What are the different types of seizures that can affect children. How do focal and generalized seizures differ in their manifestation. Can seizures in two-year-olds be a sign of epilepsy. What are the symptoms parents should watch for in toddlers experiencing seizures.

Understanding Pediatric Seizures: Focal vs. Generalized

Seizures in children can be alarming for parents, especially when they occur in young toddlers. To better understand these neurological events, it’s crucial to recognize the two main categories of pediatric seizures: focal and generalized.

Focal Seizures in Children

Focal seizures, also known as partial seizures, originate in a specific area of one side of the brain. These seizures can be further divided into two subtypes:

• Simple focal seizures
• Complex focal seizures

In some cases, children may experience an aura before a focal seizure occurs. This aura can manifest as strange sensations, including visual changes, hearing abnormalities, or alterations in the sense of smell.

Simple Focal Seizures

Simple focal seizures typically last less than a minute and can affect different parts of the body depending on which area of the brain is involved. For instance, if the seizure activity occurs in the occipital lobe, the child’s vision may be temporarily altered.

More commonly, simple focal seizures affect the child’s muscles. The seizure activity may be limited to an isolated muscle group, such as fingers, or extend to larger muscles in the arms and legs. Importantly, consciousness is not lost during simple focal seizures.

Complex Focal Seizures

Complex focal seizures often originate in the temporal lobe, which controls emotion and memory function. These seizures typically last between one to two minutes and are characterized by a loss of consciousness.

During a complex focal seizure, children may exhibit a variety of behaviors, including:

• Gagging
• Lip smacking
• Running
• Screaming
• Crying
• Laughing

After regaining consciousness, children often experience a postictal period, during which they may feel tired or sleepy.

Generalized Seizures: When Both Sides of the Brain Are Affected

Generalized seizures involve both sides of the brain and are characterized by a loss of consciousness followed by a postictal state. There are several subtypes of generalized seizures, each with distinct characteristics and age-related prevalence.

Absence Seizures

Absence seizures, formerly known as petit mal seizures, are characterized by brief episodes of altered consciousness and staring. These seizures typically last no longer than 30 seconds and may occur several times a day.

Children experiencing absence seizures may maintain their posture, with only slight movements of the mouth, face, or eyes. After the seizure, the child may not remember what happened and continue their activities as if nothing occurred.

Absence seizures are most common in children between 4 and 12 years old 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. During these seizures, children may fall from a standing position or suddenly drop their head. The child becomes limp and unresponsive for the duration of the seizure.

Generalized Tonic-Clonic Seizures

Generalized tonic-clonic seizures, previously known as grand mal seizures, are characterized by five distinct phases:

1. Flexion (contraction of the body, arms, and legs)
2. Extension (straightening out of the limbs)
3. Tremor (shaking)
4. Clonic period (contraction and relaxation of muscles)
5. Postictal period

During the postictal period, children may experience sleepiness, vision or speech problems, headaches, fatigue, and body aches.

Seizures Specific to Infants and Young Children

While seizures can affect children of all ages, some types are more common or specific to infants and young toddlers.

Infantile Spasms

Infantile spasms are a rare type of seizure disorder that occurs in infants younger than six months. These seizures often happen when the infant is waking up or falling asleep and are characterized by brief periods of movement in the neck, trunk, or legs, lasting for a few seconds.

Infants may experience hundreds of these seizures daily, which can lead to serious long-term complications if left untreated.

Febrile Seizures

Febrile seizures are associated with fever and 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 are classified into two categories:

• Simple febrile seizures: Last less than 15 minutes and typically do not have long-term neurological effects.
• Complex febrile seizures: Last more than 15 minutes and may lead to long-term neurological changes in the child.

