intracranial pressure
  • Severe physical fatigue, etc.

Signs of paroxysmal activity include transience, sudden onset and end, and a tendency to relapse. Disorders of consciousness can manifest themselves:

  • Fainting
  • Panic attacks
  • Seizure headache
  • Epileptic seizures
  • Sleep disorders, etc.

There are 3 common groups.


In epilepsy, paroxysmal disorders in children are manifested in the form of seizures and non-convulsive absences and trances.Interestingly, before the onset of a seizure, many of the patients experience an aura (precursors), which can be expressed by auditory, auditory and visual hallucinations. Some patients feel certain aromas, others hear ringing in their ears, and still others feel a tickling sensation or just a slight tingling sensation. Convulsive seizures in epilepsy last only a few minutes, but can be unpleasant and dangerous, as they are accompanied by involuntary urination or defecation, loss of consciousness, and even respiratory arrest.Non-convulsive ones arise suddenly and have no precursors. The patient can simply stop moving and look into the distance. At the same time, he will not react to external stimuli. Mental activity returns to normal immediately after the end of such an attack. The patient himself does not even fix it. Moreover, several such attacks (tens and hundreds) can occur per day.

Panic disorder

This mental disorder is characterized by spontaneous panic attacks.They can occur as little as 1-2 times a year, and several times a day. At the same time, the patient himself is constantly in anticipation of such attacks. They are unpredictable and often do not depend on the surrounding circumstances and the specific situation. The condition significantly reduces the patient’s standard of living. Anxiety, which is constantly growing, arising unexpectedly, cannot be controlled. Paroxysmal seizures of this type in children are forced to refuse communication with peers, public speaking.They become an obstacle on the way to normal learning and assimilation of information, the reason for the development of complexes.

Sleep disorders

Such paroxysmal disorders in children and adolescents can be expressed in the format:

  • Walking at night
  • Nightmares
  • Sleep paralysis
  • Screams and conversations in a dream
  • Convulsions
  • Non-standard physical activity
  • Shudders at the time of falling asleep

Nightmares can greatly scare a baby, as they are accompanied by a rapid heartbeat, shortness of breath and a jump in blood pressure.Sleep paralysis is no less unpleasant. This state is characterized by an incomplete exit from the sleep state. In this case, the eyes can open and close, but the body remains completely restrained. The child takes his dream for reality. Often, young patients also suffer from sleepy enuresis. Its appearance is often associated with a malfunction of the nervous system, when, when filling, the bladder does not receive a signal to empty it.

These and other disorders do not allow normal rest and recuperation, negatively affect attention and learning ability, reduce the level of memory, etc.After waking up, patients often complain of fatigue, headaches and a general feeling of “fatigue”.

The following pathologies are also diagnosed:

  • Paroxysmal tachycardia in children. It is an attack of sudden heart palpitations. The pulse during such an attack can rise to 200 beats per minute at a younger age and up to 150-160 at an older age. The duration of tachycardia usually does not exceed several hours. The attack is characterized by sudden onset and termination
  • Mild paroxysmal dizziness in children.This pathology is often diagnosed in babies (1-3 years old). Attacks usually occur 1-4 times a month and are short (from a few seconds to 5 minutes). Their danger lies in the fact that the child can fall. In this case, you can notice sweating and pallor. Consciousness is always preserved. Children are healthy outside of seizures

Causes of epilepsy in children and prevention of epileptic seizures

In many countries, epilepsy imposes significant restrictions on the individual and social capabilities of children with this diagnosis.They experience difficulties in everyday communication with others, which often leads them to social isolation and psychological problems, and in the future they will not be able to engage in some activities, and even just drive a car.

A special role among the causes of epilepsy is played by the intrauterine development of the child, hereditary and genetic factors.

Of course, epilepsy in children cannot go on without a trace, but with timely diagnosis and treatment of the disease, the child will be able to develop normally and lead a full life just like his peers.An example of this is the fact that in Israel, people with well-controlled epilepsy are free to drive, engage in community service and any other activity that suits their personal preferences. This is possible primarily due to the diagnosis of the disease during the intrauterine development of the child and an integrated approach to the treatment of epilepsy in children.

Organic causes of epilepsy

A special role among the causes of epilepsy is played by intrauterine development of the child, hereditary and genetic factors.To prevent serious consequences or at least correct the development of the disease, it is important to diagnose epilepsy even during pregnancy – by the middle of the term, ultrasound examination already makes it possible to study the structure of the embryo’s brain and its pathology. If changes that can lead to the development of epilepsy persist in the last trimester of pregnancy, an ultrasound examination should be confirmed by an MRI of the embryo’s brain.

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Mental norm and pathology

As a rule, the development of epilepsy in children is caused by organic disorders in the cerebral cortex, the so-called “cortex”.They may be associated with a lack of substances that are involved in the construction of the central nervous system during intrauterine development. Timely diagnostics will help to track this process and take the necessary measures. However, not only a deficiency, but also an excess of certain substances and enzymes in the body of a newborn can cause epilepsy at an early age. For the same reason, jumps in blood sugar or insulin levels can provoke an epileptic seizure in a completely healthy person.

