Seizures and Epilepsy in Children

What is epilepsy in children?

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

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

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

Focal (partial) seizures

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

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

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

Generalized seizure

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

• Absence seizure

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

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

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

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

What causes a seizure in a child?

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

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

What are the symptoms of a seizure in a child?

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

• Staring

• Jerking movements of the arms and legs

• Stiffening of the body

• Loss of consciousness

• Breathing problems or stopping breathing

• Loss of bowel or bladder control

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

• Not responding to noise or words for brief periods

• Appearing confused or in a haze

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

• Periods of rapid eye blinking and staring

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

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

How are seizures diagnosed in a child?

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

Your child may also have:

• A neurological exam

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

• Imaging tests of the brain, such as an

  MRI

  or

  CT scan

• Electroencephalogram

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

• Lumbar puncture (spinal tap)

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

How are seizures treated in a child?

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

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

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

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

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

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

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

Other treatments

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

Ketogenic diet

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

Vagus nerve stimulation (VNS)

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

Surgery

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

How can I help my child live with epilepsy?

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

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

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

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

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

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

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

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

When should I call my child’s healthcare provider?

Call the healthcare provider if:

Key points about epilepsy and seizures in children

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

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

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

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

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

Seizures | Boston Children’s Hospital

What are the symptoms of a seizure?

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

Some signs that your child may be experiencing seizures include:

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

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

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

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

What are the different types of seizures?

Focal seizures

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

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

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

Generalized seizures

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

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

Myoclonic seizures

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

Infantile spasms

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

Status epilepticus

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

Febrile seizures

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

What causes seizures in children?

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

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

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

Seizures in children – diagnosis and treatment at the medical center “Andreev Hospitals”

Seizures – a sudden disorder of the brain, manifested by various disorders of the motor, psycho-emotional, sensitive and vegetative spheres. Seizures can occur with loss of consciousness, as well as against the background of preserved or partially preserved consciousness.

Seizures in children can occur at any age, but it is generally accepted that up to two-thirds of seizures occur in the first 3 years of life. Being a typical manifestation of epilepsy, seizures do not always indicate the presence of this disease in a child. Convulsive seizures are recorded in 5-10% of children, the diagnosis of epilepsy is established in 0.5-1% of the population.

Causes of seizures in children can be:

• Perinatal disorders MV) or the causative agent of toxoplasmosis).
• Infections – meningitis, encephalitis, brain abscess.
• Brain injuries – brain contusion, rarely concussion.
• Metabolic disorders – decreased levels of calcium, sodium, magnesium, blood sugar (respectively, hypocalcemia, hyponatremia, hypomagnesemia, hypoglycemia), increased sodium levels in the blood (hypernatremia), renal failure.
• Fever (febrile convulsions)
• Neurological diseases – epilepsy, congenital malformations of the central nervous system, hereditary metabolic diseases (amino acid metabolism disorders, mitochondrial diseases, glycogenosis, etc.), phakomatoses (neurofibromatosis, tuberous sclerosis, etc.), brain tumors.
• Drug withdrawal syndrome – convulsions in newborns born to mothers who use drugs.

Main clinical types of seizures in children:

• tonic (synchronous / asynchronous tension of the muscles of the trunk, limbs)
• clonic (synchronous/asynchronous rhythmic contractions of all muscles)
• tonic-clonic (a combination of tonic and clonic seizures with a predominance of one or another component)
• myoclonic (repeated, often symmetrical contractions of individual muscles or muscle groups)
• atonic (sudden decrease in muscle tone)
• infantile spasms (short-term successive symmetrical flexion/extensor contractions of the muscles of the neck, limbs and trunk)
• absences (sudden short-term cessation of motor and speech activity with “fading” of gaze).

Diagnostics

The volume of the necessary examination of children with seizures is determined by the doctor individually, it depends on the nature, conditions of occurrence, frequency of seizures; the general condition of the patient, the characteristics of his somatic and neurological status and may include EEG, if necessary, EEG video monitoring, CT or MRI of the brain, lumbar puncture, biochemical studies of blood, cerebrospinal fluid, urine, etc. The purpose of the ongoing research is to identify a possible cause of seizures and establishing the diagnosis, allowing to form the correct approaches to the treatment of the child.

Convulsive episodes in newborns and young children in most cases are isolated and do not require further treatment. Recurrent seizures, most often associated with various types of epilepsy, require carefully selected and long-term anticonvulsant therapy under the supervision of a pediatric neurologist (epileptologist).

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Convulsive syndrome in children – causes of convulsions, symptoms, methods of prevention

Convulsive syndrome is a non-specific reaction of the child’s body to external and internal stimuli, characterized by sudden attacks of involuntary muscle contractions. The smaller the child, the more convulsive readiness he has. This is due to the immaturity of some structures of the brain and nerve fibers, the high degree of permeability of the blood-brain barrier and the tendency to generalize any processes, as well as some other reasons.

Reasons

All causes of seizures can be divided into epileptic (epilepsy) and non-epileptic.

Non-epileptic:

• Spasmophilia.
• Overheating.
• Encephalitis, meningitis, trauma and brain infections.
• Toxoplasmosis.
• Metabolic disorders, primarily potassium and calcium metabolism, for one reason or another.
• For newborns – hemolytic disease, congenital lesions of the nervous system, asphyxia.
• Various hormonal disorders.
• In acute infectious diseases, especially with a rise in temperature to febrile figures.
• Intoxication and poisoning.
• Hereditary metabolic diseases.
• Pathologies of the cardiovascular and hematopoietic systems.

Symptoms

• Tonic convulsions (spasm-muscle tension).
• Pose with the upper limbs bent at all joints, the lower limbs extended and the head thrown back.
• Respiration and pulse are slow. Contact with the outside world is lost or significantly weakened.
• Clonic convulsions (involuntary muscle twitching).

The diagnosis of convulsive syndrome in children is made on the basis of the clinic, which in most cases does not cause difficulties. After making this diagnosis, it is necessary to clarify the nature of the convulsive syndrome, for which the anamnesis of the life and illness of the child, x-ray examination of the skull, echoencephalography, electroencephalography, angiography and other methods can be used. Laboratory tests can be quite revealing.

Prevention

Febrile convulsions (at high body temperature, above 38 C) usually stop with age. To prevent their recurrence, severe hyperthermia should not be allowed if an infectious disease occurs in a child. The risk of transformation of febrile seizures into epileptic seizures is 2-10%.

In other cases, the prevention of convulsive syndrome in children includes the prevention of perinatal pathology of the fetus, the treatment of the underlying disease, and observation by children’s specialists. If the convulsive syndrome in children does not disappear after the cessation of the underlying disease, it can be assumed that the child has developed epilepsy.