What are the different types of seizures in children? How are pediatric seizures categorized and what are the symptoms of various types like focal, generalized, absence, atonic, tonic-clonic, and myoclonic seizures?

Understanding Pediatric Seizures

Seizures in children can manifest in various forms, and it is crucial for parents and caregivers to be aware of the different types and their characteristics. Pediatric seizures can be broadly categorized into two main types: focal seizures and generalized seizures.

Focal Seizures in Children

Focal seizures, also known as partial seizures, occur when abnormal electrical activity is localized to one or more areas of the brain on one side. These seizures may be accompanied by an aura, a strange feeling or sensation that precedes the seizure. There are two subtypes of focal seizures:

Simple Focal Seizures

Simple focal seizures typically last less than a minute and can manifest in various ways depending on the affected area of the brain. For example, if the occipital lobe (the visual processing region) is involved, the child may experience visual disturbances. Muscle groups, such as fingers or larger muscle groups in the arms and legs, may also be affected. Consciousness is not lost during this type of seizure, but the child may experience sweating, nausea, or become pale.

Complex Focal Seizures

Complex focal seizures, often occurring in the temporal lobe (which controls emotion and memory), can last between one to two minutes and involve a loss of consciousness. The child may exhibit various behaviors, such as gagging, lip smacking, running, screaming, crying, or laughing. When the seizure ends, the child may feel tired or sleepy, a state known as the postictal period.

Generalized Seizures in Children

Generalized seizures involve both sides of the brain and result in a loss of consciousness. There are several subtypes of generalized seizures, each with its own characteristics and common occurrence during different stages of childhood and adolescence.

Absence Seizures

Absence seizures, also known as petit mal seizures, are characterized by a brief altered state of consciousness and staring episodes. The child’s posture is typically maintained, and the mouth or face may move, or the eyes may blink. These seizures usually last no longer than 30 seconds and may occur several times a day. Absence seizures often begin between the ages of 4 and 12 years and can sometimes be mistaken for learning or behavioral problems.

Atonic Seizures

Atonic seizures, also called drop attacks, involve a sudden loss of muscle tone, causing the child to fall from a standing position or suddenly drop their head. During the seizure, the child is limp and unresponsive.

Generalized Tonic-Clonic Seizures

Generalized tonic-clonic seizures, formerly known as grand mal seizures, are characterized by five distinct phases: body, arms, and legs flexing (contracting), extending (straightening out), tremoring (shaking), a clonic period (contraction and relaxation of the muscles), and a postictal period. During the postictal period, the child may experience sleepiness, vision or speech problems, headaches, fatigue, or body aches.

Myoclonic Seizures

Myoclonic seizures are characterized by quick movements or sudden jerking of a group of muscles. These seizures tend to occur in clusters, meaning they may happen 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 infants younger than six months old. These seizures typically involve brief periods of movement in the neck, trunk, or legs that last for a few seconds. Infants may experience hundreds of these seizures per day, and this can be a serious problem with potential long-term complications.

Febrile Seizures

Febrile seizures are seizures associated with fever, and they are most commonly seen in children between 6 months and 5 years of age. 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, while seizures lasting more than 15 minutes are called “complex” and may result in long-term neurological changes.

Childhood Absence Epilepsy

Childhood absence epilepsy is a specific type of generalized seizure disorder that involves brief episodes of staring and loss of awareness. These seizures are characterized by a 3 Hz generalized spike-wave pattern on an electroencephalogram (EEG).

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

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

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.

Childhood Absence Epilepsy | Epilepsy Foundation

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Example of the 3 Hz generalized spike wave

What is childhood absence epilepsy like?

Childhood absence epilepsy (CAE) is an epilepsy syndrome with absence seizures that begin in young children.

• During an absence seizure, the child stares blankly and is not aware or responsive. The child’s eyes may roll up briefly or the eyes may blink. Some children have repetitive movements like mouth chewing.
• Each seizure lasts about 10 to 20 seconds and ends abruptly.
• The child resumes normal activity right after the seizure and often doesn’t know that a seizure happened.
• Typically children have multiple absence seizures in a day before medication is started.
• Children usually develop normally, though children with very frequent absence seizures can have learning difficulties. Some children also have attention, concentration, and memory problems.

Learn More:

Who gets childhood absence epilepsy?

