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Seizures in Children

By

M. Cristina Victorio

, MD, Akron Children's Hospital

Reviewed/Revised Mar 2023 | Modified Sep 2023
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Seizures are a periodic disturbance of the brain’s electrical activity, resulting in some degree of temporary brain dysfunction.

  • When older infants or young children have seizures, they often have typical symptoms, such as shaking or jerking of part or all of the body, but newborns may only smack their lips, chew involuntarily, or periodically go limp.

  • Electroencephalography (EEG) is used to diagnose the disorder, and blood and urine tests, brain imaging, and sometimes a spinal tap are done to try to identify the cause.

  • When a child has a convulsion, parents or other caregivers should try to protect the child from harm—for example, by keeping the child away from stairs, sharp objects, and other potential hazards. They should not put anything in the child’s mouth and should not try to hold the child’s tongue.

  • Treatment is focused mainly on the cause, but if seizures continue after the cause is treated, children are given antiseizure medications.

Seizures are an abnormal, unregulated electrical discharge of nerve cells in the brain or in part of the brain. This abnormal discharge can cause

  • Convulsions

  • Involuntary movements

  • Altered awareness

  • Abnormal sensations

Convulsions are violent, involuntary, jerking and/or stiffening of muscles in a large part of the body.

Epilepsy is not a specific disorder but refers to a tendency to have recurring seizures that may or may not have an identifiable cause.

Status epilepticus

Status epilepticus refers to a single long-lasting seizure or several shorter seizures that occur without the child regaining consciousness between seizures.

Children with status epilepticus are at risk of brain damage, so prompt treatment of any seizures lasting more than 5 minutes is necessary.

Causes of Seizures in Children

In newborns, seizures may be caused by

Seizures caused by hereditary disorders of metabolism typically start during infancy or childhood.

Table

In older infants and children, the cause of seizures may be unknown.

Seizures may run in families.

Symptoms of Seizures in Children

In newborns, seizures may be difficult to recognize. Newborns may smack their lips or chew involuntarily. Their eyes may appear to gaze in different directions. They may periodically go limp and/or stop breathing.

In older infants or young children, one part or all of the body may shake, jerk, or tighten up. The limbs may move without purpose. Children may stare, become confused, have unusual sensations (such as numbness or tingling) in parts of the body, or have unusual feelings (such as feeling very afraid for no reason).

Did You Know...

  • Sometimes seizures cause children to simply stare or appear confused instead of causing convulsions.

Diagnosis of Seizures in Children

  • Electroencephalography

  • Other tests to check for a cause depending on the child's symptoms and physical examination

Children who have seizures are evaluated immediately to check for serious causes and causes that can be corrected.

If a child has had a seizure, doctors do a physical examination. They also ask the parents whether any family members have had seizures.

Electroencephalography Electroencephalography Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Imaging tests commonly used to diagnose nervous system (neurologic) disorders... read more Electroencephalography (EEG—a test that records brain waves using sensors placed on the scalp) is done to check for abnormal electrical activity in the brain. EEG is done while infants or children are awake and while they are asleep.

Doctors do other tests to check for a cause based on the child's symptoms and the results of the examination. These tests may include

Treatment of Seizures in Children

  • Immediate measures

  • Treatment of the cause

  • Antiseizure medications

  • Sometimes surgery or other procedures if medications are ineffective

Treatment of seizures in infants and children is focused mainly on the cause of the seizure. For example, children who have a bacterial infection are given antibiotics, and children who have low a level of sugar (glucose) in their blood are given glucose. Other treatable causes include abnormal levels of sodium, calcium, and magnesium in the blood and some tumors and viral infections.

Sometimes children need to take medications to control seizures (antiseizure medications), particularly if the cause cannot be corrected.

If medications are ineffective, surgery may be recommended.

Immediate measures

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

  • Lay the child down on one side.

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

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

Did You Know...

  • Contrary to popular opinion, people should not put anything in the mouth of someone who is having a seizure.

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

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

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

  • This is the child's first seizure.

  • The seizure lasts more than 5 minutes.

