Seizures differ, depending on which portion of the brain is involved. Nerve impulses are constantly being transmitted from brain cells and processed by neurotransmitters. Seizures occur as a result of abnormal and excessive discharges of nerve impulses originating from certain brain cells. Some of these excess impulses reach skeletal muscle fibers and trigger the violent contractions witnessed with a variety of seizures.
Groups of Seizures
Focal Seizures – Occur in only one part of the brain or one hemisphere. Generalized seizures occur in both hemispheres of the brain.
Atonic Seizures – Characterized by a sudden loss of muscle tone, particularly in the lower extremities. This often results in falls which can result in traumatic brain injuries, along with other physical injuries, to the individual.
Generalized Tonic-Clonic Seizures – Also known as generalized convulsions or grand mal seizures, commonly seen with cerebral palsy.
Tonic Seizures – Spread throughout the brain, normally followed by unconsciousness, twitching of the legs and arms, convulsive body movements, and loss of bladder control. A child may bite their tongue during a tonic seizure episode. The “tonic phase” of this particular type of seizure is characterized by sudden muscle contractions and rigidity (hypertonia/spasticity).
Clonic Seizures – Involves recurring and coordinated jerking movements involving both sides of the body, as well as rhythmic contractions of the affected muscle groups and violent and extreme gross motor movements. It is also common to see convulsive gross motor involvement throughout clonic seizure episodes.
Complex Seizures – Involves involuntary, but possibly coordinated movement such as lip smacking, chewing and abnormal oral motor activity. The oral motor involvement exhibited during a complex seizure can involve repeatedly opening and closing of the mouth.
Myoclonic Seizures – Characterized by sporadic jerking movements, usually involving both sides of the body that may progress to violent gross motor convulsive movements.
Partial (Focal) Seizures – Confined to one part of the brain and may be simple or complex. Partial (focal) seizures result from electrical impulses from one part of the brain and are usually a motor or sensory seizure that is restricted to one side of the body. The individual remains conscious, however, if the seizure progresses to a more generalized seizure, a loss of consciousness will occur.
Petit mal (Absence) Seizures – Also known as Absence Seizures, this type of seizure may cause the individual to appear to be “staring off into space,” and will be unresponsive to stimulation or their environment. These seizures don’t pose the same hazards as previously discussed seizures do, but they can still put a child at risk of aspiration if reoccurring episodes take place while a child is eating.
Fever (Febrile) Convulsions – Febrile seizures are convulsions brought on by a fever in infants and small children. During the seizure, a child may lose consciousness accompanied by tremors or shaking. A majority of febrile seizures are harmless, and there is no evidence to suggest that they cause brain damage. However, children who have experienced lengthy febrile seizures or recurring within 24 hours are at greater risk of developing epilepsy. The National Institute of Neurological Disorders and Stroke (NINDS) provides a comprehensive online fact sheet on Febrile Seizures, provides a detailed and informative description of this type of seizure as well as information on diagnosis and treatment.
Simple Partial Seizures – Causes muscle twitching, chewing movement and numbness or tingling. Partial complex seizures are characterized by a brief loss of consciousness, behavioral, emotional symptoms, loss of memory and automatisms. Temporal lobe and frontal lobe seizures are often in this category.
EEG – Your child’s neurologist will probably want to do an Electroencephalogram (EEG) if they suspect seizure activity. Although EEGs are often helpful in diagnosing some types of seizures, it may not detect all. EEG’s are typically performed in the hospital’s sleep clinic and involve placing electrodes on the child’s scalp
Brain Scans and MRI – The neurologist may order a CAT scan or Magnetic Resonance Imaging (MRI) to be performed. Although these studies don’t show the electrical impulses, they may show lesions or other possible suspected causes of seizure activity.
Video EEG – This study is usually performed overnight at a hospital’s sleep clinic. It involves a video camera and constant EEG monitoring throughout the study. With the video and EEG combined, the physician can collate any suspected abnormal physical motor occurrences with the EEG, better identifying the seizure activity with the physical manifestations.
If you suspect your child may be experiencing seizures, keep a journal and document episodes or behaviors you suspect to be seizure related. If possible, have someone videotape the episode. This will give your child’s pediatrician or neurologist insight into what you are witnessing, due to the fact that it’s unlikely your child will experience a seizure during your 15-30 minutes visit with the physician.
In the case of documentation, take note of the following cases throughout the duration of the episode: did you child become cyanotic (turn blue) or have blue lips which would indicate they weren’t breathing properly? What was your child doing at the time? Note any abnormal behaviors your child may have exhibited that made you suspect the behavior as seizure activity.
If your child has already been diagnosed with a seizure of some type, and you don’t feel that their current medication is managing their seizures effectively, keep a journal of any suspected breakthrough seizure activity you may see. There are many medications and combinations of medications that can be used for seizure control. If the seizures are adversely impacting your child’s quality of life, don’t give up. Persevere and continue to question your child’s physicians until you find the right medication or combination of medications that offer a better level of control.
Treatments and Medications
- Protection – Shield an individual from harm during a seizure. One of the complicated risks of seizures is that further damage can occur in the brain with severe seizures. The individual can also be hurt while falling or during spastic episodes resulting from grand mal seizures.
- Anticonvulsant Medications – Normally prescribed in the management of a seizure disorder. Tegretol, Phenobarbital, Dilantin, Klonopin, Valium and Topamax are several examples of medications that may be prescribed.
- Vagus Nerve Stimulation Therapy – This therapy is relatively new and involves a surgically implanted battery, with leads threaded under the skin and attached to the vagus nerve. Vagus Nerve Stimulation involves a device which sends short bursts of electrical energy into the brain via the vagus nerve.
- Ketogenic Diet – This form of therapy involves a diet high in fats and low in carbohydrates and makes the body burn fat for energy instead of glucose.
Questions to Ask Physician
- You may have a thousand questions in your head about your child’s possible seizures, medications, or management, but you won’t think of half of them during your appointment with your child’s physician or neurologist. Write them down as you think of them!
- Ask your physician what side effects to expect with any medication and what contradictions you need to be aware of and what to do in the case of a serious adverse side effect.
- Should your child take the medication with or without food? Make your child’s neurologist aware of any other medications your child may be on, whether it’s seizure-related medication or not.
- Make sure you’re aware of any blood work or lab work that needs to be done and the frequency. Many anticonvulsants require blood work to monitor the levels of the medication in the blood and to monitor possible kidney and liver function in relation to the medication.
- Some children experience seizures that may be triggered by different environmental or dietary factors. Ask your physician if there are any environmental factors or dietary issues that you need to be aware of.
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