What Are Seizures in Children?
A seizure is a sudden, abnormal wave of electrical activity in the brain. Seizures begin suddenly. Most often stop on their own within a few minutes.
Seizures are common. About one in 10 people will have a single seizure in their lifetime.
People often associate seizures with dramatic symptoms, such as loss of consciousness or convulsions (uncontrolled shaking). Signs and symptoms vary depending on the type of seizure a person has and what part of the brain is involved. Some seizures are not obvious to others. Rather than physical symptoms, the child has an “odd feeling,” such as déjà vu (a sense of having experienced the present situation before). These odd feelings come “out of the blue.” They usually get worse as the person continues to have seizures.
Seizures are treatable. Many children outgrow their tendency to have them. An accurate diagnosis can help doctors find the most effective treatment.
When a child has shown a tendency to have seizures, it is called epilepsy. About one in 26 people who have seizures will develop epilepsy.
What Causes Seizures in Children?
Seizures can be divided into two general categories, provoked and unprovoked. Provoked seizures can be caused by many different conditions, such as high or low blood sugar, a head injury, infection or very high blood pressure. A stroke, kidney or liver failure, and high fever may also provoke a seizure. These types of seizures are extremely rare.
Unprovoked seizures do not have an immediate, clear cause. After further evaluation, doctors may find a cause, such as a genetic condition or lesion in the brain.
Finding the cause of seizures can be challenging for doctors and frustrating for families. Sometimes even after extensive evaluation, the cause of a child's seizure is unknown. Even if the doctor doesn't discover the cause of a child's seizures, treatment may help bring the seizures under control.
Types of Seizures in Children
There are many different types of seizures in children. They fall into a few categories:
- Focal, meaning the seizure activity begins in one part of the brain and may spread from there.
- Generalized, meaning the seizure affects all parts of the brain at once.
- Infantile spasms, a type of seizure that begins during the first year of life.
- Status epilepticus, which involve convulsions of more than five minutes.
- Febrile seizures, which occur within 24 hours of a fever for children between six months and five years of age.
Focal seizures are a common type of seizure in children. Symptoms include:
- A feeling of falling or spinning
- A feeling of "pins and needles"
- A sense that familiar things are suddenly unfamiliar, or vice versa
- A sudden feeling of anger or fear
- "Automatisms" (involuntary gestures), such as removing or fiddling with clothing, grunting, lip-smacking and clumsy movements
- Buzzing noises
- Garbled speech or problems with memory
- Repeating words or phrases, laughing or crying
- Rhythmic twitching of a limb or part of a limb (twitching may spread to other parts of the body)
- The appearance of daydreaming, including blank stares
- Smelling or tasting things that aren't there
- Vivid hallucinations
Children can experience two types of focal seizures:
- "Focal aware seizures" (previously called “simple partial seizures”)—The child remains fully alert and awake. They remember having the seizure. But they may not be able to interact with others while the seizure is happening.
- "Focal impaired awareness seizures" (previously called “complex partial seizures”)—The child is unaware of their surroundings. They may not remember the seizure.
There are two categories of generalized seizures. They include non-motor such as absence (pronounced "ab-SONCE") seizures and motor seizures.
Non-motor, Absence Seizures
Sometimes called “petit mal seizures,” absence seizures are one of the most common seizures in children. A child having this type of seizure may look like they are daydreaming or zoning out. The seizures last 15 seconds or less. They may occur many times a day. They may begin at age four through adolescence. Some children outgrow them.
The four types of generalized motor seizures include:
- Atonic seizures
- Myoclonic seizures
- Tonic seizures
- Tonic-clonic seizures
Atonic seizures involve a sudden loss of muscle tone. Sometimes called a "drop attack," these can cause symptoms such as:
- Brief loss of consciousness
- Falling to the ground
- Head dropping down
Myoclonic seizures involve sudden, shock-like muscle contractions affecting one or more limbs. These seizures may happen once or in clusters, with more than one occurring in a short period of time.