CAE accounts for 1 to 4 out of 50 people with epilepsy (2 to 8%). Absence seizures usually begin between the ages of 4 and 8 years old.

The cause is usually genetic. However, most children with CAE do not have abnormal results on testing for specific epilepsy genes.

• About 1 out of 3 families of children with CAE report a family history of absence seizures or other generalized seizures.
• The brothers and sisters of children with CAE have about a 1 in 10 chance of developing epilepsy.

How is CAE diagnosed?

• A history of the staring spells and any other health and learning problems is the first step in diagnosing CAE. A physical exam looks for other problems that could cause or be associated with the seizures. Children with CAE who have not yet started medicine often will have absence seizures with hyperventilation (deep breathing for 3-5 minutes).
• An EEG (electroencephalogram) is done to look for possible seizure activity. Hyperventilation and photic stimulation (exposure to rapid flashing lights) are often performed during the EEG. The EEG shows generalized spike and wave discharges at 3 Hz (cycles per second).
• CT (computed tomography) and MRI (magnetic resonance imaging) scans of the brain are normal and are not indicated for typical CAE.
• Screening for attention problems is recommended.

How is CAE treated?

• First-line medications (seizure medicines that are most helpful) include ethosuximide, valproic acid and lamotrigine. In most cases, these provide effective seizure control.
• In a recent study, ethosuximide (Zarontin) was shown to be the first drug of choice to treat absence seizures.
  • Valproate (Depakote) was equally as effective as ethosuximide, but ethosuximide caused fewer problems with attention than valproate.
  • Lamotrigine (Lamictal) was less effective, but certain side effects were less frequent compared to valproate. The side effects generally went away quickly and did not require stopping the drug during the study.
• If absence seizures continue after trying one of these seizure medications, combining these medications may help.
• Other medications have been used to treat absence seizures, like topiramate (Topamax), zonisamide (Zonegran), levetiracetam (Keppra), benzodiazepines (clobazam), stiripentol, and in a few reports amantadine (Symmetrel). These medicines should only be considered if the first-line medications are not working.
• Some children may also benefit from the ketogenic diet if their absences are not controlled by any combination of medicines.

What’s the outlook for children with CAE?

• At least 2 out of 3 children with CAE respond to treatment and the seizures disappear by mid-adolescence. In these cases, antiseizure medications can usually be weaned off.
• Problems with attention may continue despite controlling the seizures and are an important part of this epilepsy syndrome.
• Approximately 10-15% of children will develop other seizure types in adolescence, usually generalized tonic-clonic and myoclonic seizures.

Here’s a Typical Story

Sonia, a 6-year-old girl, “blanks out” for a few seconds and sometimes stops dancing for 10 seconds during her ballet lessons. Her teacher calls her name, but Sonia doesn’t seem to hear her. She usually blinks a few times and her eyes may roll up a bit, but with the short seizures she just stares. Then she is right back where she left off in her dance routine. Some days she has more than 50 of these spells.

What’s the difference?

How are childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE) different?

• When seizures start
  • CAE: usually between the ages of 3 and 11 years, most often between 5 and 8 years of age
  • JAE: usually between the ages of 9 and 13 years, but could start before age 9
• Frequency of absence seizure
  • CAE: multiple, often 10-50, per day
  • JAE: often less than daily
• Outlook
  • CAE often goes away as the child gets older
  • JAE is usually a life-long condition

Learn More

• Absence Seizures
• First Aid for Absence Seizures
• Signs & Symptoms of Seizures in Youth
• Is epilepsy inherited?
• Genetics: The Basics

Resources

• Epilepsy Foundation My Seizure Diary
• School Nurse, School Personnel, & Child Care Personnel Training
• Find your local Epilepsy Foundation

Learn More:

Authored By:

Gregory L. Holmes MD

Robert Fisher MD, PhD

on Sunday, September 01, 2013

Reviewed By:

Elaine Wirrell MD

on Sunday, January 19, 2020

Leg cramped! How to help a child with muscle cramps?

The golden rule for parents – do not compare children with each other. And give everyone your affectionate nickname.

Pediatricians regularly encounter complaints of leg cramps, both from teenagers and from toddlers. Most often, seizures occur during falling asleep or in the middle of the night, causing the child to wake up from a sharp pain. Why does such an unpleasant phenomenon occur and how to deal with it?

