Seizure /Convulsions

What is Seizure?

A seizure or (convultions) 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 children has epilepsy-recurring seizures.

Seizure Types

Febrile seizure

Occurs in children in illness such as an ear infection, cold, or chickenpox accompanied with fever.

• Febrile seizures are 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 not known, 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 to have a second episode.

Neonatal seizures

Occur within 28 days of birth. Most occur soon after the child is born. They may be due to a large variety of conditions. It is difficult to determine if a newborn is actually having seizer, because they do not show convulsions. Instead, their eyes rolling and appear to be looking in different directions. They may have lip smacking and irregular breathing.

Partial seizures

Part of the brain involved and therefore only a part of the body effects

• 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. abnormalities movements and can "march" to other parts of the body as the disease progresses.
• Complex partial seizures are similar, except that the child is not aware of what is going on. Frequently, children with this type of seizure repeat an activity, such as clapping, throughout the seizure. They have no memory of this activity. After the seizure ends, the child is often disoriented in a state known as the postictal period.

Generalized seizures

It involves a much larger portion of the brain. They are grouped into 2 types: convulsive (muscle jerking) and non-convulsive 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 than a few seconds and start and stop abruptly; however, the child does 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

It 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 children have generalized tonic-clonic seizures. Status epilepticus is very serious. With any suspicion of a long seizure, you should call 108.

Seizures in Children - Causes

Although 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. Other causes may be due to meningitis, developmental problems such as cerebral palsy and head trauma.

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.
• Other reasons for seizures are these:
  • Infections
  • Metabolic disorders
  • Drugs
  • Medications
  • Poisons
  • Disordered blood vessels
  • Bleeding inside the brain
  • These may include brain tumor, infections, fever, birth injuries, injury, or trauma

Seizures in Children - Symptoms

Seizures 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 often sleepy 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. All 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 by pediatrician.
• 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 – 108
• 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.

Your initial efforts, first at protecting the child from 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 108 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 or paracetamol) may be given
• 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. Children with known epilepsy should also be prevented from further injury by moving away solid objects in the area of the child.

Medical Treatment

Treatment 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 anti-seizure medications, admitted to the intensive care unit, and possibly be placed on a breathing machine

Prevention

Most 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.
• To prevent further injury if a seizure does occur.

The child can participate in most activities just as other children do. Parents 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. Everyone has the potential to have seizures. Some people have them frequently.

Seizure disorders vary tremendously. Some people have only an occasional seizure, and other people have daily or more frequent seizures.

There are many different types of seizures. Seizure activity may range from simple blank staring to loss of consciousness with spasticity or muscle jerking.

Generally, a seizure should be considered an emergency in these situations:

• Seizures that do not stop within a few minutes
• Prolonged confusion remains after the seizure (more than 10-15 minutes).
• The person is not responsive after a seizure.
• The person has trouble breathing.
• The person is injured during the seizure.
• The seizure is a first-time seizure.
• There is a significant change in the type or character of the seizure from that person's usual seizure pattern.

Cautions

One common area for added caution is in the bathroom. Showers are preferred because they reduce the risk of drowning more than bath-tubs. Many people have seizures for reasons that are unknown. Other people have seizures from some condition that affects normal brain functioning..

• Other problems that might affect the functioning of the brain and lead to seizures include drugs or medications, alcohol, low blood sugar, or other chemical abnormalities.
• Rapidly flashing lights, high stress, or lack of sleep may induce seizures in certain people.
• Seizures in children are a special category of seizures that are addressed a bit differently. Common generalized seizures often begin when the person cries out or makes some sound. This may be followed by several seconds of abnormal stiffening, progressing to abnormal rhythmic jerking of the arms and legs.

• The eyes are generally open, but the person is not responsive or alert.
• The person may not appear to be breathing. They are, however, actually usually breathing adequately for the brief duration of the seizure. The person often breathes deeply for a while after an episode.
• He or she will return to consciousness gradually over several minutes.
• Incontinence, or loss of urine, is common.
• Often people will be combative briefly after a generalized seizure (a seizure that involves the entire brain).
• Many other seizure types exist, including isolated abnormal movements of a single limb, staring spells, or abnormal stiffening without the rhythmic jerking.

Source: emedicinehealth