Recognizing Seizure Symptoms in Two-Year-Olds

Identifying seizures in two-year-olds can be challenging, as symptoms may vary depending on the type of seizure. However, there are some common signs parents should be aware of:

• Sudden loss of consciousness or awareness
• Staring spells
• Repetitive movements (such as lip smacking or hand rubbing)
• Sudden falls or loss of muscle control
• Jerking movements of the arms, legs, or body
• Changes in breathing patterns
• Sudden mood changes or confusion

If you suspect your two-year-old is experiencing seizures, it’s crucial to consult a pediatric neurologist for proper diagnosis and treatment.

Diagnosing Seizures in Young Children

Diagnosing seizures in two-year-olds and other young children often involves a combination of medical history, physical examination, and diagnostic tests. The process may include:

• Detailed medical history, including family history of seizures or epilepsy
• Neurological examination
• Electroencephalogram (EEG) to measure brain activity
• Imaging studies such as MRI or CT scan
• Blood tests to rule out other conditions

In some cases, video EEG monitoring may be necessary to capture seizure activity and correlate it with behavioral changes.

Treatment Options for Pediatric Seizures

The treatment of seizures in two-year-olds and other children depends on various factors, including the type and frequency of seizures, as well as the underlying cause. Common treatment approaches include:

Anti-Epileptic Medications

Anti-epileptic drugs (AEDs) are often the first line of treatment for recurring seizures. These medications work by stabilizing electrical activity in the brain to prevent seizures. The choice of medication depends on the type of seizure, the child’s age, and potential side effects.

Ketogenic Diet

In some cases, particularly for children with drug-resistant epilepsy, a ketogenic diet may be recommended. This high-fat, low-carbohydrate diet has shown effectiveness in reducing seizure frequency in some children.

Vagus Nerve Stimulation

For children who don’t respond well to medications, vagus nerve stimulation (VNS) may be considered. This involves implanting a device that sends electrical pulses to the vagus nerve, which can help reduce seizure activity.

Surgery

In rare cases where seizures are caused by a specific area of abnormal brain tissue, surgery to remove that area may be recommended. This option is typically considered only when other treatments have failed and the seizures significantly impact the child’s quality of life.

Long-Term Outlook for Children with Seizures

The long-term prognosis for children experiencing seizures varies depending on several factors, including:

• Type and frequency of seizures
• Age of onset
• Response to treatment
• Underlying cause of the seizures

Many children with seizures, especially those with well-controlled epilepsy, go on to lead normal, healthy lives. However, some may face challenges in areas such as learning, behavior, and social development. Early intervention and comprehensive care are crucial for optimizing outcomes.

Supporting Children with Seizures: Tips for Parents and Caregivers

Caring for a child with seizures can be challenging, but there are several ways parents and caregivers can provide support:

• Educate yourself about your child’s specific type of seizures and treatment plan
• Keep detailed records of seizure activity to share with healthcare providers
• Create a safe home environment to minimize injury risks during seizures
• Develop an emergency action plan and share it with family members, teachers, and caregivers
• Encourage open communication with your child about their condition
• Join support groups to connect with other families facing similar challenges
• Work closely with your child’s healthcare team to optimize treatment and monitor progress

By staying informed and proactive, parents can help ensure the best possible quality of life for children experiencing seizures.

Advances in Pediatric Seizure Research and Treatment

The field of pediatric neurology is continuously evolving, with ongoing research aimed at improving our understanding and treatment of seizures in children. Some promising areas of advancement include:

Precision Medicine Approaches

Researchers are exploring ways to tailor seizure treatments based on an individual child’s genetic profile and specific seizure characteristics. This personalized approach may lead to more effective and targeted therapies with fewer side effects.

Novel Anti-Epileptic Medications

New anti-epileptic drugs are being developed and tested, offering hope for children with drug-resistant epilepsy. These medications aim to provide better seizure control with fewer adverse effects.

Neuromodulation Techniques

In addition to vagus nerve stimulation, other neuromodulation techniques are being investigated for their potential in treating pediatric seizures. These include responsive neurostimulation (RNS) and deep brain stimulation (DBS).