In case of metabolic disorders in the child’s body, substances and toxins can accumulate that he is not able to remove in a natural way for a healthy person. As a rule, metabolic disorders in children are associated with the breakdown of sugar, fats and carbohydrates, therefore, when drug treatment of epilepsy does not have the desired effect, the patient is transferred to a special diet that excludes potentially dangerous organic compounds in food.

The long-standing Remedia baby food scandal in Israel, when an entire batch of vitamin B-free infant formulas arrived in Israel, is a prime example of the role of the endocrine system and organic metabolism in the development of epilepsy in children.Several childhood deaths and dozens of disabilities associated with the development of the central nervous system became the price of the manufacturer’s mistake, and lawsuits from parents continue to come to this day.

Forms and symptoms of the development of epilepsy in children

There are many forms of development of epilepsy and the severity of the disease, which, by and large, can be divided into 2 categories: general and partial epilepsy.It is very simple to distinguish one from the other: if during a convulsive seizure a child loses consciousness for even a split second, epilepsy is considered common. It cannot be said which of these two evils is the lesser, because both are caused by serious organic pathologies of the central nervous system – the only difference is in their localization. But it is absolutely possible to say that any kind of general epilepsy is accompanied by changes in the consciousness of the child, which ultimately cannot but affect his personal development.

Successful treatment of physiological problems associated with childhood epilepsy does not exclude psychological work with the child.

Children with epilepsy have cognitive and behavioral problems – disorders of memory, attention, learning and development difficulties. Experts find it difficult to say what they are caused in the first place: the course of the disease itself or the effect of drugs against epilepsy. However, it is impossible not to deal with the treatment of childhood epilepsy at all: each seizure destroys part of the neurons in the cerebral cortex – this means that over time, the child will not only stop developing, but, on the contrary, will regress in its development.Refusal to treat epilepsy can lead to a state of encephalopathy, when the child stops responding to external stimuli, including his family and friends.

Psychological support for children with epilepsy

Successful treatment of physiological problems associated with childhood epilepsy does not exclude psychological work with the child. After all, the disease not only affects his body, but also negatively affects the development of communication skills, relationships in the family and in the social environment of the child, which is extremely important for psychological health and development.Often these problems are caused by the fear of the parents: after all, even if the child is “balanced” with medication (that is, taking medication allows you to prevent and restrain epileptic seizures for a long time), you can never say for sure at what moment the seizure will occur. This can happen when swimming, when a child crosses the road, in a dream, and in many other unpredictable and dangerous situations.

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Myths about the diagnosis of mental illness

Therefore, children with epilepsy are under the vigilant control of their parents and are very limited in communication: they cannot communicate freely with their peers, cannot go on vacation to relatives or summer camp, and cannot play sports.Of course, in such a situation, social communications, which are important for personal development at an early age, are disrupted. Therefore, the course of treatment for epilepsy in children should include psychological work with the child and his parents. Outside of the constraints imposed on it by parental care, a child with epilepsy is largely able to learn, communicate and develop normally as a person.

Prevention of epileptic seizures

Prevention of epileptic seizures is of great importance in this development.You can only prevent an epileptic seizure with medication. However, you can protect yourself by avoiding the factors that provoke the onset of attacks, or at least prepare for them. In addition to purely individual factors, among such factors, one can single out well-known ones: flickering light, flickering of pillars or trees outside the car window on a trip, lack of sleep, being in the sun and some others.

Often, people with epilepsy experience special sensations characteristic of the onset of an attack – for example, they suddenly smell a schnitzel where there is no trace of it.Feelings like this can serve as a timely warning to prepare yourself and those around you for an impending attack.

However, no matter how you teach your child to adapt to your disease, his successful treatment depends on qualified and timely assistance from medical specialists.

90,000 Generalized convulsive seizures – Alpha Rhythm

The most famous and dramatic type epileptic seizures are generalized seizures.A convulsive epileptic seizure can be primary or secondary generalized. The development of a generalized convulsive seizure may be preceded by certain symptoms, which are called prodrome, or precursor. It may be general discomfort, anxiety, aggression, headache, irritability, etc. Harbingers appear several hours or days before the development of a generalized convulsive attack, but they may be absent.

A secondary generalized convulsive attack is preceded by the onset of an aura (a feeling of unreality of what is happening, discomfort in the stomach, visual or auditory sensations, sensations of non-existent odors, more often unpleasant, etc.). The aura is the part of the seizure that precedes the loss of consciousness, which the patient remembers after the seizure ends. The aura is usually short-term, it lasts only a few seconds, but for the patient the meaning of the aura is very great, some patients manage to protect themselves – to call for help, sit on the floor, stop the car. The stereotype (repeatability) of the aura from seizure to seizure allows the epileptologist in some cases to determine the localization (location) of the epileptic focus.

