SEIZURES IN CHILDRENhttp://www.emedicinehealth.com/seizures_in_children/article_em.htmSeizures in Children OverviewA seizure occurs when the brain functions abnormally, resulting in a change in movement, attention, or level of awareness. Different types of seizures may occur in different parts of the brain and may be localized (affect only a part of the body) or widespread (affect the whole body). Seizures may occur for many reasons, especially in children. Seizures in newborns may be very different than seizures in toddlers, school-aged children, and adolescents. Seizures, especially in a child who has never had one, can be frightening to the parent or caregiver. Around 3% of all children have a seizure when younger than 15 years, half of which are febrile seizures (seizure brought on by a fever). One of every 100 childrenhas epilepsy-recurring seizures. A febrile seizure occurs when a child contracts an illness such as an ear infection, cold, or chickenpox accompanied by fever.Febrile seizuresare the most common type of seizure seen in children. Two to five percent of children have a febrile seizure at some point during their childhood. Why some children have seizures with fevers is notknown, but several risk factors have been identified. Children with relatives, especially brothers and sisters, who have had febrile seizures are more likely to have a similar episode. Children who are developmentally delayed or who have spent more than 28 days in a neonatal intensive care unit are also more likely to have a febrile seizure. One of 4 children who have a febrile seizure will have another, usually within a year. Children who have had a febrile seizure in the past are also more likely tohave a second episode.

