Epilepsy in Children: Causes, Treatment and What to Do When Your Child Has a Seizure

• Seizures are a symptom in a patient.
• Epilepsy is a seizure disorder disease.

A common misconception about seizures is that they are all caused by epilepsy. While epilepsy is a seizure disorder disease, not every person who suffers a seizure will have epilepsy. 

A patient can be diagnosed with epilepsy when: 

• They have two seizures separated by 24 hours with no known cause. 
• One seizure combined with another risk factor, such as brain tissue abnormalities or delayed development children.  

In some cases, electrolyte imbalance, bleeding disorder, brain infection or other brain insults cause the seizure. When a child has a seizure for the first time and these causes are not present, tests, including an electroencephalogram (EEG), are conducted to determine if its epilepsy. Diagnosing the disease can be done in a few days. 
 

The category and type of seizure a child suffers from can depend on his or her age group. Generalized seizures affect both sides of the brain while focal seizures affect a single side. Each category is characterized by different types of seizures which have unique characteristics. 

Types of generalized seizures that can occur in children include:

• Tonic-Clonic Seizures – These are most common in children and involve convulsions, shaking and twitching.
• Myoclonic Seizures – This type of seizure causes a jerking motion in the arm, shoulders and neck area.
• Absence Seizures – A child suffering from an absence seizure will be unresponsive and stare off into the distance. This type is usually quicker than others and can be easy to miss.
• Infantile spasm – This type is characterized by a cluster of jerking motions usually in both limbs.These are more frequent in infants.
• Focal seizures
  Types of focal seizures that may occur in children include:
• Simple focal seizure – These cause uncontrolled movement in a specific body part or muscle group on one side of the body.
• Complex Focal Seizures – This type causes a child to exhibit unusual behavior while being unaware of their surroundings.

Signs and symptoms of a seizure in children can vary which means you may not always know what to look for. In some instances, these can even be dismissed as normal behavior. That can lead to delays in the diagnosing and treatment of epilepsy.

The following physical signs and symptoms can indicate a child may be having a seizure:

• Jerking or twitching motions either in a specific body part, like an arm or leg, or the entire body.
• Unexpectedly falling down.
• Blankly staring off into the distance or not responding to their surroundings.
• Wandering around or moving in an unnatural manner.

• Picking at something nearby, such as their clothes or even the air, or smacking their lips repeatedly.  

   

Parents and teachers should also be aware of the following verbal signs and symptoms that may indicate a child is having or has experienced a seizure:

• Telling you about an unusual smell or bad taste in their mouth.
• Informing you of a tingling or numb sensation.

• Being in a general state of confusion. 

   

Children can experience more than one of these signs and symptoms when experiencing a seizure. You should take note of everything that happens as well as the duration of the episode should you believe a child is having a seizure. 

There are three stages to a seizure: 

Before
Adolescents or young adults may experience an abnormal sensation, or what is called aura. This can be difficult for younger children to explain. In some instances, they may run to hug their parent or an adult they trust, such as a teacher, or look around in fear.

During
What happens during a seizure is dependent upon the type they are suffering from. Most typically last three-to-five minutes.

After
The period after a seizure is known as the postictal state. During this time, a child can feel sleepy or dizzy, suffer from blurry vision or hallucination and may stop talking. This state normally passes after 15-30 minutes but can last more than an hour. If a child hasn’t regained full awareness after 60 minutes, they may be dealing with a reoccurring seizure or have another issue that requires medical attention.

It is necessary to be on the lookout for any type of abnormal movement and not just major spasms or convulsions that most people equate with a seizure. If you believe a child is having a seizure, it is important to remain focused and calm while taking the following steps:

•    Create a safe environment by removing any sharp objects they are holding and moving them away from potentially hazardous areas, such as swimming pools. If feasible, lay the child on his or her side. 
•    Make a note of when the seizure starts and ends. If possible, take a video recording of the child. A doctor can use this to determine the type of seizure and potentially diagnose epilepsy.
•    During the 30 to 60 minutes following the seizure, monitor the child to see if they have regained awareness. This can be done by asking simple questions and checking their general responsiveness.

Finally, you do not want to put something in the child’s mouth as they aren’t likely to bite their tongue during a seizure. If there is food in their mouth, you may remove it if safe to do so. 

If you see two or more children suffering from a seizure simultaneously, the same steps apply. Start by creating a safe environment for each one and then monitor them closely. 

Approximately 70 percent of seizures stop by themselves after three-to-five minutes. If a seizure does not stop after five minutes, take the child to the hospital immediately. Should a child be unresponsive more than an hour after having a seizure, you should also seek urgent medical attention

It is most common for epilepsy to appear in children between the ages of two and ten. However, it can be present in newborn babies and may even be discovered in adults.

There is no exact cause known for more than half of all epilepsy cases. However, these can still be treated and even cured. The causes we do know of vary by age group.

• In newborns, epilepsy can be caused by an infection, brain tissue abnormality or low oxygen during delivery.
• Infection and birth trauma are potential causes of epilepsy in children. 
• Epilepsy in adolescents can be the result of an autoimmune disease or abnormal genes. 
   

Those suffering from one of the following may be at higher risk for epilepsy:

• Global Developmental Delay
• Autism Spectrum Disorder
• Brain trauma
• Certain skin legions
• Low oxygen during birth
• Recurrent atypical febrile seizure
• Family history of delayed development or epilepsy

In order for treatment to begin, a person with epilepsy must undergo a comprehensive diagnosis based on their unique factors. This process can include a neurological exam, EEG, MRI and other tests. 

Once completed, anti-seizure medication (ASM) will be prescribed based on the test results. A doctor will observe the child’s response to the ASM as well as potential side effects. Approximately, 60-70 percent of children with epilepsy respond to ASM prescribed. If there is no noticeable improvement or the side effects are too great, a different ASM will be recommended. 

In some cases, a child may suffer from drug-resistant epilepsy (DRE). This form of epilepsy cannot be cured by ASM and requires different treatments. The right approach to treating DRE must be created in consultation with a comprehensive team of specialist doctors. 

Alternatives to ASM include:

• Ketogenic diet & modified Atkins diet: This method can adjust how the brain produces energy to function.
• Surgical treatments: This is an option when the spot that produces seizure discharge is identified and can be removed with minimal side effects.
• Vagus Nerve Stimulator (VNS): An implant device which reduce the duration, frequency and severity of seizures in certain cases.
   

For the most part, children with epilepsy can live a normal life with the help of ASM. That being said, parents should be mindful of activities, such as swimming or bicycling, that present risks if done unsupervised. 

It is also important parents inform their child’s teachers, coaches and care providers of his or her epilepsy so they too can be prepared in case of seizure. 

As kids reach adolescence and eventually adulthood, other risk factors emerge. Namely driving and alcohol consumption. The latter, in particular, is a concern as it can stimulate seizures and even cause them to return in patients who may have no longer suffered from them.

Regardless of age, getting enough sleep each night is beneficial. Those with epilepsy are advised to get at least eight hours of rest per day. Finally, vaccination against fever-causing illnesses is also recommended. Fever can be a major cause of seizures, so being immunized against potential causes, like the flu, is advised.