In case of primary generalized convulsive seizures, there is no aura; these seizures are dangerous because of their suddenness. Most often, these poultices develop in the structure of idiopathic generalized epilepsy, more often in the morning after waking up, often seizures occur during sleep. The attack, as a rule, begins with a loud cry, there is tension in the muscles of the whole body, the teeth are clenched, the lips are tightly compressed, the tongue bite is possible. There is a short-term cessation of breathing followed by the appearance of cyanosis (cyanosis of the skin).Further, rhythmic twitching of the muscles of the trunk and limbs develops. The attack usually stops spontaneously after 1-5 minutes. It is very important to be able to provide adequate assistance during a seizure. As a rule, this form of epilepsy responds well to treatment with anticonvulsants, which are prescribed by the epileptologist , against the background of adequate treatment it is possible to achieve complete remission of the seizures. For the appointment of an adequate treatment for this form of epilepsy, the information obtained from the EEG monitoring of sleep is very important.In all cases, but especially if idiopathic generalized epilepsy is suspected, the recording continues for 10 minutes after the patient wakes up, it is during this period that an increase in epileptiform activity is observed.

90,000 Epilepsy in young children

Epilepsy in children is one of the three most common diseases on earth, being one of the most common forms of chronic pathologies of the nervous system in our time. It should be noted that the term “epilepsy” is wide enough, its concept includes a huge number of different types of seizures, characterized by the same type and repetition.Unfortunately, most often the onset of the disease manifests itself precisely in childhood (in 75% of cases). This is most likely due to the immaturity of the brain in babies, as well as a predisposition to disorders of cerebral processes, but this is not worth talking about with due confidence, because to date, the causes of the onset of the disease have not yet been fully studied.

Diagnosis of epilepsy in children

A neurologist is engaged in the treatment of epilepsy in young children, he will help to find the cause of the disease.You can sign up for a consultation right now!

The main and most serious problem of epilepsy in children is the diagnosis of syndromes and the validity of the selected treatment. At the moment, a huge number of different manifestations of the disease, epileptic syndromes and disorders similar in symptoms have been classified, and in each case, based on the individual characteristics of the child’s body, their own principles of therapy and personal predictions are selected. It is especially important for a wide variety of childhood diseases, various painful attacks of a differential nature, to discern the onset of the disease, not to miss the first manifestations of the disease.The younger the child, the more difficult it is to diagnose epilepsy in the early stages of its manifestation, and this is extremely important, since due to frequent epileptic seizures in the child’s body, functional disorders develop rapidly, which subsequently lead to persistent disorders of speech, memory, behavior, mental retardation. and physical development.

Epilepsy in newborns is extremely difficult to diagnose because seizures are subtle, and convulsive movements are very similar to the usual motor activity of an infant.Symptoms of the manifestation of the disease in the first year of life are most often caused by brain damage due to birth trauma, hypoxia, intracerebral hemorrhage, or an infectious disease suffered by the mother during pregnancy (Rolandic epilepsy). Another common cause of epilepsy in infants is genetic predisposition. In this case, we are not talking about damage to the cerebral cortex, the predisposition to the disease is transmitted with genetic information from the parents to the child.

During the first year of life, babies can have large and small epileptic seizures. Attacks come on suddenly, without any connection with external factors. They manifest themselves in the form of specific motor spasms, often against the background of an increase in temperature, can be with or without loss of consciousness. During the day, a child may have from 2-3 to 100 seizures.

Symptoms of epilepsy in children

The signs of epilepsy in infants are poorly expressed, moreover, the seizures do not always spread to the whole body, and it happens that the spasm only binds the arm or leg.Therefore, parents should be more careful about the behavior of the little crumbs and do not miss the alarming symptoms.

Let’s list the main signs of small seizures:

  • unnatural sharp extension of the trunk
  • Muscle tension throughout the body, spontaneous flexion of the limbs
  • sudden throwing back of the torso or
  • sharp bending forward sharp unreasonable jerking

And the following signs are even less noticeable, but require even greater sensitivity on the part of the parents, i.because they can easily be mistaken for groundless twitching of the baby:

  • sudden freeze of the child

  • aloof look, looking at “one point”

  • subtle head nods

  • unobtrusive twitching of the shoulders

Large attacks are more noticeable, they happen suddenly and very quickly:

  • the head is tilted forward and the shoulder girdle is tilted

  • legs bent, pulled up to the stomach

  • arms outstretched and raised up

Treatment of epilepsy in children

Treatment of epilepsy in children of the first year of life is carried out in most cases quite successfully.After the doctor prescribes drug therapy, the attacks become less severe and occur much less frequently. The child grows, brain processes are stabilized. It happens that in some cases, epileptic seizures disappear altogether!

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Neurologist for parents about children

What do a child who is afraid to go to the blackboard and an excellent student with skin allergies and tics have in common?

Between an impulsive child who is rude to teachers and beats his classmates, and a fearful and insecure C grade with headaches and impaired attention?

Between a restless, irritable, nervous child for any reason and his deskmate suffering from sleep disorders and enuresis, who is not interested in anything, who is not affected by shouts or deuces?

Many of these behavioral manifestations in children are based on disturbances in the mechanisms of development of the nervous system …

What explains the disturbances in the nervous activity in a baby if no visible changes in the brain are detected?

The fact is that an outwardly well-formed brain is not yet a guarantee of its normal functioning.Having experienced unfavorable influences in a critical period (in utero, during childbirth or in a newborn), the brain “leaves the schedule” of its development in the most critical phase. The formation of the most important functions does not have time to “fit” into the optimal age period allotted for this, in a kind of peak of the plasticity of the nervous system, and then, in addition to what has already been said, irreversible conditions may develop in the baby ….