These seizures involve stiffening of the body and/or arms and legs. They may occur when the person is awake or asleep. If they happen while standing or sitting, the person may fall to the ground.
When a person has a tonic-clonic seizure (sometimes called a “grand mal seizure”), they lose consciousness, their muscles stiffen, and their arms and legs jerk uncontrollably. A tonic-clonic seizure usually begins on both sides of the brain. It can also start on one side and spread to the whole brain. There are two phases:
- Tonic phase: The person's muscles stiffen. They may fall to the floor. Breathing is affected. The person may turn a bit blue in the face and cry out. The person may bite their tongue or cheek, causing bleeding from the mouth.
- Clonic phase: This follows the tonic phase. It involves convulsions—the person's arms and usually legs begin to jerk. Sometimes the person loses control of their bladder or bowel.
These seizures usually last a few minutes. A tonic-clonic seizure of five minutes or more is a medical emergency.
Infantile Spasms (West Syndrome)
Sometimes called "epileptic spasms," these seizures are diagnosed in a baby's first year of life. They may start with a quick spasm involving a downward head jerk. Over time, these may develop into clusters of spasms in which the child’s arms or legs arms rise and/or straighten suddenly.
Seizures most often occur when the child is waking up or falling asleep. At first, these symptoms may be subtle. Over time, they become more noticeable.
Infantile spasms are a medical emergency. They do not pose an immediate danger, but children with infantile spasms are at high risk for developmental delays. The child may lose skills, such as crawling and walking, if left untreated. They need immediate treatment for the seizures to minimize their risk for long-term problems.
Cincinnati Children's offers a specialized neurometabolic program to help infants or children experiencing infantile spasms. It is available through our Infant Seizure Program.
Status epilepticus is a medical emergency. It involves convulsive seizures lasting more than five minutes. If the seizures last longer than 30 minutes, serious problems could occur, including permanent brain damage. Children diagnosed with status epilepticus need to have "rescue medication" nearby at all times. An adult can give this medication to stop the convulsions quickly.
Febrile Seizures (seizures in toddlers)
These seizures occur in children ages six months to five years old. They happen within 24 hours before or after the child has a fever. These motor seizures involve convulsions. Children typically outgrow these seizures.
Febrile seizures can be simple or complex. To be considered complex, febrile seizures must last longer than 15 minutes or occur more than once in 24 hours or affect one part of the body. The shaking may affect one or both sides of the body. A small percentage of children who have complex febrile seizures develop epilepsy.
Signs and Symptoms of Seizures
When you hear the word seizure, you may picture someone lying on the ground and shaking violently. This is how seizures are shown on television and in the movies. However, many types of seizures are subtle. They can be hard to recognize, especially in infants.
The most common symptoms include:
- A color change of the lips or face
- A funny feeling the child can't describe
- Lack of awareness and/or decreased responsiveness, plus staring
- Eyes or head turned into one direction
- Staring with eye fluttering
- Seeing stars or shapes
- Excessive drooling
- Loss of bowel or bladder control
- "Automatisms," or repetitive activities, such as fiddling with clothing, grunting, lip-smacking and clumsy movements
- Convulsions (uncontrolled shaking of the body)
- Drooping facial features
- Jerking movements or stiffening of one or more arms and legs
- Sudden loss of muscle control
- Twitching or jerking of the face, arm or leg
When the seizure is over, the child may be tired and need to rest.
Some people experience an "aura" (warning). This is part of the seizure. Auras usually last seconds to minutes. They occur before the person has visible signs of a seizure. Some common auras can include:
- A physical sensation (numbness or tingling, racing heartbeat, dizziness, headache)
- An emotion (suddenly feeling sad or anxious)
- A change in senses (unusual smells or taste)
People who experience an aura can take safety precautions, such as sitting down, telling someone they are about to have a seizure, or taking medication as prescribed.
What Do You Do if a Child is Having a Seizure?
- Stay calm and stay with your child.
- Protect your child from getting hurt. Move objects away that may harm them.
- Place a soft object under your child's head.
- Roll your child onto their side.