Neonatal seizures occur within 28 days of birth. Mostoccur soon after the child is born. They may be due to a large variety of conditions. It may be difficult to determine if a newborn is actually seizing, because they often do not have convulsions. Instead, their eyes appear to be looking in different directions. They may have lip smacking or periods of no breathing. Partial seizures involve only a part of the brain and therefore only a part of the body. Simple partial (Jacksonian) seizures have a motor (movement) component that is located in one portion of the body. Children with these seizures remain awake and alert. Movement abnormalities can "march" to other parts of the body as the seizure progresses. Complex partial seizures are similar, except that the child is not aware of what is going on. Frequently, children with this type of seizurerepeat an activity, such as clapping, throughout the seizure. Theyhave no memory of this activity. After the seizure ends, the childis oftendisoriented in a state known as the postictal period. Generalized seizures involve a much larger portion of the brain. They are grouped into 2 types: convulsive (muscle jerking) and nonconvulsive with several subgroups. Convulsive seizures are noted by uncontrollable muscle jerking lasting for a few minutes-usually less than 5-followed by a period of drowsiness that is called the postictal period. The child should return to his or her normal self except for fatigue within around 15 minutes. Often the child may have incontinence (lose urine or stool), and it is normal for the child not to remember the seizure. Sometimes the jerking can cause injury, which may range from a small bite on the tongue to a broken bone. Tonic seizures result in continuous muscle contraction and rigidity, while tonic-clonic seizures involve alternating tonic activity with rhythmic jerking of muscle groups. Infantile spasms commonly occur in children younger than 18 months. They are often associated with mental retardation and consist of sudden spasms of muscle groups, causing the child to assume a flexed stature. They are frequent upon awakening. Absence seizures, also known as petit mal seizures, are short episodes during which the child stares or eye blinks, with no apparent awareness of their surroundings. These episodes usually do not last longer then a few seconds and start and stop abruptly; however, the childdoes not remember the event at all. These are sometimes discovered after the child's teacher reports daydreaming, if the child loses his or her place while reading or misses instructions for assignments. Status epilepticus is either a seizure lasting longer than 30 minutes or repeated seizures without a return to normal in between them. It is most common in children younger than 2 years, and most of these childrenhave generalized tonic-clonic seizures. Status epilepticus is very serious. With any suspicion of a long seizure, you should call 911. Epilepsy refers to a pattern of chronic seizures of any type over a long period. Thirty percent of children diagnosed with epilepsycontinue to have repeated seizures into adulthood, while othersimprove over time.Seizures in Children CausesAlthough seizures have many known causes, for 3 out of 4 children, the cause remains unknown. In many of these cases, there is some family history of seizures. The remaining causes include infections such as meningitis, developmental problems such as cerebral palsy, head trauma, and many other less common causes. About one fourth of the children who are thought to have seizures are actually found to have some other disorder after a complete evaluation. These other disorders include fainting, breath-holding spells, night terrors, migraines, and psychiatric disturbances. The most common type of seizure in children is the febrile seizure, which occurs when an infection associated with a high fever develops. Other reasons for seizures are these: Infections Metabolic disorders Drugs Medications Poisons Disordered blood vessels Bleeding inside the brain Many yet undiscovered problemsSeizures in Children SymptomsSeizures in children have many different types of symptoms. A thorough description of the type of movements witnessed, as well as the child's level of alertness, can help the doctor determine what type of seizure your child has had. The most dramatic symptom is generalized convulsions. The child may undergo rhythmic jerking and muscle spasms, sometimes with difficulty breathing and rolling eyes. The child is oftensleepy and confused after the seizure and does not remember the seizure afterward. This symptom group is common with grand mal (generalized) and febrile seizures. Children with absence seizures (petit mal) develop a loss of awareness with staring or blinking, which starts and stops quickly. There are no convulsive movements. These children return to normal as soon as the seizure stops. Repetitive movements such as chewing, lip smacking, or clapping, followed by confusion are common in children suffering from a type of seizure disorder known as complex partial seizures. Partial seizures usually affect only one group of muscles, which spasm and move convulsively. Spasms may move from group to group. These are called march seizures. Children with this type of seizure may also behave strangely during the episode and may or may not remember the seizure itself after it ends.When to Seek Medical CareAll children who seize for the first time and many with a known seizure disorder should be evaluated by a doctor. Most children with first seizures should be evaluated in a hospital's emergency department. However, if the seizure lasted less than 2 minutes, if there were no repeated seizures, and if the child had no difficulty breathing, it may be possible to have the child evaluated at the pediatrician's office. After the seizure has stopped and the child has returned to normal, contact your child's doctor for further advice. Your pediatrician may recommend either an office or an emergency department visit. If you do not have a pediatrician or none is available, bring the child to the emergency department. If you are worried about possible absence seizures, evaluation at the pediatrician's office is appropriate. Caregivers of children with epilepsy should contact the child's pediatrician if there is something different about the type, duration, or frequency of the seizure. The doctor may direct you to the office or to the emergency department. Take the child to the emergency department or call 911 if you are concerned that your child was injured during the seizure or if you think that he or she may be in status epilepticus (seizures of any kind that do not stop).Most children who have seized for the first time should be taken to the emergency department for an immediate evaluation. Any child with repeated or prolonged seizures, trouble breathing, or who has been significantly injured should go to the hospital by ambulance. If the child has a history of seizures and there is something different about this one, such as duration of the seizure, part of body moving, a long period of sleepiness, or any other concerns, the child should be seen in the emergency department.Exams and TestsFor all children, a thorough interview and examination should occur. It is important for the caregiver to tell the doctor about the child's medical history, birth history, any recent illness, and any medications or chemicals that the child could have been exposed to. Additionally, the doctorasks for a description of the event, specifically to include where it occurred, how long any abnormal movements lasted, and the period of sleepiness afterward. A wide variety of tests can be performed on a child who is thought to have seizures. This testing depends on the child's age and suspected type of seizures. Febrile seizures Children should receive medication for the fever such as acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil). Depending on the age of the child, the doctor may order blood or urine tests or both, looking for the source of the fever. If the child has had his or her first febrile seizure, then the doctor may want to perform a lumbar puncture (spinal tap) to test for possible meningitis. The lumbar puncture should be performed in children younger than 6 months, and some doctorsperform them in children as old as 18 months. Most childrendo not get a CT scan of the head, unless there was something unusual about the febrile seizures, such as the child not returning to his or her normal self shortly afterward. Very few children with febrile seizures are admitted to the hospital. The treatment for febrile seizures is keeping the temperature down, and possibly a medication if a specific infection is found such as an ear infection. Follow up with the child's doctor in a few days.

