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).