But if everything that happens in childhood was irreversible, then childhood diseases of the nervous system would be incurable …

And this is not so!

How are brain diseases treated? Our children’s neurologists and psychoneurologists will answer this.

A pediatric neuropsychiatrist, in contrast to an adult neuropathologist, has to deal with almost all pathology inherent in the body:

  • damage to the nervous system in utero and during childbirth as a result of various adverse factors
  • disorders of motor development (from tempo delays in the formation of initial motor skills to paresis and paralysis)
  • birth and household traumatic brain injury and their consequences
  • epilepsy, etc.convulsive conditions
  • sleep disorders, including paroxysmal
  • cerebrovascular accidents (strokes) in both acute and chronic stages
  • Congenital and acquired hydrocephalus
  • “rejuvenated” multiple sclerosis, brain tumors and other progressive diseases of the nervous system
  • pains of various origins
  • hereditary neuromuscular diseases, etc.genetic diseases with damage to the nervous system
  • behavior disorders, adaptation problems, neurotic reactions and habits (tics, stuttering, urinary incontinence, obsessions, fears, etc.)
  • mental illness (early childhood schizophrenia, autism, mental retardation – intellectual disability of varying severity)
  • disorders “accompanying” chronic somatic diseases

and many other disorders, apart from perhaps a very small range of age-related genetic conditions, but they also tend to rejuvenate …

Perinatal damage to the nervous system is a collective diagnosis, implying a violation of the function or structure of the brain (encephalopathy) and the spinal cord of various origins, arising in the perinatal period (from 28 weeks of intrauterine development, including childbirth, to the period corresponding to the first week of a child’s life with processes characteristic of it adaptation of the newborn to environmental conditions).The reasons influencing the onset of PPNS symptoms can be:

  • intrauterine infections (rubella, herpes, cytomegalovirus, syphilis, etc.)
  • exacerbation of chronic diseases of the expectant mother with unfavorable changes in metabolism
  • intoxication
  • effect of various types of radiation
  • genetic condition
  • long dry period
  • absence or weak severity of contractions and the inevitable stimulation of labor in these cases
  • insufficient opening of the birth canal
  • Rapid labor
  • the use of manual obstetric techniques
  • Caesarean section
  • umbilical cord entanglement of the fetus
  • large body weight and size of the fetus
  • neuroinfection
  • injuries

The consequence of these reasons is a violation of breathing and blood circulation (asphyxia, hypoxia), energy deficiency of the heart and brain, failure of individual organs or functional systems (multiple organ failure), leading in some cases to irreversible phenomena.

Birth trauma of newborns is damage to organs and tissues of the fetus, which occurs during childbirth as a result of a discrepancy between the birth expelling forces (contractions, attempts) and the elasticity of the fetal tissues. Predisposing reasons include: toxicosis of pregnant women, cardiovascular diseases of the mother, infections suffered during pregnancy, metabolic disorders, premature and prolonged pregnancy, etc. Intrauterine asphyxia (hypoxia) of the fetus plays a special role in the occurrence of birth trauma.

Sometimes injuries are accompanied by intracranial hemorrhages, cerebral edema with increased intracranial pressure, with the development of hydrocephalus (dropsy of the brain), fractures of the clavicles and humerus bones, spine, facial nerve injuries and paralysis of the brachial plexus, etc.

Traumatic brain injury (including household). Head injuries can be very different in severity, ranging from minor contusions to the soft tissues of the head to severe injuries to the skull and brain.In young children, even sometimes outwardly “harmless” falls from a small height can hide fractures of the skull, its inner platinum with damage to the brain tissue. Mechanical trauma to the skull leads to compression of the brain tissue, tension and displacement of its layers, and a temporary sharp increase in intracranial pressure. The displacement of the medulla may be accompanied by rupture of the brain tissue and blood vessels (hemorrhages), brain contusion. Usually, these mechanical disorders are complemented by complex changes in the brain and their consequences.

Epilepsy, a chronic neuropsychiatric disease characterized by a tendency to recurrent sudden seizures. There are various types of seizures (convulsive and non-convulsive), but all of them are based on very high electrical activity of the nerve cells in the brain.

Epilepsy has been known since ancient times. Epileptic seizures were noted in many prominent people, such as the Apostle Paul and Buddha, Julius Caesar and Napoleon, Handel and Dante, Van Gogh and Nobel.Its prevalence reaches 15–20 cases per 1000 people. In addition, about every twentieth child has had convulsions at least once with a rise in temperature. Distinguish between epilepsy as an independent disease, epileptic syndromes (in various diseases of the brain) and epileptic reactions to sudden external stimuli (poisoning, intoxication, the influence of environmental conditions, trauma, stress, etc.)