- Loosen tight clothes.
- Time the seizure when it starts.
- Be prepared to give seizure rescue medication based on your child’s individual seizure plan.
- Call 911 if seizure lasts five minutes or longer and you do not have a seizure rescue medication.
- Do not put anything in the child's mouth. Your child cannot swallow their tongue.
- Do not try to keep your child from moving. This may cause you or your child to get hurt.
- Do not give liquids or medicine by mouth until your child is fully awake and alert.
Most seizures will stop within minutes on their own. If your doctor has prescribed “rescue medication” for seizures lasting five minutes or longer, be prepared. Know where the medication is and how to give it to your child. Store the medications securely at room temperature. Avoid storing it in places such as a car's glove compartment or a tote bag that will be out in the sun.
After a seizure:
- Your child may be confused and sleepy. It is OK to let them sleep.
- Your child may have pee or poop in their pants.
- Any bleeding from the mouth may mean that your child bit their tongue or the inside of their cheek. Check the mouth only after the seizure is over. Put a clean cloth on the area and use gentle pressure to stop the bleeding.
Most seizures are not emergencies. But you should call 911 if your child:
- Has a seizure that lasts longer than usual
- Has a cluster of seizures (more than one seizure in a short period of time)
- Does not return to "normal" after the seizure within their usual timeframe (being sleepy is OK)
- Is not breathing normally after the seizure ends
- Has a seizure while in the water
- Is injured during a seizure
Diagnosing Seizures in Children
If your child experiences a seizure, they should be seen by a pediatric neurologist or pediatric epileptologist (a pediatric neurologist specializing in epilepsy).
During your child's first appointment, the doctor will ask questions about your child's seizure history and health history and whether other people in your family have had seizures. The doctor will also do a thorough exam and may order tests, such as:
- Electroencephalogram (EEG)
- Magnetic resonance imaging (MRI) of the brain
- Genetic testing
The goal is to discover the underlying cause of the seizure(s) and provide treatment. Sometimes it is not possible to find the underlying cause.
Treatment for Seizures
If your child is diagnosed with epilepsy, the doctor may prescribe anti-seizure medication. This medicine helps control seizures. The doctor will choose the medicine based on your child's age, weight, seizure type and physical condition.
The goal of treatment is to achieve the best quality of life with no seizures and no side effects from the medicine. Sometimes the medicine will need to be changed if there are side effects that are too much to handle or if it doesn't control the seizures. If a child is seizure-free after two years of being on medicine, the doctor may try to take them off their seizure medicine.
If a child still has seizures after taking two different epilepsy medications, their epilepsy is called intractable. This is the case for about 30% of children with epilepsy.
Learn about intractable epilepsy and how it's treated.
Your child’s provider may prescribe anti-seizure medication. It is also important for you to be aware of situations that seem to lead to your child’s seizures. These are called seizure triggers. Some common seizure triggers include:
- Fatigue – it is important to keep a good sleep schedule.
- Excessive stress – mental health professionals can help children and families learn to manage stress in healthy ways.
- Fever or other symptoms of illness – it is important to have good hand washing. Stay up to date on immunizations.
- Visual stimuli, such as flashing bright lights or computer games (please note that this type of seizure trigger is rare.)
- Using certain medications or not taking anti-seizure medication as prescribed.
- Hormonal changes, such as those with the menstrual cycle
Knowing your child’s seizure triggers can help your child avoid situations that could lead to a seizure. This will help you be more aware during “high risk” times (such as when your child is sick).
To identify seizure triggers, keep a seizure log. For each seizure, write down what time it is, what was happening and how your child felt before the seizure started. Look for patterns and connections. Talk to your child’s provider about what you learn.
What Is the Outlook for Children with Seizures?
Seizures are not necessarily a lifelong condition. Many children outgrow their tendency to have seizures. And for those who do not, treatment is often effective.
In recent years, science has come a long way to develop new treatments for people with seizures, especially those who have intractable epilepsy. Most children who have seizures can go to school, play sports and live full lives.