Seizures - Reeve Foundation

The brain works by nerve impulses being transmitted throughout it. A sudden disruption or bursts in nerve transmissions in the brain can lead to a seizure. This excessive nerve activity in the brain can lead to changes in the level of consciousness, movements, sensations, and behavior. There are many reasons why seizures occur. Seizures can be the source of neurological injury or the consequence of it. They can appear at any age, temporarily appear or be life lasting, and may appear even without neurological disease or injury. Knowing the signs of seizures can help you identify this medical concern for your child.

Many individuals think seizures are full-body shaking episodes, but there are other types as well. Seizures can be confused for tone (spasticity), so understanding the difference is important to getting the proper treatment for the situation.

Seizures can be focal in just one particular part of the brain or general, which are throughout the brain. Focal seizures affect certain parts of the body that are controlled by the area of the brain affected. Focal seizures are sometimes called partial seizures not because they are not full-body seizures but because they appear in an isolated or focused part of the body. General seizures occur throughout the entire body as the entire brain is affected. A generalized seizure occurs on both sides of the brain. The results of a generalized seizure can be minimal, like staring, to full body uncontrolled movement.

Focal seizures occur when the electrical burst is in a part or one side of the brain. Focal seizures can be simple or complex.

A simple focal seizure occurs in a small, specific area of the brain. The location can vary by individual. It may be seen in the body as jerking in one leg (mimicking tone or spasm), a finger, visual disturbance, or an inability to speak. Simple focal seizures affect any function of the body depending on the location of the electrical burst in the brain. The key is that it is isolated to one area or muscle group. A nerve disruption on one side of the brain affects the opposite side of the body. Consciousness is not lost in simple seizures. Your child may also have sweating, nausea, or loss of color in their skin.

Complex focal seizures most often occur in the temporal or frontal lobe of the brain but can occur anywhere in the brain. The temporal and frontal lobe affects emotion and memory function therefore, the child becomes unaware of their surroundings. They may appear awake but lost in their own thoughts or ‘zoned out.’ Behaviors can range from no responses to running, screaming, emotional extremes of crying or laughing, or milder behaviors such as lip smacking or gagging. After a complex focal seizure, the child may be tired or fall asleep. Loss of consciousness typically occurs in complex seizures.

Secondary generalized seizures begin as a focal seizure that affects one area of the brain and a specific part of the body but then evolves into a generalized seizure. Close monitoring of the seizure may help you identify if this is occurring.

There are several types of generalized seizures.

Absence seizure (used to be called petit mal seizure) affects consciousness and lasts about 30 seconds. This seizure can be easy to overlook since it is so brief. It consists of staring, sometimes with facial twitches or rapidly blinking eyes occur. You may think your child has just zoned out. Absence seizures are important to be diagnosed as they are often confused with a behavioral or learning issue, even though a seizure is occurring. When the seizure is over, the child generally does not recall what happened. They may just resume their current activity without notice that the seizure has even happened. These seizures generally appear between ages 4 to 12.

Generalized tonic-clonic seizure (used to be called grand mal seizure) consists of rhythmic movement of the body, arms, and legs, followed by muscle stillness. Consciousness is affected. When the seizure is over, your child may be tired, have visual and/or speech issues, headache, fatigue, and body aches.

Myoclonic seizures occur in clusters over a day or several days. They consist of sudden jerking motions in groups of muscles.

Some children who have a seizure or multiple seizures may have an ‘aura’ or warning of an impending seizure. An aura is actually a focal seizure. It may consist of an unusual sensation, visual disturbance, or another feeling. This warning might allow time for the child to call for help or to sit down or otherwise protect themselves from falling or hitting objects during the seizure. Auras can be different for each child. They may be something that only the child notices or can include a body movement that is seen by others.

After a seizure has ended, there is usually a period of time for recovery called postictal. This is a time when the child returns to their baseline condition. It gives the brain recovery time. Typically, the child is tired or sleeps and may not respond to questions or directions until the postictal period has ended.