Why is the child’s leg cramping?

A cramp is an involuntary contraction of one or more muscle groups, in other words, a spasm. With a leg cramp, it usually reduces the calf muscle, located on the back of the leg. The spasm can be so strong that the child is simply unable to straighten the foot, and from the side it seems as if he stood on tiptoe.

There are actually many possible causes of such seizures. But there are three main factors that lead to the vast majority of calf spasms in children. First of all, this is a violation of the balance of vitamins and trace elements, especially a lack of magnesium. More than half of the cramps of the lower extremities are associated with a deficiency of this mineral, since it is necessary to relax the muscles and relieve its hypertonicity.

Potassium and calcium deficiency can also affect. Often, leg cramps torment babies during the period of active growth, when many vitamins and minerals are consumed by the child’s body at an accelerated pace.

Prolonged, excessively intense loads on the legs, such as running, swimming, football, etc., also lead to cramps. Children, in comparison with adults, are very active physically. They have an amazing ability to not feel tired when something grabs them. For example, a preschool child can ride a bicycle for hours until he is completely exhausted, without realizing it. In this case, night cramps become a reaction of the body to overload.

In addition, spasms of the calf muscles can be a precursor to the beginning or already developed flat feet.

The above causes are most likely if the child has had regular seizures for a long time. But there are also causes of “one-time” spasms of the calf muscles:

• Finding the leg in an uncomfortable position and in an unchanging position;
• Hypothermia of the lower extremities (especially dangerous is swimming in a pond at low water temperature).

Prolonged and intense exercise on the legs causes spasms of the calf muscles.

First aid for leg cramps

When a child has a leg cramp, you need to perform an action that will stretch the calf muscle. This is the basic principle of first aid for a cramp. The child should pull the toe of the closed leg towards himself, as if straightening it. For a few seconds, this may cause acute pain, but then the cramp should pass. If the condition has not improved, the thrust should be weakened, and then strengthened again. But if this procedure does not help, you need to get up and walk around a bit to speed up blood flow to the limbs and help relieve spasm.

The muscle should then be massaged and a heating pad applied, or simply immersed in a bath of warm water. After that, ask the child to lie down for about ten minutes with legs raised – this will improve the outflow of blood in the limbs and reduce the likelihood of re-convulsions.

For leg cramps, stretch the calf muscle.

Treatment and prevention of seizures

A child experiencing regular seizures should see a pediatrician. The attending physician will prescribe an examination and, if necessary, give a referral to narrower specialists, for example, to an orthopedist in case of suspected flat feet.

Parents, on the other hand, should adjust the baby’s nutrition by adding foods rich in magnesium and potassium to the diet. These include legumes, carrots, green leafy vegetables, seaweed, bananas, and dried apricots. It will also be useful to take children’s vitamin and mineral complexes.

Organize the child’s sleeping area so that the child sleeps with legs slightly elevated. To do this, you can put several sofa cushions or a cushion on the edge of the bed. Before going to bed, the baby can be given a light foot massage with a warming ointment (it must be chosen on the advice of a pediatrician) or take a warm bath.

Of course, if the child experiences a lot of physical stress on the legs while playing sports, the intensity of training will have to be reduced for some time. In general, convulsions will not bother the baby for a long time when family members notice and promptly begin to solve this problem.

Convulsions in a child. Why does the child have seizures? Help. Causes.

What should I do if my child has seizures?

Seizures in early childhood are one of the most common reasons for parents to visit a doctor, and often these convulsions have a painful basis – ion exchange disorders, fever, injuries.

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Seizures in children

The cause of seizures is a central nervous system lesion a child with the appearance of a focus of pathological excitation and the transition of excitation to the nerve endings and body muscles. This gives a typical clinical picture of seizures.

Most convulsions occur in children at an early age, when the nervous system is still immature and easily excitable by impulses coming from outside or from within the body. The stages of maturation of the brain and the entire nervous system of the child determine the features of the age-related manifestation of seizures – both diagnostic and therapeutic measures. There are many types of seizures and their equivalents, so it’s important to know what it looks like and how to help if a seizure occurs.

