Introduction
What Types
of Seizures Do Children Have?
Some
Basic Epileptic Syndromes and What They Mean for Your Child
Seizures and Fever
Tests—Which
Need to Be Done, and How Often?
Epilepsy and Brain Damage
What
to Do if Your Child has a Seizure
More Ways to Protect
Your Child
Seizures and Video Games
Summary
Introduction
The majority of epilepsies begin in childhood. The brain
is less mature during this time and is therefore less able to protect itself
from abnormal electrical discharges, which are abnormal electrical signals
that the cells in the brain (neurons)
use to communicate with one another. Childhood epilepsy is similar to adult
epilepsy, with a few very important differences. For instance, seizures
and the medications used to treat them (called anticonvulsants)
can have an effect on the growing brain. This article will describe some
of the basic types of epilepsy in children and will answer some of the
questions that parents frequently ask upon hearing that their child has
epilepsy.
What
Types of Seizures Do Children Have?
In general, children can have all the same types of seizures
that adults have.
Generalized seizures
They can suffer from generalized seizures, which immediately
involve the entire brain and cause loss of consciousness. An example of
this type is a grand mal or generalized tonic-clonic seizures—during which
the child falls to the ground, his eyes roll up, and he develops stiffening
of the body followed by rhythmic jerking movements. Another kind of generalized
seizure is the absence or petit mal seizure, which consists of an episode
of brief staring, sometimes accompanied by eye-fluttering or brief rolling
up of the eyes. Myoclonic seizures manifest in brief, non-rhythmic jerking
movements of the arms, legs, or body, similar to the jerking you experience
as you are drifting off to sleep or when you are startled.
Partial seizures
In contrast to generalized seizures, partial seizures
start in one part of the brain. The place of origin varies from person
to person, and is referred to as the epileptogenic
focus. Partial seizures are typically divided into two types:
simple
and complex. Simple partial seizures
do not cause unconsciousness—patients may continue to interact with their
environment except for the limitation caused by the seizure. On the other
hand, complex partial seizures impair consciousness and produce partial
or incomplete unresponsiveness.
The symptoms depend on which part of the brain is involved.
Partial seizures often consist of staring, and are sometimes accompanied
by chewing, twitching of the fingers, or drooling. This type of seizure
could also exhibit the following symptoms:
-
An inability to speak or understand
-
A strange sensation
-
Beating of the eyes to one side
-
Involuntary movements of an arm or a leg
Partial seizures can turn into generalized tonic-clonic seizures.
After absence or myoclonic seizures, the child will recover
consciousness immediately, while after generalized tonic-clonic or partial
complex seizures, the child is generally very sleepy or confused.
Children can also have some types of seizures that adults
don’t have, such as infantile spasms. Seizures in newborn babies or very
young infants are more common in infants who have genetic abnormalities,
serious infections, or babies who had problems during pregnancy or delivery.
Seizures at this age often appear quite unusual. Diagnosis can be difficult
since children can have many strange episodes that appear to be seizures,
but are not—nightmares, for example.
These are signs that an event might be a seizure:
-
The episode occurs repeatedly and is always the same (e.g.,
first the child stares, then the eyes roll up briefly, and then the lips
turn blue).
-
The child does not respond during the event.
-
The child’s behavior is not related to the surroundings (e.g.,
fiddling with shirt buttons, although the child is not trying to undress).
-
The child seems drowsy or confused afterwards, or does not
remember what happened.
Children who are slower to develop, who are not learning
to walk or talk, or who are not keeping up in school have a higher risk
of developing epileptic seizures.
Some
Basic Epileptic Syndromes and What They Mean for Your Child
Petit mal or classical
absence epilepsy occurs in children between 3 and 12 years of
age. It is characterized by absence seizures, which last only for a few
seconds, but occur many times daily. Sometimes a teacher may notice staring
spells, or may complain that the child is daydreaming in school, or not
keeping up with others. Some children additionally have infrequent, short,
generalized tonic-clonic seizures. With this type of epilepsy, the EEG
(electroencephalogram—a study of brain waves used to diagnose epilepsy)
shows a consistent pattern. The seizures are usually easily controlled
with anticonvulsant medications and are outgrown in 80 percent of cases
by adolescence. About 40 percent of children will have infrequent, brief,
generalized tonic-clonic seizures as adults, particularly if they also
had them as children. This type of epilepsy runs in families.