Paroxysmal sleep disorders (parasomnias).Paroxysmal sleep disorders have been known since antiquity and are described in the writings of Hippocrates and Aristotle. Some of them have similarities with epilepsy, both in manifestations and in diagnostic characteristics. To date, a large number of independent syndromes that arise in sleep are known, which are associated with the peculiarities of the development of the child’s nervous system (including general medical, neurological, emotional, social problems, environmental factors). These are enuresis, night fears and nightmares, autonomic disturbances (excessive sweating, respiratory disturbances, attacks of suffocation and palpitations), bruxism (teeth grinding), excessive motor activity during sleep, flinching, sleeping, sleeping, paroxysmal night pains, convulsions in the extremities, disorders of awakening after sleep.

Along with these sleep disorders, there are also disturbances of the “sleep-wakefulness” rhythm associated with sleep disorders (dyssomnia), as well as sleep disorders with concomitant diseases (ARVI, rhinitis, various pain syndromes, teething period in children, etc.), sleep disorders can also be observed in psychiatric diseases, etc.

Cerebral circulation disorders in children. In children, it is possible to develop all types of cerebrovascular accidents, starting from their initial manifestations (in the form of headaches, dizziness, disturbances of consciousness, delays in intellectual development, etc.).) and ending with strokes. Diseases of the blood, brain tumors, abnormal development of the walls of the cerebral vessels themselves (aneurysms), diabetes mellitus, alcohol and drug use can lead to vascular diseases of the brain, both in adults and in children. The likelihood of their development is quite high in heart disease, heart rhythm disturbances, heart defects and inflammatory diseases of the heart muscle. Inflammatory diseases of the cerebral vessels – vasculitis – can also cause cerebrovascular accident.In children, vasculitis is more common with rheumatism. Cerebral circulation disorders of the brain and spinal cord in children can also be a long-term consequence of the birth trauma of the spine.

A nervous child is an irritable, naughty child who does not know how and does not want to control himself. Moreover, almost 90% of completely different children fall under this parental “diagnosis”. The birth of a nervous child may depend on the fact that the expectant mother was nervous, suffered from toxicosis, and had a hard time giving birth.But even in the case when there is none of the above reasons, and your child was born and grows up in favorable conditions, congenital insufficiency of certain brain structures can become the cause of nervousness. From the point of view of medicine, the concept of a “nervous child” can mean a child with increased emotional sensitivity, as well as with anomalies in character development, neurosis, and organic disorders of the brain.

A child also becomes nervous when he does not sleep enough, watches TV all day, listens to horror films, when the house is very noisy and crowded, the family quarrels when he is the only child in the family, and the adults who love him fulfill his every whim or desire, thinking that in this is true love.

If something worries you about the behavior of a nervous child, be sure to consult a doctor: a neurologist, a neuropsychiatrist, a clinical psychologist. In most cases, we are not talking about serious mental abnormalities, but about ordinary ailments, which, if they are “captured” in time, are quite easy to correct. Specialists will be able to find out the cause using various types of examination – ultrasound examination (ultrasound), electroencephalography (EEG), laboratory tests, neuropsychological and pathopsychological examination.Treatment of a nervous child is complex – medication (psychopharmacotherapy), psychosocial treatment (aimed at correcting the microsocial environment surrounding the child, at forming support and helping relationships), psychotherapy (aimed at correcting behavior),

Neurotic reactions are psychogenic disorders that appear due to quarrels, conflicts, “gnawing” feelings of loneliness, any fears. A neurotic reaction easily arises due to an experienced sad or terrible event for a person.The intense rhythm of modern life and school work pushes them towards them, and more and more often they are found in the most unprotected – in our children. Of course, the life of a little man is not without problems. But the problems of children are different. It is one thing when they fit into the framework of the age norms of development. But some baby problems can only be solved by specialists, such as tics, stuttering, enuresis, attention deficit hyperactivity disorder sucking fingers and tongue, rocking the body and head (yakation), masturbation (masturbation), which arose in pre-pubertal age, nail biting (onychophagia) , hair pulling (trichotillomania), etc.

With mental retardation, assistance is provided by a child neurologist, neuropsychiatrist, and psychiatrist. Parents do not always realize the desirability of early contact with these specialists, although they can provide assistance in the child’s problems, including behavioral and emotional ones. Consultation of an endocrinologist, cardiologist is obligatory, because the reasons for the delay can lie in neurological, hormonal disorders, diseases of the cardiovascular system. The child may need additional studies – MRI (magnetic resonance imaging), computed tomography (CT), ultrasound (ultrasound), EEG (electroencephalography).For a more accurate understanding of the causes of the origin of the child’s problems.

According to indications, medications can be prescribed that improve memory and attention, reduce excitability and develop perseverance. Children, unlike adults, have more reserves and capabilities of the body. With timely assistance, the phenomena of mental retardation are noticeably smoothed out in the future, good adaptation in everyday life occurs

What is attention deficit hyperactivity disorder (ADHD)?

“Hyperactivity” is restlessness, inattention and impulsivity, frequent night awakenings, occurs most often in childhood and affects the general atmosphere in your family and the social future of your child.This syndrome is a “hodgepodge” of various diseases, their cause must be found out.

Early organic brain damage in the perinatal period (for example, complications during pregnancy, birth trauma, hypoxia during childbirth), as well as genetic and socio-psychological factors (family conflicts, defects in upbringing, acute and chronic stresses that reduce the resistance of the nervous system to external and internal influences).