Seizures and convulsive syndrome are distinguished separately in the neonatal period, at the age of the first year of life, in early childhood, in later life. But if in adulthood it is possible to at least communicate with the patient and find out the data necessary for the doctor, then it is more difficult for kids, here parents come to the rescue and their attention and observation.

Causes of seizures

Seizures in children at different ages can be caused by different groups of causes, but in general there are several leading factors in the development of seizures:

1. infectious diseases, including those with damage to the nervous system, viral or microbial diseases,
2. intoxication with various substances, poisons, waste products of microbes,
3. head injuries, brain injuries, cysts, tumors, hemorrhages in the brain area,
4. metabolic disorders leading to problems in the nervous system,
5. diseases of the nervous system, hypoxia of the nervous system, circulatory disorders, clotting disorders,
6. genetic predisposition factors, birth defects,
7. epilepsy.

Seizures are one of the typical symptoms of epilepsy, but the occurrence of seizures does not mean that a child may have epilepsy. There are plenty of reasons for the development of seizures, in addition to epilepsy itself. Therefore, we can talk about two types of seizures – epileptic origin and non-epileptic seizures.

Mechanism of seizures in children

Since there are many causes of seizures, the mechanism of seizures is multifactorial, complex and may be different depending on age. However, one of the always present factors should be an excessively excited focus of activity in the brain as a result of any influences, as well as the predominance of excitatory processes over inhibition processes in this focus. Excitation can move from one zone to another, spreading from a congestive focus, and can also occur as a reaction to the death of neurons in tumors, hemorrhages, or vascular malformations. This is proved by the fact that when the dead neurons and tumors are surgically removed, the convulsive activity disappears.

Sometimes excessive stimulation of special receptors in brain structures by various psychoactive and neurotropic substances plays a role in the genesis of seizures. Sometimes, convulsions can be reflected in a head injury, on the other hand.

Convulsions in the neonatal period

In the early neonatal period, convulsions in newborns can be minimal or small, they are also called imaginary – with them there is convulsive activity of the brain, but there are neither tonic nor clonic twitching of the limbs, while there are respiratory disorders according to the type of apnea (stop breathing) or dyspnea (breathing disorders), there may be rolling eyes, trembling of the eyelids and their convulsive twitching, salivation, chewing by the mouth and convulsive sucking of the breast or nipples.

There may also be multifocal or multifocal manifestations of seizures, and they may also be migratory. There may also be clonic manifestations of seizures – focal seizures, tonic and myoclonic. To assess the manifestations of seizures, it is necessary to know the age of the child in days or weeks, then the causes of seizures and how to eliminate them can become clearer. On the first and second days after birth, convulsions can mainly be due to previous hypoxia and birth injuries, the presence of intracranial hemorrhages. Less frequent in the first two days of life, the causes for seizures are the effect of administered drugs, metabolic disorders, withdrawal syndrome at the birth of children from mothers with bad habits.

From the age of 3-4 days, children may develop hypoglycemia, various intrauterine and already acquired infections, especially if these are generalized infections – meningitis, sepsis, congenital diseases of rubella, herpes, cytomegaly or toxoplasmosis. Can cause convulsions in the neonatal period calcium, sodium or magnesium deficiency, kernicterus.

One of the variants of the pathology may be the manifestation of the so-called benign family seizures. The child has indications that everyone in his family at birth gave convulsions that occur on the third day or later, they go away on their own or are quickly stopped by medications, while metabolic disorders and other causes are not detected.

How are seizures treated in newborns?

These newborns should be isolated in an intensive care unit in an incubator or oxygen tent. It is necessary to create peace for the child and conduct an examination as quickly as possible. It is necessary to carry out symptomatic measures to restore the water and salt balance, normalize microcirculation and improve the nutrition of the brain tissue. The baby may be shown humidified oxygen or an oxygen mixture. If it is necessary to relieve seizures, phenobarbital or seduxen is prescribed.

In the future, the baby is transferred under the supervision of a local pediatrician and neurologist, vaccinations are canceled for at least six months or a year. The child requires targeted observation and examination of the nervous system.