Movement seizures Movement seizures, which include partial seizures and generalized (grand mal) seizures, can be very dramatic. If the child is having a seizure in the emergency department, he or she is given medications to stop the seizure. If the child has returned to normal in the hospital, then the child will probably have a few tests performed. Blood is drawn to check the child's sugar, sodium, and some other blood chemicals. If the child is on antiseizure medications, then the medication'slevels in the blood are checked (if possible). Most childrenundergo a CT scan or MRI (studies looking at the structure of the brain), but this may be scheduled for several days later rather than in the emergency department. In children, these imaging studies are usually normal but are performed to look for unusual causes of seizure such as bleeding or tumor. Most childreneventually undergo an EEG, which is a study looking at the brain waves or electrical activity of the brain. An EEG is almost never performed in theemergency departmentbutis performed later. The child will probably be admitted if he or she is very young, has another seizure, hasabnormal physical examination findings or lab test results, or if you live far from a hospital. Children in status epilepticus are admitted to an intensive care unit. If the child is doing well, doesn't have recurring seizures, and has a normal physical examination findings and blood test results, then the child will most likely be sent home to follow up with a pediatrician in a few days to continue the evaluation and arrange other tests, such as the EEG.

Absence seizures (petit mal) These can be evaluated without going to an emergency department. Most likely, the doctor will only order an EEG. If the EEG tells the doctor that the child is having absence seizures, then the child will most likely be placed on medications to control them.

Neonatal seizures and infantile spasms Seizures of this type occur in young children and are often associated with other problems such as mental retardation. Children suspected of having these seizures may have multiple lab tests done in the emergency department. They would include blood and urine samples, lumbar puncture, and possibly a CT scan of the head. These children are usually admitted to the hospital and may even be referred to a pediatric specialty hospital. In the hospital, these children undergo several days of testing to look for the many possible causes of the seizures.Self-Care at HomeYour initial efforts should be directed first at protecting the child from additionally injuring himself or herself. Help the child to lie down. Remove glasses or other harmful objects in the area. Do not try to put anything in the child's mouth. In doing so, you may injure the child or yourself. Immediately check if the child is breathing. Call 911 to obtain medical assistance if the child is not breathing. After the seizure ends, place the child on one side and stay with the child until he or she is fully awake. Observe the child for breathing. If he or she is not breathing within 1 minute after the seizure stops, then start mouth-to-mouth rescue breathing (CPR). Do not try to do rescue breathing for the child during a convulsive seizure, because you may injure the child or yourself. If the child has a fever, acetaminophen (such as Tylenol) may be given rectally. Do not try to give food, liquid, or medications by mouth to a child who has just had a seizure. Children with known epilepsy should also be prevented from further injury by moving away solid objects in the area of the child. If you have discussed use of rectal medication (for example, Valium) with your child's doctor, give the child the correct dose.Medical TreatmentTreatment of children with seizures is different than treatment for adults. Unless a specific cause is found, most children with first-time seizures will not be placed on medications. Important reasons for not starting medications During the first visit, many doctors cannot be sure if the event was a seizure or something else. Many seizure medications have side effects including damage to your child's liver or teeth. Many children will have only one, or very few, seizures.

If medications are started The doctor will follow the drug levels, which require frequent blood tests, and will watch closely for side effects. Often, it takes weeks to months to adjust the medications, and sometimes more than one medicine is needed. If your child has status epilepticus, he or she will be treated very aggressively with antiseizure medications, admitted to the intensive care unit, and possibly be placed on a breathing machine.Next StepsPreventionMost seizures cannot be prevented. There are some exceptions, but these are very difficult to control, such as head trauma and infections during pregnancy. Children who are known to have febrile seizures should have their fevers well controlled when sick. The biggest impact caretakers can have is to prevent further injury if a seizure does occur. The child can participate in most activities just as other children do. Parents and other caretakers must be aware of added safety measures, such as having an adult around if the child is swimming or participating in any other activities that could result in harm if a seizure occurs. One common area for added caution is in the bathroom. Showers are preferred because they reduce the risk of drowning more than baths.OutlookThe prognosis for children with seizures depends on the type of seizures. Most childrendo well,are able to attend regular school, and have no limitations. The exceptions occur with children who have other developmental disorders such as cerebral palsy and in children with neonatal seizures and infantile spasms. It is important to talk with your child's doctor about what to expect with your child. Many children"outgrow" seizures as their brains mature. If several years pass without any seizures, doctorsoften stop the child's medications and see if the child has outgrown the seizures. A seizure in general is not harmful unless an injury occurs or status epilepticus develops. Children who develop status epilepticus have a 3-5% risk of dying from the prolonged seizure. Children with febrile seizures "outgrow" them, but theyoften have repeated seizures when they develop fevers while they are young. Some children with febrile seizuresgo on to have epilepsy, but most doctors believe the epilepsy was not caused by the febrile seizures.