Benign rolandic epilepsy or
benign
epilepsy with centrotemporal spikes (BECT) occurs in children
between 2 and 14 years of age. Typically, the child will have partial seizures
that involve the twisting of one side of the face or mouth, twitching of
the cheeks or eyelids, and sometimes numbness or tingling of the face or
mouth. The child may make strange noises or drool. At times, the seizure
will spread to involve one arm or may turn into a grand mal or generalized
tonic-clonic seizure. The episodes are usually short and infrequent—often
occurring during sleep—and show a characteristic pattern on the EEG. The
seizures are usually easily controlled with anticonvulsant medications
and, in fact, many children do not need any medication at all. By adolescence,
the seizures usually stop. This type of epilepsy also runs in families.
Juvenile myoclonic epilepsy starts
in children between 12 and 20 years of age. It is characterized by myoclonic
seizures, which typically occur upon awakening in the morning, and last
only for a few seconds. Children with this condition also have grand mal
or generalized tonic-clonic seizures during sleep. The EEG shows a characteristic
pattern. The tonic-clonic seizures can be brought on by lack of sleep,
and sometimes by flashing lights. Both types of seizures are usually easily
controlled with anticonvulsant medications, but unfortunately persist throughout
life in the vast majority of cases. This type of epilepsy runs in families.
Infantile spasms are
seizures that usually only occur in children from one month to two years
of age. The full-blown seizure consists of a myoclonic jerk, followed by
head-drop and then sagging of the entire body. Sometimes only part of the
seizure is seen, or there may be only brief stiffening of the arms or legs.
The seizures typically occur in clusters upon awakening in the morning
or after naps. The child also stops playing and interacting with his environment,
and may stop sitting, walking or talking as the seizures become more frequent.
The EEG is very abnormal. Many other tests are usually necessary to try
to find the cause of the spasms, and treatment is very difficult and prolonged.
The infantile spasms usually stop by about twoyears of age. However, many
of these children will have other types of seizures throughout their lives,
and may be mentally retarded.
Seizures
and Fever
Febrile seizures are
generalized tonic-clonic seizures that only occur in children from six
months to five years of age. They are associated with a high fever (usually
over 102o F), which
is not necessarily due to an infection of the brain. They last less
than 15 minutes—usually only one to two minutes. Although these seizures
can occur repeatedly throughout infancy and early childhood, they are generally
outgrown by four or five years of age. Treatment with seizure medications
is usually not necessary, although a short-acting anticonvulsant (diazepam)
may be prescribed—to be given rectally or by mouth whenever the child has
a high fever. If the seizures have any atypical features—for instance,
if they last a long time, if they only involve one part of the body, or
if the fever is not very high—then there may be an increased risk of developing
epilepsy. This is particularly true if the child learned to walk or talk
at a late age, or has other neurological abnormalities. In this case, further
tests and seizure medications may be needed. Even children with epilepsy
are more likely to have seizures when they have a fever or an infection.
Tests—Which
Need to Be Done, and How Often?
Blood tests should be done at the time of the first seizure.
Infrequently, seizures can be caused by a low blood sugar or other abnormality,
which is detectable in a blood test. Blood tests are also done to check
the blood levels of certain seizure medications, and to look for side effects
such as problems with the liver or bone marrow. Many of the newer medications
do not require regular blood tests.
Standard investigations for a first seizure include an
MRI
scan of the brain (a radiographic exam that uses magnetic fields
to produce images of cross-sections of the body) and an EEG. If the seizures
are very hard to control or if your child has other neurological problems,
your doctor may recommend other tests such as specialized genetic studies,
PET
or SPECT scans (special radiographic
tests that look at brain activity), or even a skin or muscle biopsy.