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

  • Another seizure occurs immediately.

All children should be taken to the hospital emergency department the first time they have a seizure. For children who are already known to have a seizure disorder Seizure Disorders In seizure disorders, the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction. Many people have unusual sensations just before a seizure... read more , parents should discuss in advance with the doctor when, where, and how urgently evaluation is required if another seizure occurs.

Doctors usually give medications to end a seizure that lasts 5 minutes or more to prevent status epilepticus. Medications include a sedative and antiseizure medications. These medications are usually given by vein (intravenously). If a medication cannot be given intravenously, a sedative gel may be put into the rectum or a sedative liquid may be put into the nose (intranasally). Children who have received these medications or who have a prolonged seizure or status epilepticus are carefully monitored for problems with breathing and blood pressure.

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

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

Antiseizure medications

If children have only one seizure, they usually do not need to take an antiseizure medication (see sidebar Using Medications to Treat Seizures in Children Using Drugs to Treat Seizures in Children Using Drugs to Treat Seizures in Children ). Antiseizure medications are used if seizures recur or are likely to recur.

The antiseizure medication dose is usually increased if a standard dose does not adequately control seizures. The dose may also be adjusted as children grow and their weight increases. Another antiseizure medication may be added or substituted if the first one was only partly effective or had bothersome side effects. Antiseizure medications can interact with other medications, so parents should tell their child's doctor all the medications and supplements the child is taking.

At times, doctors do blood tests to measure the level of the medication, which helps determine whether the dose is correct and whether the child is taking the medication. These tests are sometimes repeated when the dose is changed, when the child has grown significantly, or when a new medication is started.

The need to continue taking antiseizure medications depends on what caused the seizures and how long children have been seizure-free. Most children continue taking antiseizure medications until they have had no seizures for 2 years. The risk of having a seizure after 2 seizure-free years is less than 50%. However, having another disorder that affects the brain and nerves (such as cerebral palsy Cerebral Palsy (CP) Cerebral palsy refers to a group of conditions that involve difficulty moving and muscle stiffness (spasticity). It results from brain malformations that occur before birth as the brain is developing... read more ) increases the risk of having another seizure.

When antiseizure medications are to be stopped, the dose is reduced over a period of time rather than stopping it all at once.

Using Medications to Treat Seizures in Children

When their child has had a seizure, parents are often concerned that the child may need to take a medication to control seizures (an antiseizure medication). Parents are concerned about side effects, and they know that getting children to take a medication on a regular basis is difficult. Learning more about antiseizure medications can help parents better participate in decisions about treatment of their child.

Positives:

  • Most children who have had only one seizure do not need to take antiseizure medications.

  • Doctors can choose from more than 20 antiseizure medications in their search for one that is appropriate for a particular child.

  • Antiseizure medications stop or control seizures in 80% of children.

  • Many children need to take only one antiseizure medication.

  • Most children can eventually stop taking antiseizure medications.

Negatives:

  • Most antiseizure medications have side effects, such as dizziness, nausea, unsteadiness, drowsiness, double vision, or rash.

  • Some antiseizure medications may affect attention span, memory, and school performance while children are taking them.

  • Children who take certain antiseizure medications must have regular blood tests, for example, to determine whether the dose is correct.

  • Some newer antiseizure medications have not been tested in young children (although these medications often are used in young children and results of that experience are published).

In weighing concerns, parents should remember that preventing recurring seizures is important because poorly controlled seizures can lead to slowing of mental processing (cognitive delays), emotional and behavioral problems, and poor quality of life. Also, preventing seizures prevents the injuries and accidents that may occur because of a seizure.

To be sure medications are taken on a regular schedule, parents can do the following:

  • Use a pill box (which contains compartments for each day of the week, for different times of each day, or both).

  • Refill prescriptions before they run out.

  • Encourage the child to take responsibility for taking the medication once the child is old enough, but continue to oversee the process until the child is reliable.

  • Discuss in advance with the doctor what to do if the child misses a dose.