Gene Therapy

For certain genetic forms of epilepsy, researchers are exploring the potential of gene therapy to correct or compensate for genetic mutations associated with seizure disorders.

Improved Diagnostic Tools

Advancements in neuroimaging and electrophysiological techniques are enhancing our ability to diagnose and localize seizure activity in children’s brains, potentially leading to more precise treatment strategies.

As research progresses, the outlook for children with seizures continues to improve, offering hope for better seizure control and improved quality of life.

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.

Epilepsy in children – Better Health Channel

About epilepsy in children

Epilepsy can begin at any time of life, but it’s most commonly diagnosed in children, and people over the age of 65.

Some children with epilepsy will outgrow their seizures as they mature, while others may have seizures that continue into adulthood.

Although epilepsy varies from person to person, many children with epilepsy have seizures that respond well to medication, and they enjoy a normal and active childhood.

Recognising epilepsy in children

Seizures may not always be recognised in children when they first occur, depending on the seizure type.

People often think of seizures as convulsive, but some seizures can be subtle and very brief, such as an ‘absence seizure’, in which the child has brief episodes of loss of awareness and responsiveness.

Furthermore, there are many ‘non-epileptic’ episodes that can mimic seizures, and epileptic seizures often don’t look the way people expect them to. This can sometimes make diagnosis complicated.

Some childhood events that may be confused with seizures are:

• fainting spells
• breath-holding spells
• normal sleep jerks
• daydreaming
• night terrors
• migraine
• heart and stomach problems
• mental health issues.

Febrile convulsions

Febrile convulsions are seizures brought on by fever during times of illness. They tend to occur in families. About 1 in 25 children has a febrile convulsion at some time, most commonly between the ages of 6 months and 6 years.

Up to one third of children will have further febrile convulsions with consecutive fevers. Having febrile convulsions does not mean the child has epilepsy and their risk of developing epilepsy is no higher than anyone else. There is a slightly higher risk of developing epilepsy if there is a family history of epilepsy, or the child has a neurodevelopmental impairment (such as cerebral palsy). Or the child has a complex febrile convulsion.

A complex febrile convulsion is when the convulsion:

• lasts more than 15 minutes
• may involve a part or side of the body
• happens more than once in 24 hours.

Understanding the diagnosis of epilepsy

If your child has had a seizure it is most likely you will have received a referral for an EEG and a neurologist or paediatrician appointment.

An important part of epilepsy diagnosis is a good description of the seizure(s) and symptoms surrounding it. Sometimes a video of a seizure can be helpful.
Tests can often return normal, but this is common and does not necessarily mean a seizure didn’t happen.

Epilepsy syndromes

There are many different seizure types. Broadly, seizures are classified as either ‘focal’ or ‘generalised’ (see the Epilepsy page for more information).

An epilepsy syndrome can be diagnosed when a group of signs and symptoms occur together. For example, when particular types of seizures begin at a certain age and are associated with other conditions or characteristics. Some of the specific signs and symptoms in epilepsy syndromes that doctors look for include:

• the type of seizures
• the age at which they start
• the specific pattern they show on EEG (electroencephalogram) (a medical test used to measure the electrical activity of the brain).

If the epilepsy fits a particular syndrome, this can help the doctor to select the best medication for that syndrome. It can also help to predict whether the seizures are likely to be easily controlled, limited to childhood, or whether the condition may be more persistent.