Convulsions in young children

A feature of convulsions in young children is that they can be provoked by impulses that are not as strong as they occur in adults. So, children often have hypoxic or febrile convulsions, and the latter are observed in children starting from two to three months of age, if their body temperature rises above 38.0 degrees. Such convulsions are usually generalized – tonic or tonic-clonic, although they can be of any other nature. Febrile convulsions can be called simple if they occurred once against the background of high fever and lasted no more than ten to fifteen minutes, there were no focal symptoms and impaired consciousness. A more complicated situation arises if convulsions are repeated repeatedly, other neurological symptoms occur and convulsions last a very long time, they stop only in a hospital.

These seizures do not occur in children after two or three years of age, seizures at this age usually indicate manifestations of epilepsy.

Why do they occur?

It is still not exactly clear why febrile seizures occur, but one of the influencing factors is the immaturity of the nervous system and the thermoregulatory center in the brain. Also contributes to the development of febrile convulsions, the weakness of the processes of inhibition in the cerebral cortex, which gives the formation of excitation in the cortex and from this focus of excitation – the formation of a convulsive attack. Such convulsions can occur against the background of a fever with a cold, flu, a reaction to a vaccination, or with an exacerbation of a chronic pathology. One of the important factors in the development of febrile seizures is the predisposition to them, transmitted genetically. If parents or relatives have epilepsy or had seizures as a child, this may also occur in the child.

How to identify seizures?

Febrile convulsions in their manifestations are very similar to convulsions in epileptic seizures, their external signs are very similar to each other. Among febrile convulsions, there may be local seizures with rolling eyes, twitching of the limbs, there may be tonic seizures with strong tension of all muscle groups, throwing the head back and bringing the arms to the chest, and strong straightening of the legs. After such a tone, a series of rhythmic twitching of the limbs or strong shuddering of individual parts of the body follow. There may also be atonic seizures with severe limpness of all the muscles of the body, stool and urine discharge. Such attacks will last from two to fifteen minutes, they can follow a small series of several visits. During an attack, the child’s consciousness is usually disturbed, and contact with him is very difficult – he may not respond at all to the speech of adults, does not cry or scream. There may be breath holdings with blue or severe pallor. In the future, for subsequent episodes of fever, a recurrence of febrile seizures occurs in 30%. Such a child requires targeted examination and observation by a neurologist.

What should I do if I have seizures?

Seizures is not a condition where you can manage with a pill or self-medication, the seizure can recur and harm the child. It is necessary to immediately call an ambulance, and until the moment the doctors arrive, put the child in a safe place and free him from tight clothing, elastic bands and fasteners. It is important to lay the child on its side so that the head is on its side and in case of vomiting there is no aspiration of the contents. A clean cloth or handkerchief should be placed between the child’s teeth so that there is no biting of the tongue and additional injury. It is also necessary to provide the child with an influx of fresh air and a calm environment, there is no need to additionally shake and disturb the child, you should not inflict additional injuries on him.

If a seizure occurs in the presence of a high temperature, the child should be given an antipyretic drug, undressed and, if possible, used all available methods of physical cooling. But, at the same time, you can’t rub it with vodka, vinegar or alcohol, this will only make it worse. From rubbing, heat transfer increases and the fever will only increase. And toxic vapors of alcohol or vinegar can create an additional focus of excitation in the brain.

You can wipe the child with a sponge soaked in water at room temperature, open it and fan it with a rag, apply cold on the projections of large arteries.

If convulsions occur against the background of a strong cry or crying of a child, the so-called respiratory convulsions, the child starts crying, turns blue, it is necessary to carry out a reflex restoration of breathing – spraying with water, ammonia on a cotton pad, pressing a spoon on the root of the tongue, then taking sedatives is necessary.

After an attack, it is necessary to calm the child and pull yourself together, be prepared for the fact that the attacks may recur. It is important to pay attention to the duration of the attacks, the intervals between them and the behavior of the child between attacks, this information will be extremely important for the doctors who will come to your aid. Also, the doctor will need information on the events that preceded the seizures, provoked them, or could affect the development and duration of seizures. It is important to note whether the child had any illnesses, medications, contact with household chemicals or toxins, vaccinations, and other things.

Doctors may suggest hospitalization and observation of the child in a hospital, but you should not refuse, convulsions may recur, and it is necessary to find out their exact cause, draw up a plan for observation and management of the child in the future. The doctor will determine what is needed – taking anti-seizure medications or just monitoring the condition. For the most part, convulsions in children do not pose a serious danger in children, and pass without a trace. But in some cases, they can be a signal of a serious pathology, and it is necessary to accurately determine their cause and eliminate it immediately.