“Disaster children”, “difficult children” – these are the names of children with ADHD.Indeed, they cause so much trouble to their parents, they constantly find themselves in some kind of unpleasant situations, since they often do not have a developed sense of self-preservation and control over behavior. At school, they can not assimilate the educational material, be at the desk during the entire lesson. Moreover, such children most often do not show mental retardation or severe neurological disorders, although increased excitability can also manifest itself with various early lesions of the nervous system (head trauma, neuroinfection, etc.).etc.). Such children require an individual approach in the educational process, therefore, the recommendations of the teacher are important. These children should not be considered aggressive and dangerous to other children. With age, in the process of social interaction, the phenomena of hyperactivity become less pronounced. Sometimes such people become leaders, have increased efficiency.

With ADHD, a neurologist, neuropsychiatrist, psychiatrist, medical psychologist (clinical psychologist) can help, and even better – all together, because then doctors will have the opportunity to discuss a comprehensive treatment regimen that will be most effective.

So, it is imperative to find out what the state of physical health is, whether the characteristics of the child’s behavior are the result of organic disorders in the brain, ultrasound examinations (ultrasound), EEG (electroencephalography), MRI (magnetic resonance imaging), consultation of a neurologist.

It is important to assess the state of the cardiovascular system (consult a therapist, cardiologist), determine the level of hormones and consult an endocrinologist.

Treatment is complex – biological, psychological and social. Drug treatment (psychopharmacotherapy) is aimed at reducing motor restlessness, improving the functions of cognition of the surrounding world, and normalizing sleep.


Enuresis (the second name is urinary incontinence) – the inability of a person to “endure” to the toilet, a constant struggle with wet sheets.

Potty training is one of the stages of general mental and physical development of the child.The age at which it is already possible to talk about enuresis in a child should be at least 4-5 years.

The causes of enuresis are very different – mental trauma, anomalies in the development of the urinary tract, underdevelopment of the lumbosacral spine, improper daily routine, inappropriate nutrition, endocrine disorders, delayed maturation of the nervous system.

Enuresis can be either an independent disease or a manifestation of any other disease.Distinguish between day and night enuresis, primary and secondary. In primary enuresis, there is a lack of prior control over the emptying of the bladder. Secondary enuresis is spoken of if a person controlled the urination process for at least 6 months, and then again began to urinate in his pants or bed, due to the influence of urological, neurological, mental or endocrine diseases.

With enuresis, persistent sleep disturbances, problems with falling asleep and waking up, excessively deep sleep, night fears, sleep-speaking and sleepwalking are noted.If such a child is violently awakened, then you can observe disorientation with motor excitement, fears.

Who will help with bedwetting?

With enuresis, a neuropsychiatrist will help. Additionally, you need to be examined to exclude malformations of the urinary tract and spine, diabetes mellitus, and diseases of the central nervous system. You will need consultations with a pediatrician, endocrinologist, laboratory tests, ultrasound examination of the kidneys and bladder (ultrasound), EEG (electroencephalography).

Treatment of bedwetting is complex. Drug treatment (psychopharmacotherapy) is aimed at eliminating anxiety and fears, stabilizing mood. Psychotherapy – to eliminate emotional disorders and change behavior, in particular, adherence to the daily routine, eating and drinking regimen – limiting fluids, eating foods with only a low fluid content. Other non-drug methods of exposure are acupuncture, manual therapy.


Children often complain of headaches.For the most part, it is, as doctors say, benign and only in rare cases does it become a manifestation of a serious general or neurological disease. Therefore, it is important not to dismiss the timid complaint of the child, who sometimes still cannot clearly formulate what hurts him. The parental anxiety that prompts them to go to the doctor to identify the causes of the child’s ill health is understandable and justified.

Why do children have headaches?

Acute headache in children is primarily one of the main symptoms of acute neuroinfectious diseases, as well as paroxysmal conditions, while chronic headache is a frequent manifestation of vegetative dystonia and neuroses.

The most common VOLTAGE HEADACHE. It is based on painful contraction of the muscles of the soft tissues of the head (scalp) or cervico-occipital region. Tension headache is usually associated with emotional stress. And what are the stresses of the child? They are countless. This, for example, preparing for a test or exams, the disappearance of a beloved pet, a quarrel with a friend … A fat child who does not want to undress in the presence of classmates often complains of a headache before physical education lessons.The duration of such pain usually does not exceed 1 to 2 hours. Of course, the doctor cannot cancel the tests and exams at school, but parents, teachers, and a doctor must work hard to eliminate and mitigate stressful influences. The doctor usually prescribes prophylactic agents.

The most common type of vascular headache is MIGRAINE. This disease is associated with genetically determined changes in cerebral vessels. Migraine attacks in children, as in adults, provoke physical and mental overload, emotional stress, changes in atmospheric pressure, weather conditions, allergic reactions: for example, the cheese and chocolate loved by a child can cause headaches.

More often, children have a simple form of migraine. The phase preceding the onset of a pain attack includes irritability, malaise, dizziness, nausea, blurred vision or spots in front of the eyes, and a sudden change in mood.