Some of the more common types or epilepsy or epilepsy syndromes in childhood include:

• childhood absence epilepsy (CAE) – these seizures usually start between ages 2 to 12. Absence seizures are very brief: the child will suddenly stop what they are doing and stare blankly, like they are daydreaming. Just as suddenly they stop and continue with the previous activity. Absence seizures can happen numerous times a day. They are usually well controlled with medication, and stop by puberty
• juvenile absence epilepsy (JAE) – these seizures usually start between ages 8 to 20. The seizures are like childhood absence seizures but may be longer and can include movements such as eyelid fluttering or chewing. They occur less often than childhood absence epilepsy seizures. Up to 80% of children with this type of epilepsy will also have tonic-clonic seizures. The seizures can be well controlled with medication, but the syndrome is considered lifelong
• benign rolandic epilepsy/benign epilepsy with centrotemporal spikes (BECTS) – onset age is usually 1 to 14 years. Seizures are often focal and include twitching, numbness or tingling of the child’s face or tongue, and may interfere with speech and cause drooling. Sometimes they can progress into a tonic-clonic seizure. Seizures usually happen in early stages of sleep. Medication is not always needed. This type of epilepsy resolves by about age 15 years.
• juvenile myoclonic epilepsy (JME) – this syndrome can be diagnosed anywhere between 8 and 25 years and tends to run in families. It typically starts with myoclonic seizures that occur soon after waking either in the morning or from a nap. They are sudden, single muscle jerks of both arms. Sometimes these movements are not obvious, and make the person seem clumsy or prone to dropping things. Tonic-clonic seizures can also occur, and this usually leads to diagnosis. Seizures can be well controlled with medication and lifestyle changes.
• temporal lobe epilepsy (TLE) – this type of epilepsy can start at any age. It involves focal onset seizures with or without impairment of awareness. Seizures are often unusual and involve confusion and changed behaviours or emotions. Sometimes seizures may progress to tonic-clonic seizures.
• frontal lobe epilepsy (FLE) – this type of focal epilepsy can start at any age. It involves focal onset seizures with or without impairment of awareness. Seizures are often unusual and may include vigorous motor (physical) activity or emotions. FLE can be confused with behaviours, psychiatric disorders or sleep disorders such as parasomnias or night terrors, and the child may need prolonged monitoring to make a diagnosis
• West syndrome or infantile spasms – onset of this syndrome is typically seen during the first year of life. The very brief spasms (seizures called infantile spasms) cause the baby to stiffen suddenly. Often the arms are flung out as the knees are pulled up and the body bends forward (‘jack-knife seizures’). The baby will cry. The spasms usually occur in clusters. Sometimes they are mistaken for colic, but the cramps of colic don’t occur in clusters. Most children develop other kinds of seizures in later childhood, including an epilepsy syndrome called Lennox-Gastaut Syndrome. Intellectual disability is usually seen.
• Lennox-Gastaut syndrome (LGS) – this syndrome has the onset of seizures from age 3 to 5 years. It can include multiple seizure types and seizures are resistant to medication. Intellectual disability is seen in up to 90% of people with this syndrome.

Some other, less common, forms of epilepsy include:

• generalised epilepsy febrile seizures plus (GEFS+)External Link
• severe myoclonic epilepsy of infancy (Dravet syndrome)External Link
• myoclonic epilepsy of infancy (Doose syndome)External Link
• Landau-Kleffner syndrome (LKS)External Link
• Rasmussen’s syndromeExternal Link.

Treatment of epilepsy

Medications used to control seizures are called antiepileptic drugs (AEDs). The decision whether to treat a child with AEDs after they have been diagnosed with epilepsy is made depending on the risk of further seizures against the potential risks and benefits of AEDs. This decision also incorporates the family’s values and preferences.

Medication is the first line of treatment for epilepsy. Medications are not a cure, but they lessen or stop the seizures, preferably with few or no side-effects. Medications are not always prescribed for every child who has a seizure.

Starting a child on medication can be a difficult choice. Most parents worry about side effects and any long-term effects of taking medications. The doctor will consider the risks of having seizures versus the risks and benefits of taking medication for the child.

Whether or not to prescribe medication, and what type of medication, will depend on:

• the likelihood of further seizures
• the type of seizures the child has, and how often they occur
• the risks the seizures may pose
• the age of the child
• the presence of developmental or behavioural problems
• the wishes or willingness of the child and family to start medication.