http://www.healthscout.com/ency/68/675/main.htmlDefinition of Seizures In ChildrenArticle updated and reviewed by Peter B. Kang, MD, Assistant in Neurology, Children's Hospital Boston, and Instructor in Neurology, Harvard Medical School, Boston, MA. Editorial review provided by VeriMed Healthcare Network on April 18, 2005. Seizures are characterized by abnormal electrical activity in the brain, usually causing changes in behavior such as rhythmic movements or confusion. An individual with epilepsy is someone who has recurrent spontaneous seizures, that is, seizures that are not associated with triggers such as fevers or head trauma.Description of Seizures In ChildrenPlease see the Epilepsy (Seizure Disorders) section for basic information about seizure types, emergency management, and medications. There are a number of seizure syndromes that affect children, not all of which meet the criteria for epilepsy. Three common seizure syndromes are febrile seizures, Rolandic epilepsy, and absence epilepsy. Febrile seizures are seizures that are triggered by fevers, and typically occur in children from the age of six months to five years. Simple febrile seizure are ones in which the seizure is brief (up to several minutes in duration), generalized (stiffening and shaking of all limbs), limited to one seizure for the duration of the illness, and occur in children who are developmentally normal and have no known chronic neurological disorders. Simple febrile seizures, barring injury during the seizures themselves, are generally benign, with no significant long term consequences for neurological development known to date and only a slightly increased risk for epilepsy in the long term. Simple febrile seizures are not generally regarded as a form of epilepsy since the seizures are not spontaneous. If there are features that mark the seizures as being complex (or atypical) rather than simple, there may be a higher risk of epilepsy and serious long term consequences for neurological development. Many children with complex febrile seizures still do fairly well. Simple febrile seizures often do not require specialized testing such as electroencephalography (EEG, an electrical brainwave test like an EKG) or an MRI scan, but complex febrile seizures may require such an evaluation. If a child has seizures both with and without fever, the child meets the criteria for epilepsy. An important concern to keep in mind, especially with an infant who has a seizure with fever, is that such a seizure may be the first sign of meningitis, so any child with a first time febrile seizure should be evaluated at the nearest hospital emergency department. Depending on the circumstances, subsequent seizures may require evaluation also, especially if the seizure is prolonged or if the child does not recover afterwards in the same manner as in previous events. Febrile seizures sometimes run in families. Rolandic epilepsy is a common form of childhood epilepsy that is characterized by partial seizures. This disorder begins between infancy and puberty. The most common seizure type is the simple partial seizure, characterized by abnormal motor activity of a specific part of the body (for example, one arm or one leg). The face may be affected, leading to difficulty speaking. These seizures generally occur at night. Sometimes one of these partial seizures will generalize (spread to the rest of the brain) and develop into a generalized tonic-clonic (grand mal) seizure. This form of epilepsy can be diagnosed based on the description of the events and a characteristic pattern of abnormalities (centrotemporal spikes) on EEG. There may be variants with slightly different forms of seizures or slightly different abnormalities on EEG. The seizures are usually easy to control with medication, and by adolescence they typically resolve and the medication can gradually be weaned off. This is a benign form of childhood epilepsy, and affected children generally have normal neurological development. Absence (petit mal) epilepsy typically begins in the first decade of life (after infancy). The seizures are mild generalized events characterized primarily by brief staring spells that last a few seconds, followed by a resumption of the interrupted activity. To others, including teachers and parents, they may appear only as a brief pause in activity. There are no convulsions (stiffening or shaking), but occasionally there may be other mild manifestations such as lip smacking or drooling. These seizures may happen dozens of times per day. Some children with absence epilepsy are thought by their parents or teachers to be daydreamers or to have attention deficit hyperactivity disorder because the spells interrupt schoolwork and make them appear distracted and unfocused. The description of the spells may be subtle, and are often not sufficient for diagnosis. Two aids to diagnosis include hyperventilation and an EEG. Hyperventilation is known to trigger these seizures, so a neurologist may ask the child to blow at a fan or other object during the office visit for several minutes. If the child stares off while hyperventilating, the neurologist may call out a color or other word, and then when the child stops staring, ask him or her what word was spoken. If the staring spell was a true seizure, the child should not have any recollection of hearing that word. In some cases, the child has the episodes so frequently that this test can be done without hyperventilation. The EEG is very accurate in diagnosing this form of epilepsy, since the seizures occur so frequently. A very characteristic electrical discharge appears on the EEG, and is usually correlated with a staring spell. Absence seizures respond very well to medication, and can make an enormous difference in the childs school performance and learning. Usually, these seizures resolve spontaneously by adolescence and the child can gradually be weaned from the medication. In some cases, the seizures persist longer, and may develop into other forms of epilepsy in adolescence and adulthood. Neurological development is variable; many affected children do well, but some have subtle difficulties that persist into adulthood. There are many other seizure syndromes that affect children. A pediatrician and/or a pediatric neurologist should be consulted whenever a seizure disorder is suspected.

