Seizures In Children: Types, Symptoms, Diagnosis & Treatment

Seizures are intense surges of electrical activity in the brain that result in different symptoms based on the parts of the brain involved. In many cases, the exact cause of seizures is unknown. However, seizures in children and infants are quite common. Further, more than one episode of unprovoked seizures may indicate epilepsy, a neurological disorder (1).

Read this article to learn about the causes, types, symptoms, complications, diagnosis, treatments, and prevention for seizures in children.

Types Of Seizures In Children

Seizures are broadly classified into two different types, namely generalized seizures and focal seizures. Let us understand both types in detail (1) (2) (3) (4) (5).

A. Generalized seizures

These seizures involve both sides of the brain. Children with generalized seizures may lose consciousness and have a postictal period (a recovery phase marked by tiredness) after the seizure. The following are the different types of generalized seizures.

1. Petit mal seizure

• It is also called absent seizure.

• It involves episodes of staring and a loss of consciousness.

• It usually does not last for longer than 30 seconds but may occur several times a day.

• The child’s mouth or face may move, and the eyes may blink, but the child might not recall the seizure episodes and carry on with their activities.

• The seizure does not cause shaking or sudden falling.

• At times, the child might experience a mild loss of muscle tone and may lean slightly forward or backward.

• It usually starts between four and 12 years of age and might be misdiagnosed for a learning or behavioral issue.

• Children can go undiagnosed for several months or even years.

• Medications can help manage absent seizures.

2. Grand mal seizure

• It is also known as generalized tonic-clonic seizure

• It is characterized by five different phases

• • Flexing the arms, legs, and body (contract)

• • Straightening out of the body (extend)

• • Tremors or shakes (shake)

• • Contractions and relaxation of the muscles (clonic period)

• • • A period when the child might complain of a bad headache, body ache, problems with speech and vision, and a general feeling of sleepiness and fatigue (postical period).

• Sometimes, child might have giddiness or vomiting prior to seizure (prodromal period).

3. Atonic seizure

• It is also called a drop attack.

• A sudden loss of muscle tone can be noticed during the seizure, and the child may collapse from a standing position or suddenly drop their head. During the seizure, the child may be unresponsive and their body limp and floppy.

4. Myoclonic seizure

• This type of seizure causes jerky movements in a particular muscle or a group of muscles for a brief period.

• They happen in clusters, meaning they occur multiple times a day or many days in a row.

5. Infantile spasm

• It is a rare type of seizure that occurs in the first year of life.

• The seizures are more common when the child is waking up or falling asleep.

• It is characterized by the movement of the trunk, neck, or legs for a few seconds.

• The baby can have hundreds of infantile spasms a day.

• It may have long-term effects and is more common in young children with underlying brain issues.

6. Febrile seizure

• It is associated with fever and is characterized by muscle contractions.

• It can be either mild, such as stiffening of the limbs, or severe, such as convulsions.

• It is commonly seen in children between six months and five years and may run in families.

• Febrile seizures lasting less than 15 minutes are called “simple febrile seizures” and, in most cases, do not have long-term neurological effects.

• Febrile seizures lasting for longer than 15 minutes are called “complex febrile seizures” and may result in long-term neurological effects or evolve into epilepsy.

B. Focal seizures

• They were formerly called partial seizures.

• They may occur as a result of abnormal electrical activity in any particular lobe of the brain.

• Before the seizure, the child may experience a strange feeling or an aura that involves alterations in senses of smell, sight, and hearing.

• Focal seizures can be classified into the following two types.

1. Simple focal seizures

• Simple focal seizures usually occur for less than a minute.

• Most often, they affect the muscles of a particular group (for example, fingers and larger muscles of the hands and legs of a particular limb) and may cause abnormal movements.

• The child may sweat, feel nauseated, or turn pale, but they do not lose consciousness.

2. Complex focal seizures

• Complex focal seizures usually last for more than one or two minutes, and the child will most likely lose consciousness.

• They generally affect the temporal lobe of the brain.

• The temporal lobe controls the emotion and memory function.

• The child may exhibit symptoms such as gagging, lip-smacking, running, screaming, crying, or laughing. After the seizure, the child may feel tired or sleepy.

Causes Of Seizures In Children

While the exact cause of seizures is unknown in most cases, the following factors may make a child more prone to seizures (2) (5).

• Head injury
• Trauma during birth
• Congenital health problems
• Poisoning
• Fever
• Infection of brain
• Brain tumors
• Maternal illness during pregnancy
• Genetic causes
• Degenerative brain disorders
• Stroke
• Metabolic disorders
• Chemical imbalances
• Abuse of alcohol or drug during pregnancy
• Use of certain medicines during pregnancy 

Symptoms Of Seizures In Children

Each child may exhibit different symptoms when they have seizures. While the symptoms of some seizures are pretty evident, others are mild and may not be easily recognizable for parents or caregivers. In some cases, a child may not show any symptoms. The following are some common symptoms of seizures in children (2) (5).

• Staring
• Tremors
• Convulsions
• Jerky movements of the arms and legs
• Stiffening of the body
• Unconsciousness
• Problems with breathing
• Bowel or bladder incontinence
• Collapsing suddenly
• Unresponsiveness to noise or words for a brief period
• Confusion
• Drowsiness
• Irritability
• Lethargy
• Head nodding
• Periods of rapid eye blinking and staring
• Vomiting
• Alterations in vision, speech, or both

These symptoms are also seen in other conditions, and thus, the doctor must rule out other conditions before confirming a diagnosis of seizure in children.