Treatment is not recommended lightly and the decision to treat is usually based on sound clinical evidence. AEDs are effective for approximately 70% of people with epilepsy (although it may take time to find the right medication or combination of medications). If several medications fail to control seizures, other options for treatment may be considered such as:

• surgery
• vagus nerve stimulation
• dietary management.

Most AEDs are started at a low dose and slowly increased until seizures no longer occur or if there are troublesome side effects. The dose may need to be adjusted as the child grows and their weight increases, or if new medications are added.

A second AED may be added or substituted if the first was not fully effective in stopping seizures, or if it caused unwanted side effects.

Many AEDs interact with other medications, causing unwanted reactions or reducing their effectiveness. Speak to your doctor or pharmacist before giving your child any other medication or supplement, even over-the-counter medicines for coughs and colds.

Never stop AEDs suddenly. This can cause seizures – sometimes seizures that are more severe than usual. Instead, under the guidance of your doctor, wean your child off these medications slowly to avoid withdrawal side effects.

AEDs are not prescribed long term for seizures that aren’t considered epilepsy, such as febrile convulsions.

Epilepsy and the family

Epilepsy can sometimes be inherited, or passed down, in a family. If you’re planning a baby and concerned about the potential risks of epilepsy in the family, ask your doctor to explain any risks in your case. Genetic risks don’t apply to all epilepsies and, in most cases, are low.

The unpredictable nature of epilepsy can result in significant worry for children as well as their parents. People with epilepsy have a higher risk of experiencing depression and anxiety. Parents of children with epilepsy can sometimes experience isolation, stigma and the financial strain of increased medical appointments and time off work. They also report higher levels of anxiety and depression compared to parents of children without a chronic illness. In these cases, it’s important that parents also feel supported, which may include professional psychological support or financial assistance.

Parents with epilepsy may worry about the impact that their condition has on their role as a parent. You may decide to have a discussion with your child about your epilepsy and what to do in the event of a seizure. If you would like further support as a parent with epilepsy, the Epilepsy Foundation’s Information Line (Tel. 1300 761 487) is a free service for supporting people living with epilepsy.

Siblings can also feel overlooked when one child has additional needs (this is not only the case with epilepsy). Siblings AustraliaExternal Link has a range of resources for supporting siblings of children and adults with chronic illness or disability.

Epilepsy and learning

Most children with epilepsy have the same range of intelligence and abilities as other children. However, some children with epilepsy will have learning difficulties. This may be due to epilepsy-related factors such as an underlying brain abnormality, how often seizures happen, or due to a coexisting condition such as attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). Night-time seizures can cause daytime drowsiness, which can impact on learning and educational participation.

Sometimes medication also contributes to drowsiness, moods or behaviours. When a learning difficulty is identified in a child, there are strategies available – both medical and educational – that can be applied.

The Epilepsy Foundation has also developed a program called Epilepsy Smart SchoolsExternal Link. This national program provides a range of information and classroom supports for families, teachers and children living with epilepsy.

If you feel like there have been significant changes in your child’s learning, thinking skills, concentration or memory, then your child may need a full neuropsychological assessment. A neuropsychologist has specific training in understanding the relationship between the physical brain and behaviour, cognition (thinking skills) and how this can be affected by factors such as epilepsy, medication and mood.

Epilepsy – sport and play

Children with epilepsy should be encouraged to participate in and enjoy a full school and social life. They should be given the opportunity to engage in recreational activities where possible with the appropriate risk management strategies in place to support the child.

To manage the risk in schools, the Victorian Department of Education and Training Epilepsy and Seizure policyExternal Link states that schools are required to ensure appropriate health and management plans are in place for students with epilepsy. It also states that staff are trained by a recognised epilepsy provider to provide medical assistance in cases where emergency medication is required. The same approach can be applied to all recreational activities in the community.

Exercise can lead to improved physical and emotional health, including positive effects on seizure control. Striking a safe balance between epilepsy, its treatment, and appropriate exercise recommendations can bring children important health benefits.