http://www.webmd.com/epilepsy/epilepsy-in-childrenSeizures in ChildrenWhat happens inside your child's brain during a seizure? Here is a simplified explanation: Your brain is made up of millions of nerve cells called neurons, and these cells communicate with one another through tiny electrical impulses. A seizure occurs when a large number of the cells send out an electrical charge at the same time. This abnormal and intense wave of electricity overwhelms the brain and results in a seizure, which can cause muscle spasms, a loss of consciousness, strange behavior, or other symptoms.Anyone can have a seizure under certain circumstances. For instance, a fever, lack of oxygen, head trauma, or illness could bring on a seizure. People are diagnosed with epilepsy when they have seizures that occur more than once without such a specific cause. In most cases -- about seven out of 10 -- the cause of the seizures can't be identified. This type of seizure is called "idiopathic" or "cryptogenic", meaning that we don't know what causes them. There may be a problem in the way the brain is wired, or with high levels of specific brain chemicals called neurotransmitters.Genetic research is teaching doctors more and more about what causes different types of seizures. Traditionally, seizures have been categorized according to how they look from the outside and what the EEG (electroencephalogram) pattern looks like. The research into the genetics of seizures is helping experts discover the particular ways different types of seizures occur. Eventually, this may lead to tailored treatments for each type of seizure that causes epilepsy.Diagnosing a Seizure in a ChildDiagnosing a seizure can be tricky. Seizures are over so quickly that your doctor probably will never see your child having one. The first thing a doctor needs to do is rule out other conditions, such as nonepileptic seizures. These may resemble seizures, but are often caused by other factors such as drops in blood sugar or pressure, changes in heart rhythm, or emotional stress.Your description of the seizure is important to help your doctor with the diagnosis. You should also consider bringing the entire family into the doctor's office. The siblings of children with epilepsy, even very young kids, may notice things about the seizures that parents may not. Also, you may want to keep a video camera handy so that you can tape your child during a seizure. This may sound like an insensitive suggestion, but a video can help the doctor enormously in making an accurate diagnosis.Some kinds of seizures, such as absence seizures, are especially difficult to catch because they may be mistaken for daydreaming."Nobody misses a grand mal (generalized tonic-clonic) seizure," says William R. Turk, MD, Chief of the Neurology Division at the Nemours Children's Clinic in Jacksonville, Florida. "You can't help but notice when a person falls to the ground, shakes, and sleeps for three hours." But absence or staring seizures may go unnoticed for years.Diagnosing a Seizure in a Child continued...Turk says you shouldn't worry if your child gazes open-mouthed at cartoons on TV, or stares out the window in the car. Most kids who appear to be daydreaming really are just daydreaming. Instead, watch for spells that come at inappropriate times, such as when your child is in the middle of speaking or doing something, and suddenly stops.Other kinds of seizures, such as simple or complex partial seizures, can be mistaken for different conditions, such as migraines, psychological illness, or even drug or alcohol intoxication. Medical tests are an important part of diagnosing seizures. Your child's doctor will certainly do a physical exam and blood tests. The doctor may also order an EEG to check the electrical activity in the brain, or request a brain scan such as an MRI with a specific epilepsy protocol.The Risks of Seizures in ChildrenAlthough they may look painful, seizures don't really cause pain. But they may be frightening for children and the people around them. Simple partial seizures, in which a child may have a sudden, overwhelming sense of terror, are especially frightening. One of the problems with complex partial seizures, for instance, is that people have no control of their actions. They may wind up doing inappropriate or bizarre things that upset people around them. It's also possible for children to injure themselves during a seizure if they fall to the ground or hit other things around them. But the seizures themselves are usually not harmful.Experts don't yet understand the long-term effects of seizures on the brain very well. In the past, most scientists thought that seizures did not cause any damage to the brain. They attributed any brain damage to an underlying illness. Now, however, some doubts are beginning to emerge.Solomon L. Moshe, MD, Director of Clinical Neurophysiology and Child Neurology at the Albert Einstein College of Medicine in New York, is researching the subject and remains cautious. "I don't think it's good to say one way or another whether seizures do long-term damage," he says. "I think it all depends on the individual case."Moshe notes that the brains of children are very flexible. They are perhaps the least likely people with epilepsy to suffer any brain damage from a seizure.Dangerous Seizures in KidsAlthough the majority of seizures aren't dangerous and don't require immediate medical attention, one kind does. Status epilepticus is a life-threatening condition in which a person has a prolonged seizure or one seizure after another without regaining consciousness in between them. Status epilepticus is more common among people with epilepsy, but about one-third of the people who develop the condition have never had a seizure before. The risks of status epilepticus increase the longer the seizure goes on, which is why you should always get emergency medical help if a seizure lasts more than five minutes.You may also hear about a condition called Sudden Unexplained Death, in which a person dies for no known reason. It can happen to anyone, but it's more likely to happen in a person with epilepsy. The causes aren't known, but parents of children with epilepsy should know that it's a very rare occurrence. Controlling seizures, especially those that occur in sleep, is the most effective plan for helping to prevent this tragedy from occurring.