The EEG and other tests may be repeated if the seizures are poorly controlled,
if other symptoms develop, or if your doctor plans to stop the seizure
medication.
Epilepsy
and Brain Damage
Children with epilepsy have a slightly increased risk
of mental retardation, learning disabilities, and attention deficit disorder,
however most children with epilepsy are not mentally retarded. Sometimes
uncontrolled seizures or medication side effects can cause drowsiness or
hyperactivity, or may interfere with the child’s ability to learn. Sometimes
it is possible to identify a specific brain abnormality causing the seizures
and interfering with the child’s intellectual development. You should tell
your child’s doctor about any learning or behavior problems so that they
can be investigated and treated.
Brief, infrequent seizures do not seem to damage the brain.
On the other hand, prolonged seizures (e.g., generalized tonic-clonic seizures
lasting more than 30 minutes, or frequent, brief seizures without recovery
of consciousness), called status epilepticus,
may
cause permanent brain injury. It is also possible to fall and injure yourself
during a seizure, although this is less common in children who are more
closely supervised.
What
to Do if Your Child has a Seizure
It is important to realize that most seizures are very
short and stop by themselves. You should prevent the child from falling
or walking into dangerous situations. You should loosen the child’s clothing
if it is tight and place him on his side on a flat surface.
Do not put anything in the child’s mouth, as you can chip
teeth or severely injure your fingers. Physiologically, it is not possible
to swallow the tongue, though tongue biting may occur. Call the ambulance
if:
-
The child is not known to have seizures.
-
The seizure lasts more than 10 minutes.
-
The child is having difficulty breathing.
-
The child is having repeated seizures.
More
Ways to Protect Your Child
How many and what type of precautions you need to take
depends on how frequently your child has seizures, whether there is any
warning before the seizures, and whether the seizures occur in the daytime
or only at night. In general, the child should avoid activities with a
high risk of head injury, such as boxing or football. The child should
wear a helmet and protective pads when riding a bicycle or roller-blading,
and should not ride on a street with traffic. Activities such as SCUBA
diving, sky-diving, rock climbing, and bungee jumping are prohibited. Someone
should be with the child at all times when swimming. Do not restrict the
child unnecessarily, but consider the child’s safety when planning activities.
If your child is a teenager, he should not be allowed
to drive a car unless he is seizure-free for one year. Restrictions must
be more severe for the first six months to one year after the first seizure,
if the seizures are poorly controlled, or after stopping seizure medications.
Consider telling your child’s teacher that your child has seizures so that
the school staff can report any unusual events or problems with the medications.
Seizures
and Video Games
The overwhelming majority of children with epilepsy can
play video games safely. Video games may trigger seizures in a small number
of children (less than three percent) who are photosensitive—the
seizures are brought on by flickering lights or flashing images. Stress,
exhaustion, and rapid breathing may also trigger seizures while playing
video games. A child who is photosensitive may report strange or unusual
feelings while playing video games, or in response to shimmering light
on water, flickering sunlight or any sudden or strong light. The EEG can
help determine whether the child is photosensitive. The risk of seizures
during video games can be reduced by:
-
playing in a well-lighted room and reducing the brightness
of the screen.
-
keeping as far away from the screen as possible.
-
using smaller screens.
-
taking regular breaks and looking away from the screen from
time to time.
-
avoiding playing for long periods of time.
-
covering one eye when playing (switching eyes from time to
time).
Summary
Most epilepsies begin in childhood because the brain is
less mature at this time. Children can have all of the seizures that adults
have, but can also have other types of seizures characteristic only of
this age. Seizures may be part of an epileptic syndrome such as Petit Mal
epilepsy. Sometimes seizures are outgrown, i.e., they stop spontaneously
as the child gets older. Most seizures are short and self-limited. Seizures
may require some restriction of activities to ensure the child's safety,
however, the majority of children with epilepsy can have their seizures
controlled with medications and can lead normal or nearly normal lives.
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