Seizures in children: types, causes, first aid

Seizures in children are a serious medical emergency that requires immediate medical attention. Convulsions in a child can develop for many reasons due to the functional immaturity of the nervous system, so the baby’s parents must have comprehensive information on this issue and be able to provide the necessary assistance in a timely manner before the arrival of the ambulance team.

The concept of convulsions implies a sudden involuntary (uncontrolled) contraction of the child’s muscles, most often accompanied by loss of consciousness, involuntary defecation and urination, the appearance of foam from the mouth, often accompanied by respiratory arrest.

Causes of seizures

The appearance of seizures in a child indicates a violation in the functioning of the central nervous system. In some cases, damage to the nervous system is congenital, that is, there is an organic lesion of the central nervous system that occurred during pregnancy: then convulsions develop in the child shortly after birth under the influence of any provoking factors. Seizures can also be functional in nature, that is, they can be caused by a temporary disruption in the functioning of the nervous system – such changes are completely reversible, with timely medical care and treatment, it is possible to achieve a complete cure for the child.

The most common causes of seizures in children are:

1. Perinatal damage to the central nervous system . Among the causes of convulsive syndrome in a child is the most common. Damage to the central nervous system occurs due to hypoxia (acute oxygen starvation of the brain) or asphyxia (for example, aspiration of amniotic fluid) suffered during pregnancy or during childbirth.
2. Anomalies in the formation of the brain . Violation of the laying of structures and parts of the brain in a child during embryogenesis can also lead to the appearance of seizures.
3. Idiopathic epilepsy . The disease often manifests in childhood, there is a hereditary predisposition.
4. Damage to the nervous system of an infectious nature (meningitis, encephalitis, meningoencephalitis). Neuroinfections often cause convulsions due to acute inflammation in the membranes and substance of the brain.
5. Septic conditions. With a systemic inflammatory reaction, multiple organ failure occurs, one of the manifestations of which is the appearance of seizures in a child. With sepsis, high fever is typical, which also aggravates the state of the nervous system and provokes the appearance of involuntary muscle contractions.
6. Fever (so-called febrile convulsions ). They develop with an increase in body temperature above 38-38.5 degrees. Febrile convulsions are most typical for children under one year of age due to the functional immaturity of the thermoregulation system.
7. Brain tumor . The presence of focal pathology of the central nervous system can provoke an increase in the convulsive readiness of the child’s body in response to any stimuli.

Types of convulsions

Depending on the type of involuntary muscle contractions, the following types of convulsions can be distinguished :

1. Tonic convulsions . Involuntary muscle contraction, while the limb freezes in the position of extension or flexion, the child’s body itself, as a rule, is straightened, and the head is thrown back.
2. Clonic convulsions . With this type of muscle contraction, the flexor and extensor muscles are fast, involuntarily contracting, while the movements of the child’s body resemble the movements of a puppet.
3. Tonic-clonic . This variant of seizures includes a sequential alternation of tonic and clonic phases of a convulsive seizure.

First aid measures

The occurrence of convulsive syndrome in a child requires immediate first aid measures. First of all, an order should be given for one of the family members to call an ambulance, be sure to inform the dispatcher that the child has convulsions, a specialized neurological team will be sent, and the parents themselves begin first aid measures for convulsions.

The child should be placed on a flat hard surface, the child’s head should be turned on its side (this is done in order to prevent aspiration of vomit in case of spontaneous vomiting, which often happens during a convulsive attack), remove clothing that restricts movement, unbutton the collar. The window in the room should be wide open to provide fresh air. The child should not be shaken or attempted to restrain involuntary movements and muscle contractions, this can prolong the time of a convulsive attack. So that the child does not injure himself during an attack of convulsions, be sure to remove all sharp objects that are nearby, and insert a folded handkerchief between the child’s teeth to prevent injury to the tongue by involuntary clenching of the jaws. In no case should hard objects be inserted between the teeth, this action can lead to trauma to the teeth, their fracture, followed by aspiration of foreign objects into the respiratory tract, which can lead to asphyxia.