http://www.childrenshospital.org/az/Site1967/mainpageS1967P0.htmlWhat is a seizure?

The brain is the center that controls and regulates all voluntary and involuntary responses in the body. It consists of nerve cells that normally communicate with each other through electrical activity. A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function. The incidence of seizures is high before the child's first birthday. Approximately 3 to 5 percent of all children may experience a seizure.

What are the different types of seizures?

There are several different types of seizures in children, including the following:

Focal seizures - 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. Two types of focal seizures include the following: Simple focal seizures - The seizures 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 - This type of seizure commonly occurs 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 seizures involve both sides of the brain. There is loss of consciousness and a postictal state after the seizure occurs. Types of generalized seizures include the following: Febrile seizures - This type of seizure is associated with fever. Approximately 2 to 5 percent of all children in the United States experience febrile seizures. 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. Absence seizures (also called petit mal seizures) - These 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. Atonic (also called drop attacks) - With atonic seizures, 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 (GTC or grand mal seizures) - This seizure 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 3 months to 12 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.

Sometimes, prolonged or clustered seizures can worsen and develop into non-stop seizures. This is called status epilepticus. This condition is a medical emergency. The child needs to be hospitalized to receive the proper treatment to control the seizures.

What is epilepsy?

Epilepsy is a neurological condition involving the brain that makes people more susceptible to having seizures. It is one of the most common disorders of the nervous system and affects people of all ages, races and ethnic background. More than 2.3 million Americans live with epilepsy. When a person has two or more seizures, he or she is considered to have epilepsy. There are many possible causes of epilepsy, including tumors, strokes, and brain damage from illness or injury. In many cases, there may be no detectable cause for epilepsy.

What causes epilepsy?

While the exact cause of epilepsy may not be known, it may be caused by the following:

family history genetic problem underlying brain problem

What is status epilepticus?

