Epilepsy is best regarded as the symptoms of some underlying brain dysfunction, which causes gross misbehaviour of brain cells, either at a specific place (focal epilepsy), or more widely (generalised epilepsy). This misbehaviour causes physical consequences, like the loss of consciousness, or loss of muscle control. These physical consequences are called epileptic fits (aka seizures or convulsions).
Because the brain is so complex, epileptic fits take many forms, although each sufferer usually only experiences one type, or a limited number of types of fit. While over 40 different types of fit have been described, the main physical manifestations are:
In a typical fit, various of these physical manifestations may be combined. Thus in a generalised tonic clonic fit, the child may emit a short cry, lose consciousness and fall to the floor; the muscles stiffen (tonic phase) and then the limbs jerk and twitch (clonic phase); bladder control may be lost. Consciousness is regained slowly, and afterwards the child may feel fatigue, confusion and disorientation. These final effects may last for a few minutes or several hours.
The pattern of fit depends on where in the brain the epileptic event starts, and how it propagates to other areas of the brain. In a simple fit pattern, the event only occurs in one area of the brain. In more complex patterns, like the one described above, it starts in one area of the brain and propagates to other areas.
While there is a wide variety of patterns of fit, most children who suffer from fits will experience the same pattern of fit on successive occasions, or at most a limited number of different patterns. The pattern of fits may also evolve with time.
The consequences to the child are not related to the physical violence of the fit. While violent fits may cause physical damage, most fits are not thought to further harm the brain. However, some of the minor manifestations, particularly minor tremors in babies a few months old may be an indicator of infantile spasms, a serious condition, which can cause serious damage to the brain, and needs to be treated as soon as possible. It is important to consult a doctor if you notice anything that might be a fit. It is better to be safe than sorry.
(not available) What to do if you child has a fit
Most fits stop naturally after a minute or so, without any special medical treatment. If the fit continues, or repeats immediately, the condition is known as status epilepticus (often abbreviated to status).
Status epilepticus is serious condition and must be treated as a medical emergency. An ambulance should be called and the child taken to hospital immediately.
In hospital, status epilepticus is usually treated with diazepam (valium) or lorazepam (ativan), given intravenously. Phenobarbital is sometimes added intravenously. If your child is prone to status epilepticus, your doctor may teach you to administer diazepam or lorazepam suppositories at home.
If your child has suffered epileptic fits, it is important to have a plan to cope with status epilepticus. Since each child is different, this plan should be worked out and agreed with your neurologist.
If you child has no history of status and only has brief fits,but then has an episode that shows no sign of stopping after five minutes - or if a second fit follows almost immediately after the first, get emergency help.
If you child has no history of status but normally has longer fits, and then has an abnormally long episode, or if a second fit follows almost immediately after the first, get emergency help.
If you child has already had one or more episodes of status, he faces a higher than average risk of this happening again. You will make future episodes easier to handle by creating a plan of action, covering the following points:
Continuing fits have to be taken seriously because, untreated, they may last for hours, placing enormous strain on the brain and the body. In some cases, they can cause brain damage, or even death. Convulsive (tonic-clonic, grand mal) fits are more often associated with status, but fits which produce body jerking, staring spells, or a state of confusion can also occur in series or fail to stop in the usual way.
With prompt emergency care, status epilepticus can usually be successfully treated and the fits brought under control before other problems occur. But status is a dangerous problem and even with good care, the outcome is sometimes bad if the cause of the status damages the brain.
To summarise, status epilepticus is frightening and does carry serious risk. However, with prompt treatment, most children recover completely. In fact, children who experience status generally come through the experience much better than older people. The important thing is to prevent fits whenever possible and to have a plan of how to get your child medical care quickly if it looks as if they're not going to stop.
(not available) What is an epileptic fit?
(not available) Non epileptic fits
Classification of fits
Confusingly, there are classifications of fits, and classifications of eplepsies; although the two types of classification overlap, they are different.
Traditionally, two types of fits were distinguished:
More recently, an international standard classification has been introduced. This distinguishes fits medically, based on whether the fit is focal (affecting a specific area of the brain), or generalised (affecting the brain as a whole):
- Tonic clonic
To confuse the issue still further, there is not a direct relationship between fits and epilepsy. Even healthy people can experience a fit, and the jerks that we all have when falling asleep are a form of benign myoclonic spasm. Epilepsy is usually only diagnosed when there is a clear disposition to fits. It is also possible to have fits which are not epileptic - that is, they do not appear to be caused by a massive electrical discharge within the brain. Such fits may be caused by other syndromes like alternating hemiplegia of childhood, or even by psychological problems.
return to Infantile
spasms and other epilepsies
continue to Types of epilepsy
(update 2.1: 8 November 2002)
(issue 2: 4 May 1998)