One of the most frightening experiences a parent may witness in her or his child is a seizure or convulsion. In order to deal with this problem effectively, it is best to ‘demystify' a seizure by defining it.
A seizure is an abnormal discharge of electrical activity in the brain. A child is considered to have epilepsy when she or he has had two or more unprovoked seizures. Unprovoked implies that there are no obvious triggering events such as infection, fever, trauma, drug intoxication, hypoglycemia or other known stresses that may bring about a seizure in a child not otherwise prone to having epilepsy.
Seizures are not uncommon in children, with approximately 4-5% of children developing febrile seizures, 1% having at least one febrile seizure before age 14 years, and between 0.4-0.8% of children having epilepsy by the age of 11 years.
Seizures are divided into:
Partial seizures consist of either simple seizures such as motor or sensory seizures or complex seizures which involve some impairment of consciousness. Partial seizures may spread and become a more generalized seizure, called secondary generalized seizures. Partial seizures begin in a localized area of the brain and may be either genetic or secondary to some injury or abnormality in a particular brain region.
Generalized seizures may consist of diffuse discharges which spread throughout the brain and not in a localized area. These seizures may consist of stiffening movements called "tonic," shaking movements called "clonic," periods of unresponsiveness called "absence," loss of muscle tone called "akinetic," and quick lightening-like movements called "myoclonic."
What Causes a Seizure?
Seizures may be due to a myriad of causes. Seizures are divided into primary or secondary depending on the etiology. Primary seizures are often inherited and may result from disturbances in ion channels or in the neurotransmitters or their receptors in the brain. Idiopathic seizures mean that the cause for the seizure is not known. Secondary seizures are usually due to a specific injury to the brain such as a stroke, perinatal injury, trauma or infection to name a few. Genetic causes for seizures are well known and certain genetic syndromes such as Down syndrome or Cornelia de Lange syndrome, may have a higher incidence of seizures.
What Should I Do if My Child has a Seizure?
If your child has a seizure, the first thing to remember is "Don't panic." Fortunately most seizures are brief, lasting less than 5 minutes, and they will usually stop spontaneously. It is important to keep children lying on their side so that they will not aspirate secretions which may accumulate in the mouth. It is also important to keep the child from hitting objects during the seizure to prevent injuries. Children commonly stop breathing momentarily during a seizure but rarely stop breathing for a prolonged period of time. Placing something into the mouth to ‘keep it open' does not improve the breathing and only increases the potential for injury. If a seizures lasts longer than 5 minutes, it is time to call for an ambulance to take the child to the nearest medical facility.
What Should I do for the First Seizure?
Assessment of the first seizure is usually the most important. Causes such as infection, accidental drug ingestion, trauma, low blood sugar or electrolyte imbalances, and other causes must be excluded. Investigations that may be undertaken include an electroencephalogram (EEG) or brain wave and imaging studies such a computerized tomography (CAT) scan or magnetic resonance imaging (MRI) scan. The decision to treat a first seizure is complicated and usually predicated on the etiology.
What can be done to treat a seizure?
Fortunately a number of new anticonvulsants have been developed over the last 10 years which add in the treatment of epilepsy. The choice of anticonvulsant depends on the seizure type and the age of the child. All anticonvulsants are powerful drugs associated with risks and it is important to know what common side effects may occur. As with all medications, there is a risk of an allergic reaction and interference with other medications which may be used at the same time. Most children can be successfully treated with a single anticonvulsant medication.
When can I stop the anticonvulsant?
Anticonvulsant medication should never be suddenly discontinued since this may precipitate a prolonged seizure that may be very difficult to control. Some children eventually can be withdrawn from medication if they have not had seizures in over one to two years. Partial seizures, especially if there is a structural change in the brain, may be less likely to cease spontaneously.
Is there anything my child can't do because of seizures?
In general, children with seizures should not be restricted in their activities. A common sense attitude is helpful in that considering whether a seizure during an activity could be life threatening. Climbing in high places, swimming unsupervised, operating equipment should obviously be discouraged. In general, seizures should not be a major restriction to the child's normal activity.
Where can I learn about seizures?
The internet can be a great resource but the information must come from a reliable source since there is more ‘misinformation' than information on the Net. An approved Web site, such as from the Epilepsy Foundation, may be an invaluable guide for families. There are local chapter of the Epilepsy Foundation throughout the United States and information can be requested. Of course, you child's doctors or clinic are always a good source of help.
Despite the great concerns about seizures, most children can be successfully treated with little impact on their daily lives. The adverse effects of anticonvulsants can usually be minimized especially if single drug is used. Knowledge about seizures and the drugs used for this problem is the best defense against epilepsy. A team approach which includes the child, parents, and health care providers is the best method to control epilepsy.