Surgery for seizures

Surgery occasionally may be an option for children (but generally not for newborns or infants) if they continue to have seizures while taking two or more antiseizure medications or if side effects are intolerable. This operation involves surgically removing an area of the brain. It is usually done only when seizures are caused by only one area in the brain and that one area can be removed without significantly affecting the child's ability to function. Sometimes this operation substantially reduces the number of seizures a child has. Tests may be done to help locate the area in the brain that is causing seizures. These tests include the following:

Before surgery is done, a neurosurgeon and a neurologist (usually one who specializes in caring for people with epilepsy) explain the risks and benefits of surgery to the parents. Even when surgery reduces the frequency and severity of seizures, many children need to continue to take antiseizure medications. However, they can usually take lower doses or fewer medications.

Stimulating the vagus nerve

Stimulating the vagus nerve (the 10th cranial nerve Overview of the Cranial Nerves Twelve pairs of nerves—the cranial nerves—lead directly from the brain to various parts of the head, neck, and trunk. Some of the cranial nerves are involved in the special senses (such as seeing... read more ) can sometimes reduce the number of seizures children have. The vagus nerve is thought to have indirect connections to areas of the brain that are often involved in causing seizures. This procedure can be used in children as young as 4 years old. Doctors consider using this procedure when antiseizure medications are ineffective and epilepsy surgery is not possible.

To stimulate the vagus nerve, doctors implant a device that resembles a heart pacemaker under the left collarbone and connect it to the vagus nerve in the neck with a wire that runs under the skin. The device causes a small bulge under the skin. The device turns on and off all the time and thus periodically stimulates the vagus nerve. The doctor can easily and painlessly change the settings for stimulating the nerve using a magnetic wand placed over the device. Also, when the child senses that a seizure is starting or when a family member sees a seizure begin, a magnet (often worn in a bracelet) can be used to set the device to stimulate the nerve more often.

Vagus nerve stimulation is used in addition to antiseizure medications. Possible side effects include hoarseness, cough, and deepening of the voice when the nerve is stimulated. Vagus nerve stimulation usually makes the child more alert. Increased alertness may improve attention but sometimes interferes with sleep.

Stimulating the brain

Sometimes, giving electrical stimulation to the part of the brain in which seizures start can interrupt a seizure before it begins or shorten a seizure that has started. The responsive neurostimulation system is a device that looks like a heart pacemaker. It is implanted within the skull. The device is connected by wires to one or two areas in the brain that are causing the seizures. This system monitors the brain's electrical activity. When it detects unusual electrical activity, it stimulates the areas of the brain that are causing the seizures.

The responsive neurostimulation system is used in addition to antiseizure medications.

Children cannot feel the device or the stimulation, and the device can be removed if needed.

Ketogenic diet

A ketogenic diet may be prescribed by the doctor in some situations. This strict diet is typically medically supervised by a dietician, a neurologist, and perhaps other health care personnel at a specialized center.

The ketogenic diet is very low in carbohydrates and very high in fat. When the body breaks down fat to use for energy, substances called ketones are formed. In some children, the ketones help control seizures.

The ketogenic diet must be carefully followed and requires that the amounts of foods be measured precisely. Even one bite or taste of a restricted food can lead to a seizure. Children may have difficulty following such a strict diet. If children who are following a ketogenic diet improve substantially, the diet is often continued for at least 2 years.

Side effects of a ketogenic diet may include a low blood sugar level, sluggishness (lethargy), and weight loss.

Sometimes the Atkins diet is used instead. It is a less strict form of the ketogenic diet.

Prognosis for Seizures in Children

The prognosis depends on the cause.

A seizure itself does not appear to damage the brain or cause lasting problems unless it continues for more than 30 minutes (most seizures last only a few minutes). However, many disorders that cause seizures can cause lasting problems. For example, some disorders can interfere with the child's development. Whether some types of recurring seizures can affect the developing brain is debated.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  • Epilepsy Foundation: Information about community services, research, public education, and seizure first aid training for epilepsy

  • Epilepsy Action: Provides advice, advocacy, education, and supportive care services

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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