Parents should know: a child suffering from migraines has a particularly sensitive type of nervous system, which reacts to various stimuli with painful sensations along the vessels of the brain and scalp.Therefore, it is very important, with the help of a doctor, to identify as much as possible all the factors that provoke seizures, and, if possible, exclude them from the life of children.

Often, children are diagnosed with PSYCHOGENIC HEADACHE. It can be associated with depression, fear of going to school, increased with difficulties in assimilating the school curriculum and lack of contact with peers or parents. Such children require the consultation of a neuropsychiatrist and a psychologist.

It happens that parents fear that their child’s headache is caused by BRAIN TUMOR.Although this is the most rare cause, it should be ruled out with careful examination. In children, tumors are localized mainly in the posterior cranial fossa, cause difficulty in the outflow of cerebrospinal fluid, increase its pressure. The pain is felt in the back of the head or neck, accompanied by nausea and vomiting. The child often looks lethargic, indifferent. There is unsteadiness in gait. The development of hemiparesis (weakness in the muscles of the left or right extremities) may indicate the development of a tumor in one of the cerebral hemispheres.The most informative diagnostic procedure for confirming or excluding a brain tumor is computed tomography, which is usually referred to the patient.

It is extremely rare in children that there is neuralgic pain that has a paroxysmal nature. These are short, consecutive attacks of piercing, cutting, burning pain localized in the face area (cranial neuralgia or prosopalgia) with the presence of zones, the irritation of which provokes an attack (touching, washing, eating, etc.)in particular, trigeminal neuralgia.

In addition, they release a medicinal headache caused by taking certain medications, for example, antihistamines, antibiotics, etc.

Headache associated with the abuse of various analgesics, more often non-steroidal anti-inflammatory drugs, as well as anti-migraine drugs, is called abusal, or ricochet. There is also known a headache of caffeine withdrawal in lovers of strong tea and coffee when it is impossible to drink their favorite drink again and again.

If a child has a headache combined with a high fever and tension in the neck muscles, which makes it difficult to bend the head forward, there is reason to suspect MENINGITIS. In such cases, contact your doctor immediately.

Mixed headache. Headache is only a subjective symptom that accompanies various diseases. To successfully treat headache, it is necessary, first of all, to find out the mechanism of its occurrence, since different types of headaches require a completely different approach.

The examination of children with headaches begins with a thorough examination of complaints, history of the development of the disease and a careful medical examination. If the examination reveals symptoms of organic damage to the central nervous system, then special instrumental and laboratory studies are carried out to clarify the diagnosis. Neurologists and psychoneurologists provide help for headaches. For correct diagnosis, studies are important – vascular ultrasound (Doppler study), EEG, MRI, CT, examination by an ophthalmologist, etc.specialists according to indications.

You shouldn’t be afraid of them. On the contrary, do everything prescribed by your doctor without delay. Because only then the result of your child’s treatment will be ensured as much as possible

Headache treatment. Our center uses a pathogenetic approach to the treatment of headaches. It includes not only drug therapy, but also non-traditional methods of treatment (acupuncture, manual therapy), psychological correction, rational psychotherapy and recommendations for lifestyle changes (behavioral medicine).

Epilepsy and other convulsive conditions

The onset of a single seizure characteristic of epilepsy is possible due to the specific reaction of a living organism to the processes that have occurred in it. According to modern concepts, epilepsy is a heterogeneous group of diseases, the clinic of chronic cases of which is characterized by recurrent convulsive seizures. The pathogenesis of this disease is based on paroxysmal discharges in the neurons of the brain. Epilepsy is characterized mainly by typical recurrent seizures of a different nature (there are also equivalents of epileptic seizures in the form of sudden mood disorders (dysphoria) or characteristic disorders of consciousness (twilight clouding of consciousness, somnambulism, trances), as well as the gradual development of personality changes characteristic of epilepsy and (or ) characteristic epileptic dementia.In some cases, epileptic psychoses are also observed, which are acute or chronic and are manifested by such affective disorders as fear, melancholy, aggressiveness or heightened ecstatic mood, as well as delusions, hallucinations. If the occurrence of epileptic seizures has a proven connection with somatic pathology, then we are talking about symptomatic epilepsy. In addition, within the framework of epilepsy, the so-called temporal lobe epilepsy is often distinguished, in which a convulsive focus is localized in the temporal lobe.Such an allocation is determined by the peculiarities of the clinical manifestations characteristic of the localization of a convulsive focus in the temporal lobe of the brain. Neurologists and epileptologists are involved in the diagnosis and treatment of epilepsy.

In some cases, seizures complicate the course of a neurological or physical illness or brain injury.

Epileptic seizures can have various manifestations depending on the etiology, localization of the lesion, EEG characteristics of the level of maturity of the nervous system at the time of the seizure development.Numerous classifications are based on these and other characteristics. However, from a practical point of view, it makes sense to distinguish between two categories:

Primary generalized seizures

Primary generalized seizures are bilateral symmetrical, without focal manifestations at the time of onset. These include two types:

  • tonic-clonic seizures (grand mal)
  • absences (petit mal) – short periods of loss of consciousness.