The duration of the attack usually does not exceed 3-5 minutes, most often the attack lasts a few seconds. After an attack, the child’s behavior can be different: from deep sleep to nervous excitement. Most often, the child falls asleep after an attack and does not remember what happened to him. By the time the ambulance arrives, the attack, as a rule, ends, the neurologist examines the child and decides on the need for hospitalization and the introduction of anticonvulsant drugs to prevent the occurrence of a recurrent seizure. When diagnosing neuroinfections in a child (meningitis, meningoencephalitis), which are often meningococcal in nature, or a septic condition, hospitalization of the child in the intensive care unit or intensive care unit at the neurological department of the children’s clinical hospital is required.

Help with febrile convulsions

In febrile convulsions, the main etiopathogenetic link is an increase in body temperature to febrile numbers, which provokes a response of the child’s nervous system in the form of a convulsive attack, so first aid measures should be aimed at a rapid decrease in body temperature. For these purposes, preparations based on paracetamol are used, the remedy of choice is paracetamol in the form of rectal suppositories (cefecon). Rectal administration of antipyretic drugs has the advantage of rapid absorption (temperature usually begins to decrease after 10-15 minutes from the time of administration), and also does not provoke vomiting, since oral administration of drugs during an attack is impossible. Also, to quickly reduce body temperature, you can apply rubbing with cool water or a very weak solution of vinegar. You can put ice on the carotid and femoral arteries (this is the most effective way, in children the vessels are located close to the skin, so the cooling effect of the blood develops quite quickly). Upon arrival of an ambulance, if the temperature does not decrease, the child can be given an antipyretic injection. It has been proven that there is no correlation between a history of febrile seizures in a child and the incidence of epilepsy in the future, the etiopathogenesis of these conditions is completely different.

Examination of a child after a seizure

In most cases, after the attack has been controlled, hospitalization in the neurological or infectious diseases department is necessary to examine the child in order to determine the cause of the seizure. Hospitalization should not be refused, since a repeated attack or convulsive status may develop, which cannot be stopped without the use of medical assistance, since respiratory arrest may occur during an attack.

The amount of necessary research depends on the age of the child, the reasons that triggered the seizures, as well as the presence of concomitant diseases. It is obligatory to examine the child by a neurologist with an assessment of the neurological status of the child. It will also be necessary to perform an EEG during wakefulness or during sleep of the child (day and night) in order to fix the possible epiactivity and convulsive readiness of the nervous system. If a large fontanel has not yet closed in a child, then neurosonography is indicated to assess the state of the brain structures in order to identify a possible organic pathology of the child’s central nervous system. If the fontanel in a child has already closed, or its size is so small that it does not allow a clear picture of the brain structures, then the method of choice is to conduct an MRI of the brain and its vessels to exclude focal neurological pathology.

In some cases, if a neuroinfection is suspected, a lumbar puncture may be required to obtain CSF for bacteriological and microscopic examination.

After an attack of convulsions, the child should be registered with a neurologist, undergo regular examinations: an examination by a neurologist once every 3-4 months with an assessment of the neurological status, a planned EEG.

Prevention

Preventive measures should begin long before the birth of a child, at the stage of pregnancy planning. It is advisable for future parents to start taking folic acid (on average at a dose of 400 mcg per day) 3 months before the intended conception of a child, this reduces the likelihood of malformations of the nervous system in the unborn child.

During pregnancy, a woman should avoid exposure to adverse factors, such as acute and chronic viral infections, TORCH infections (rubella, cytomegalovirus infection, toxoplasmosis, herpes virus infection), x-rays, unreasonable intake of any medications. It is imperative to undergo screening examinations (ultrasound and biochemical blood tests) in a timely manner, which allows timely diagnosis of possible disorders in the development of the nervous system in the fetus.

After childbirth, a routine examination should not be neglected, which includes an examination by a neurologist in the first year of life at the age of 1 month, 3 months, 6 months, 9 and 12 months. At the age of 1 month of life, it is also mandatory to conduct neurosonography (NSG), this study allows you to evaluate the structures of the brain using ultrasound through the large fontanel. If any pathology of the central nervous system is detected, neurosonography may be recommended in 2-3 months for dynamic monitoring. If deviations from the norm are detected, timely treatment can be recommended, which will prevent the child from developing a convulsive syndrome, as well as a lag in physical and neuropsychic development.

Prevention of febrile convulsions in a child occupies a separate place in prevention.