It’s uncommon for seizures to be triggered by exercise or sports. Most sporting activities are suitable if the child avoids overexertion, dehydration and low blood sugar (hypoglycaemia). Take special care with activities such as water sports, or activities from heights.

Where an activity carries risk, general restrictions are sometimes unnecessarily imposed on children with epilepsy. Risks are best assessed for each child. Other safety precautions or adapting various activities may lower risks to an acceptable level. There are some activities that require closer supervision than others, for example:

• swimming – supervision by a competent adult is good practice for all children in and around water, whether that is a pool, beach or bath
• cycling – all children should wear a bike helmet and cycle away from busy roads
• climbing – trees and rocks present risks if the child’s seizures are not well controlled.

Epilepsy and genetics

Some types of epilepsy can run in families. Even if your family has a genetic form of epilepsy, the chances of passing it on are relatively low. For instance:

• A sibling of a child with epilepsy may have a slightly higher risk of developing epilepsy if there is a genetic tendency in the family for seizures and epilepsy. Even so, most siblings will not develop epilepsy.
• The risk for children whose father has epilepsy is only slightly higher.
• If the mother has epilepsy and the father does not, the risk is still less than 5 in 100.
• If both parents have epilepsy, the risk is a bit higher. Most children will not inherit epilepsy from a parent, but the chance of inheriting some types of epilepsy is higher.

If you’re planning on having a baby in the future and you are concerned about the potential risks of epilepsy, ask your doctor to explain the risks or refer you to a genetic counsellor for genetic testing. Genetic risks do not apply to all epilepsies.

If your child is diagnosed with epilepsy, it’s a good idea to learn as much as you can. Some suggestions that may help include:

• There are many types of epilepsy. Get a clear diagnosis if you can and seek out the information that is specific to your child.
• Your child will have questions – answer these clearly. There are some great animations to help explain to your child such as Understanding epilepsy digital comicExternal Link and Understanding epilepsy digital comic with narrativeExternal Link.
• Make sure that anyone who cares for your child knows how to help your child if a seizure occurs.
• A good first aid seizure animation for childrenExternal Link is also available. Or a first aid seizure animation for adultsExternal Link.
• The Epilepsy Foundation webinar Epilepsy During the School YearsExternal Link provides families with information and insights around the impact of epilepsy during the school years from the perspectives of a clinical neuropsychologist, a social worker and a parent of a child with epilepsy.
• As your child gets older, it’s important to help them take responsibility for their epilepsy – for example, remembering to take their medication at the right times without you prompting them.

Remember to keep a balance between protecting your child and fostering independence.

Epilepsy Parents AustraliaExternal Link is an active Facebook support group for parents of children with epilepsy.

Where to get help

• Your GP (doctor)
• Your paediatrician
• Your paediatric neurologist
• NURSE-ON-CALL Tel. 1300 60 60 24
• Epilepsy Action AustraliaExternal Link Tel. 1300 37 45 37
• Epilepsy Action Australia have produced animated seizure first-aid videos aimed at both adults and childrenExternal Link.
• The Epilepsy Nurse LineExternal Link is a phone and email service to support people living with epilepsy and their families. The Epilepsy Nurse Line is available from 9am to 5pm, seven days a week in all Australian states and territories. Tel. 1300 EPILEPSY (37 45 37) or email [email protected]
• Paediatric Epilepsy NetworkExternal Link
• Epilepsy Foundation VictoriaExternal Link Information Line Tel. 1300 761 487 or (03) 8809 0600
• The National Epilepsy Support Service (NESS)External Link available Mon – Sat, 9:00am – 7:00pm (AEST) to provide support and information across Australia. Tel. 1300 761 487 Email: [email protected]
• Children’s Epilepsy Program, The Royal Children’s Hospital MelbourneExternal Link Tel. (03) 9345 5661

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.