Sometimes, prolonged or clustered seizures can worsen and develop into non-stop seizures. This is called status epilepticus. This condition is a medical emergency. The child needs to be hospitalized to receive the proper treatment to control the seizures.

What causes a seizure?

A child may experience one or numerous seizures. While the exact cause of the seizure may not be known, the more common seizures are caused by the following:

in newborns and infants: birth trauma problems that the infant is born with fever/infection metabolic or chemical imbalances in the body in children, adolescents, and young adults: alcohol or drugs head trauma infection congenital conditions genetic factors unknown reasons other possible causes of seizures may include: brain tumor neurological problems drug withdrawal medications

What are the symptoms of a seizure?

The child may have varying degrees of symptoms depending upon the type of seizure. The following are general symptoms of a seizure or warning signs that your child may be experiencing seizures. Symptoms or warning signs may include:

staring jerking movements of the arms and legs stiffening of the body loss of consciousness breathing problems or breathing stops loss of bowel or bladder control falling suddenly for no apparent reason not responding to noise or words for brief periods appearing confused or in a haze sleepiness and irritable upon waking in the morning nodding the head periods of rapid eye blinking and staring

During the seizure, the child's lips may become bluish and breathing may not be normal. The movements are often followed by a period of sleep or disorientation. The symptoms of a seizure may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

How are seizures diagnosed?

The full extent of the seizure may not be completely understood immediately after onset of symptoms, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a seizure is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the child and family and asks when the seizures occurred. Seizures may be due to neurological problems and require further medical follow up. Diagnostic tests may include:

blood tests electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp. magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body computerized tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. lumbar puncture (spinal tap) - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord.

Treatment of a seizure:

Specific treatment for a seizure will be determined by your child's physician based on:

your child's age, overall health, and medical history the extent of the condition the type of seizure your child's tolerance for specific medications, procedures, or therapies expectations for the course of the condition your opinion or preference

The goal of seizure management is to control, stop, or decrease the frequency of the seizures without interfering with the child's normal growth and development. The major goals of seizure management include the following:

proper identification of the type of seizure using medication specific to the type of seizure using the least amount of medication to achieve adequate control maintaining good medicating levels

Treatment may include:

Medications - There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, age of the child, side effects, the cost of the medication, and the adherence with the use of the medication. Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles, or syrup), but some can be given rectally (into the child's rectum). If the child is in the hospital with seizures, medication by injection or intravenous (IV) may be used. It is important to give your child his/her medication on time and as prescribed by your child's physician. Different people use up the medication in their body differently, so adjustments (schedule and dosage) may need to be made for good control of seizures. All medications can have side effects, although some children may not experience side effects. Discuss your child's medication side effects with his/her physician. While your child is taking medications, different tests may be done to monitor the effectiveness of the medication. These tests may include the following: Blood work - frequent blood draws testing is usually required to check the level of the medication in the body. Based on this level, the physician may increase or decrease the dose of the medication to achieve the desired level. This level is called the "therapeutic level" and is where the medication works most efficiently. Blood work may also be done to monitor the affects of medications on body organs. Urine tests - these tests are performed to see how the child's body is responding to the medication. Electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp. This test is done to monitor how the medication is helping the electrical problems in the brain. Ketogenic diet - Certain children who are having problems with medications, or whose seizures are not being well controlled, may be placed on a special diet called the ketogenic diet. Certain children who are having problems with medications, or whose seizures are not being well controlled, may be placed on a special diet called the ketogenic diet. This type of diet is low in carbohydrates and high in protein and fat.

What is a ketogenic diet?

The ketogenic diet is sometimes offered to those children who continue to have seizures while on seizure medication. When the medications do not work, a ketogenic diet may be considered. No one knows exactly how the diet works, but some children do become seizure-free when put on the diet. However, the diet does not work for everyone.

What does the diet consist of?