Partial seizures

Partial or focal seizures are the most common manifestation of epilepsy. They arise when nerve cells are damaged in a specific area of ​​one of the cerebral hemispheres and are subdivided into simple partial, complex partial and secondary generalized.

  • simple – no impairment of consciousness occurs with such attacks
  • complex – seizures with impairment or change in consciousness, caused by areas of overexcitation of various localization and often turn into generalized.
  • Secondary generalized seizures are characterized by onset in the form of a convulsive or non-convulsive partial seizure or absence with subsequent bilateral spread of convulsive motor activity to all muscle groups.

Epileptic seizure

The occurrence of an epileptic seizure depends on a combination of two factors of the brain itself: the activity of the convulsive focus (sometimes also called epileptic) and the general convulsive readiness of the brain.Sometimes an epileptic seizure is preceded by an aura (Greek word meaning “breath”, “breeze”). The manifestations of the aura are very diverse and depend on the location of the part of the brain whose function is impaired (that is, on the localization of the epileptic focus). Also, certain states of the body can be a provoking factor for an epileptic seizure (seizures associated with the onset of menstruation; seizures that occur only during sleep). In addition, a number of environmental factors (such as flickering light) can trigger an epileptic seizure.There are a number of classifications of characteristic epileptic seizures. From the point of view of treatment, the most convenient classification is based on the symptoms of seizures. It also helps distinguish epilepsy from other paroxysmal seizure conditions.

Diagnosis of epilepsy


For the diagnosis of epilepsy and its manifestations, the method of electroencephalography (EEG) has become widespread, that is, the interpretation of the electroencephalogram.Particularly important is the presence of focal “peak-wave” complexes or asymmetric slow waves, indicating the presence of an epileptic focus and its localization. The presence of a high convulsive readiness of the whole brain (and, accordingly, absences) is indicated by generalized peak-wave complexes. However, it should always be remembered that the EEG reflects not the presence of a diagnosis of epilepsy, but the functional state of the brain (active wakefulness, passive wakefulness, sleep and sleep phases) and can be normal even with frequent seizures.Conversely, the presence of epileptiform changes on the EEG does not always indicate epilepsy, but in some cases it is the basis for the appointment of anticonvulsant therapy even without obvious seizures (epileptiform encephalopathy).

Treatment of the disease is carried out both on an outpatient basis (by a neurologist or psychiatrist) and inpatient (in neurological hospitals and departments or in psychiatric departments – in the latter, in particular, if an epileptic patient has committed socially dangerous acts in a temporary mental disorder or in case of chronic mental disorders and compulsory medical measures were applied to him).In the Russian Federation, involuntary hospitalization must be sanctioned by a court. In especially difficult cases, this is possible before the judge makes a decision. Patients who are forcibly placed in a psychiatric hospital are recognized as disabled for the entire period of being in the hospital and are entitled to receive pensions and benefits in accordance with the legislation of the Russian Federation on compulsory social insurance [7] .

Drug treatment for epilepsy

Main article: Anticonvulsants

  • Anticonvulsants, another name for anticonvulsants, reduce the frequency, duration, and in some cases completely prevent seizures.

In the treatment of epilepsy, anticonvulsants are mainly used, the use of which can continue throughout a person’s life. The choice of anticonvulsant depends on the type of seizure, epilepsy syndromes, health status and other medications the patient is taking. It is recommended to use one product at the beginning. In the event that this does not have the desired effect, it is recommended to switch to another medicine. Take two drugs at the same time only if one does not work.]
In about half of the cases, the first remedy is effective, the second has an effect in about 13% more. A third or a combination of the two can help an additional 4%. ]
In about 30% of people, seizures continue despite treatment with anticonvulsants.

Potential drugs include phenytoin, carbamazepine, valproic acid, and are approximately equally effective for both partial and generalized seizures (absences, clonic seizures). In the UK, carbamazepine and lamotrigine are recommended as first-line drugs for the treatment of partial seizures, and levetiracetam and valproic acid are second-line drugs because of their cost and side effects.Valproic acid is recommended as the first line of treatment for generalized seizures, and lamotrigine as the second; in those who do not have seizures, ethosuximide or valproic acid is recommended, which is especially effective for myoclonic and tonic or atonic seizures.

  • Neurotropic drugs – can inhibit or stimulate the transmission of nervous excitement in various parts of the (central) nervous system.
  • Psychoactive substances and psychotropic drugs affect the functioning of the central nervous system, leading to a change in mental state.
  • Racetam is a promising subclass of psychoactive nootropic substances.

Consequences of craniocerebral trauma (concussion of the brain and its consequences, bruising of the GM, hemorrhages, hematomas), consequences of spinal trauma. ConsequencesConsequences

As already written above, you can never neglect the intervention of doctors, even with the mildest degrees of injury. In the worst cases, this leads to undesirable consequences.

For example, in acute forms of manifestation

  • depression;
  • mood swings;
  • Partial memory impairment;
  • insomnia.

Such symptoms can persist even with mild injuries if the doctors do not follow the clear treatment instructions.

After the end of treatment and complete recovery, for a firm conviction in the retreat of the disease, it is necessary to undergo a control examination.