Diagnosis Of Seizures

The pediatrician or neurologist will do a complete physical examination and obtain the medical history of the child and family before performing further diagnostic tests to confirm seizures in the child.

The following diagnostic tests are used to diagnose seizures in children (6) (7).

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

2. Electroencephalogram

It is a procedure that checks for abnormal electrical activity in the brain. Some electrodes are attached to the child’s scalp to run the test.

3. Magnetic resonance imaging (MRI)

MRI is a diagnostic procedure that provides detailed images of different organs and tissues of the human body by using magnets, radiofrequency, and a computer.

4. Computed tomography scan (CT Scan)

A CT scan uses a combination of x-rays and computer technology to produce detailed images of body parts, including the bones, muscles, fat, and organs.

5. Lumbar puncture (spinal tap)

A long needle is inserted in the area around the spinal cord to check the pressure of the cerebrospinal fluid and collect the cerebrospinal fluid to test for infections or any other conditions.

Treating Seizures In Children

The treatment plan for seizures in children depends on their overall health, age, medical history, severity and type of seizure, the child’s tolerance to medicines and therapies, and expectations from the treatment.

The primary aim of the treatment is to reduce the frequency or stop the seizures in children in a way that does not hamper the child’s normal growth and development.

The following are the usual approaches for treating seizures in a child (8) (9) (10).

1. Medicines

• Several types of medicines may be used for the treatment of seizures in children.

• The type and dosage of medicines depend on the child’s age, symptoms, allergies, side effects, and cost of the medicine.

• Medicines can be administered orally, rectally, or intravenously.

• Medicines do not cure the condition but help reduce the frequency of seizures and improve the child’s quality of life.

• Carbamazepine, lamotrigine, levetiracetam, eslicarbazepine, etc., are examples of medicines that may be used to treat seizures in children.

• The doctor might have to try different medicines in different dosages before determining which works best for your child.

2. Vagus nerve stimulation (VNS)

• VNS is used only for children above the age of 12 years.

• It is used in managing focal seizures if the medicines do not help.

• The procedure helps control seizures by sending small bouts of energy to the brain via the vagus nerve.

• A small battery is implanted in the chest wall, and small wires attached to the battery are connected to the vagus nerve.

• The battery is programmed to send impulses to the brain at regular intervals.

• When the child feels an impending seizure, they may activate the impulse by holding a small magnet over the battery.

• Hoarseness and deepening of the voice and pain in the throat are some of the common side effects of the VNS procedure.

3. Surgery

Surgical intervention is performed if everything else does not help. It is useful in the following cases.

• Seizures that medicines cannot manage

• Seizures that are caused by only a specific area of the brain

• Seizure in an area of the brain that can be removed without causing any problems associated with speech, memory, and vision

Surgery for seizures and epilepsy is highly complex, and a specialized team performs it on children. They may remove the part of the brain causing seizures to help in stopping the spread of wrong electrical signals throughout the brain.

What To Do When A Child Has A Seizure

All children who have repeated seizures or have a seizure for the first time must be evaluated by a doctor.

The following guidelines may help you manage and protect your child better when they have a seizure (10).

When the child has a seizure

• Lay them down on a flat floor.

• Turn them on one side if they begin to froth or foam from the mouth.

• Move them away from the stairs.

• Move sharp and hard objects away from the child.

• Do not put any objects in the child’s mouth, and do not try to hold their tongue.

After the seizure ends

• Stay with the child until they are fully alert and awake

• Check if the child is breathing. Perform mouth-to-mouth breathing if the child shows no signs of breathing.

• Call 911

• Do not give any food, water, or medicines orally until the child is fully conscious.

• Check for fever. If the child has a fever, give them medicines to treat the fever.

If the child has a known history of seizures, discuss with the doctor about the signs that need immediate medical care and when they should be rushed to the hospital.

Home Care For Children With A Known History Of Seizures

Seizures in themselves do not hurt as much as the injuries caused by the seizures. However, the following steps can help prevent children from getting hurt during a seizure episode (11).

• Drowning is the leading cause of accidents in children with seizures. Do not leave the child alone near a pool, bathtub, or any water body. Small children can drown in even an inch of water

• If the child is young and is using a tub, remove the drain stop.

• Ensure they do not latch the bathroom door from the inside while showering and that someone else is in the house when they take a bath.

• A child or teen with a history of seizures should never swim unsupervised.

• Older children may swim with a lifeguard but should always wear life jackets when swimming or boating in murkier waters of the oceans, lakes, and ponds.

• Children should always wear helmets when they are riding bikes, skateboards, or rollerblades.

• They should avoid heights, must not engage in play on higher playground equipment, should not climb trees, and must not sleep on the top bunk of the bed.

• Water heaters must not be set above 120⁰ F to avoid scalding.

• Older children should not cook unsupervised.

References

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Reviewer

Dr. Anuradha BansalMD

   

Dr. Anuradha Bansal is a highly accomplished pediatrician and neonatologist with 13 years of professional experience. Presently, she is working as Assistant Professor in the Department of Pediatrics at PIMS Jalandhar. She has done her MBBS and MD Pediatrics at GMCH, Chandigarh.

Read full bio of Dr. Anuradha Bansal