The ketogenic diet is very high in fat (about 90 percent of the calories come from fat). Protein is given in amounts to help promote growth. A very small amount of carbohydrate is included in the diet. This very high- fat, low- carbohydrate diet causes the body to make ketones. Ketones are made by the body from protein. They are made for energy when the body does not get enough carbohydrates for energy. If your child eats too many carbohydrates, then his/her body may not make ketones. The presence of ketones is important to the success of the diet

High-fat foods:

butter heavy cream oil mayonnaise cream cheese bacon cheese cheese

High-carbohydrate foods:

fruit and fruit juice breads and cereals vegetables (corn, peas, and potatoes) beans milk soda snack foods (chips, snack cakes, crackers) sweets

Your child's physician will determine if this diet is right for your child. When the ketogenic diet is started, your child will be admitted to the hospital. It may take four to five days in the hospital to get the diet started and for you to learn how to plan the diet. While in the hospital, your child may not be able to eat for one to two days until ketones are measured in the urine. Once ketones are present in the urine, special high-fat, low-carbohydrate shakes may be started. These are sometimes called "keto shakes." After several meals of keto shakes, your child will be started on solid foods. You may also be taught how to check your child's urine for ketones. The dietitian will help determine how much fat, protein, and carbohydrate your child is allowed to have, usually divided into three meals a day. The ketogenic diet can by very challenging to prepare and requires that all foods be weighed using a food scale. The ketogenic diet is not nutritionally balanced, therefore, vitamin and mineral supplements are needed. Some medications and other products, such as toothpaste and mouthwash, contain carbohydrates. It is important to avoid these products if your child is on the ketogenic diet. Your child may not make ketones in their urine if too many carbohydrates are included in the diet. Your child's physician and dietitian can give you a list of medications, and other products, that are free of carbohydrates.

How long is the diet used?

Children usually stay on the diet about two years. The diet is then slowly changed back to a regular diet. Additional treatment options:

vagus nerve stimulation (VNS) - Some children, whose seizures are not being well-controlled with seizure medications, may benefit from a procedure called vagus nerve stimulation (VNS). VNS is currently only used for children over the age of 12 who have partial seizures that are not controlled by other methods. VNS attempts to control seizures by sending small pulses of energy to the brain from the vagus nerve, which is a large nerve in the neck. This 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 the vagus nerve. The battery is then programmed to send energy impulses every few minutes to the brain. When the child feels a seizure coming on, he/she may activate the impulses by holding a small magnet over the battery. In many people, this will help to stop the seizure. There are some side of the effects that may occur with the use of VNS. These may include, but are not limited to, the following: hoarseness pain or discomfort in the throat change in voice surgery - Another treatment option for seizures is surgery. Surgery may be considered in a child who: has seizures that are unable to be controlled with medications. has seizures that always start in one area of the brain. has a seizure in a part of the brain that can be removed without disrupting important behaviors such as speech, memory, or vision.

Surgery for epilepsy and seizures is a very complicated surgery performed by a specialized surgical team. The operation may remove the part of the brain where the seizures are occurring, or, sometimes, the surgery helps to stop the spread of the bad electrical currents through the brain. A child may be awake during the surgery. The brain itself does not feel pain. With the child awake and able to follow commands, the surgeons are better able to make sure that important areas of the brain are not damaged. Surgery is not an option for everyone with seizures. Discuss this with your child's physician for more information.

More information regarding the child with seizures or epilepsy:

Make sure you and your child (if age appropriate) understand the type of seizure that is occurring and the type of medication(s) that are needed. Know the dose, time, and side effects of all medications. Consult your child's physician before giving your child other medications. Medications for seizures can interact with many other medications, causing the medications to work improperly and/or causing side effects. Young women of childbearing age, who are on seizure medications, need to be informed that seizure medications are harmful to a fetus, and the medication may also decrease the effectiveness of oral contraceptives. Check with your state to understand any laws about people with epilepsy or seizures operating a motor vehicle. If a child has good control over the seizures, only minimal restrictions need to be placed on the child's activities. The child should always wear a helmet with sports and bike riding (including in-line roller-skating, hockey, and skateboards). The child should also always have a buddy or adult supervision while swimming. Specific follow-up will be determined by your child's physician. Medications for seizures may not be needed for the entire life of the child. Some children may be taken off their medications if they have been seizure-free for one to two years. This will be determined by your child's physician.