Seizures can be caused by several sources in children. The most common source for all children, with or without neurological issues, is fever. Infections are usually present such as colds, flu, ear infection, or urinary tract infection. These seizures are generalized, with loss of consciousness, body, arm and leg jerks or twitches, eye-rolling, and still limbs. Febrile seizures occur with a fever of 101°F (38.3°) or greater. They affect children ages six months to five years with age two being the most common. It is important to remember that many children with a fever do not have a seizure.

Reduce the fever by removing blankets and clothing, and with cool cloths placed directly on the skin. Treatment consists of acetaminophen or ibuprofen to reduce fever, but these should only be given to children that are conscious with the ability to swallow or provided through a gastric tube. Febrile seizures may or may not repeat with other fever events. If this is your child’s first febrile seizure, call 911 for care. You may be taught how to care for seizures should a febrile seizure occur again. A child who has a febrile seizure has a high risk of seizure with following fevers.

Other sources of seizures can include flashing lights, sleep deprivation, caffeine, recreational drugs, missing prescription medication doses, alcohol, and stress. Medical causes of seizure in children can include low blood sugar, chemical imbalances especially sodium, dehydration, brain injury, brain tumor, stroke, uncontrolled autonomic dysreflexia, congenital issues, and prematurity. Some children have seizures due to unknown causes.

Repeated seizures lead to a diagnosis of epilepsy. Diagnosis of a seizure or multiple seizure activity in the brain is made through testing. A physical examination with neurological evaluation is performed by your child’s healthcare professional. Usually, an electroencephalogram (EEG) is performed to assess the nerve activity in your child’s brain. This may be done with the child awake or asleep, maybe a single test or recorded for 24 or more hours, and may be performed with or without sleep deprivation. In the hospital, a child may have a video recording of their activity/movements in conjunction with EEG readings. An MRI or CT scan of the brain or lumbar puncture (spinal tap) may be done.

The most common treatment for seizures is medication. There are a variety of medications that can be used but the one that will work best for your child’s specific needs is chosen as well as how the medication will be best delivered into your child’s body. The drugs are classified as antiepileptic, anticonvulsant, or antiseizure drugs. Commonly used medications for seizures are phenobarbital, or valproic acid, however, there are many. Your child’s healthcare provider will select the best option for your child.

Other treatments may include dietary changes. The ketogenic diet, which is high in fat and low in carbohydrates, has been explored for seizure control. This should be used only with supervision by your healthcare professional as it has been helpful for some children but not for others. Specifics of the diet must be followed meticulously.

CBD oil has been used by some, also with varying outcomes. Again, be sure to be under the direction of a healthcare professional as interactions with other medications or withdrawal of other medications can have serious consequences for your child.

Internal placement of an electrical stimulator on one side of the vagus nerve has been used successfully for some children depending on their type of seizure classification. The child must be able to have a warning of impending seizure and hand function to control the device.

Surgery is used only in the most severe cases of seizures in children. The part of the brain causing the seizure is silenced or removed. This may be a localized area within the brain or the removal of a larger section of the brain. When performed in children, there often is no change in mentation as adults.

Keeping your child safe during a seizure is important to avoid other complications. You will want to loosen tight clothing, remove eyeglasses and turn the child on their side to assist with breathing and in case of vomiting. They may be safest in their wheelchair. Keep the area free from things that could be hit against. A flat but soft item under their head will help protect it without impeding breathing. Never put anything in the mouth. Note the length of the seizure, and what happened during the seizure. If this is a first-time seizure, if breathing is affected, if anything unusual occurs, if you are not comfortable handling the situation, or if the seizure lasts over 5 minutes, call 911. A quick review of Seizure First Aid is found here: https://www.cdc.gov/epilepsy/about/first-aid.htm.

More information about seizures is located here: https://www.cdc.gov/epilepsy/about/types-of-seizures.htm.

Remember not every child with neurological issues will have a seizure or a seizure disorder. Children without neurological issues may have a seizure disorder. There are all sorts of medical reasons why a child does or does not have seizures. However, it is important to understand what seizures are and how to assist a child who does have a seizure.

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.