Seizures in Children
Frank L Christopher, MD, FAAEM
Robert R Westermeyer II, MD, FAAEM
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
Thomas Rebbecchi, MD, FAAEM
Seizures in Children Overview
A seizure 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.
- A febrile seizure occurs when a child contracts an illness such as an ear infection, cold, or chickenpox
accompanied by fever. Febrile seizures are the most 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
- 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 may be difficult to
determine if a newborn is actually seizing, because they often do not have
convulsions. Instead, their eyes appear to be looking in different directions.
They may have lip smacking or periods of no breathing.
- Partial seizures involve only a part of the brain and therefore only a part of the body.
- 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. Movement abnormalities can
"march" to other parts of the body as the seizure 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
- Generalized seizures
involve a much larger portion of the brain. They are grouped into 2 types:
convulsive (muscle jerking) and nonconvulsive 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 then 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 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 911.
- Epilepsy refers to a
pattern of chronic seizures of any type over a long period. Thirty percent of
children diagnosed with epilepsy continue to have repeated seizures into
adulthood, while others improve over time.
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