Seizures are a periodic disturbance of the brain's electrical activity, resulting in some degree of temporary brain dysfunction.

Seizures are an abnormal, unregulated electrical discharge of nerve cells in the brain or part of the brain. This abnormal discharge can alter awareness or cause abnormal sensations, involuntary movements, or convulsions. Convulsions are rhythmic contractions of the muscles. In newborns, seizures may be difficult to recognize. Newborns may smack their lips or chew involuntarily. Their eyes may appear to gaze in different directions. They may periodically go limp. In older infants or young children, one part or all of the body may shake and jerk. The limbs may move without purpose. Children may stare or become confused.

Epilepsy is not a specific disorder but refers to a tendency to have recurrent seizures that may or may not have an identifiable cause.

Seizures in children often have similar manifestations as in adults (see Seizure Disorders). However, some types of seizures, such as febrile seizures and infantile spasms, occur only in children. Seizures caused by inherited disorders of metabolism typically start during infancy or childhood. Certain conditions in children, such as breath-holding (see see Behavioral and Developmental Problems in Young Children: Breath-Holding Spells) and night terrors (see see Behavioral and Developmental Problems in Young Children: Night Terrors and Sleepwalking), may resemble seizures but do not involve abnormal electrical activity in the brain and thus are not seizures.

In children, the condition causing the seizures may also affect their development. Brief, infrequent seizures do not seem to cause brain damage. Whether some types of recurrent seizures can affect the developing brain is debated. Seizures that last for hours may be associated with brain damage, especially if a high fever is also present, but seizures seldom last for hours.

Did You Know... People should not put anything in the mouth of someone who is having a seizure.

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Some Causes of Seizures in Newborns and Infants Type Disorder General disorders High fevers Lack of oxygen, as may occur during labor or delivery Brain disorders Birth defects of the brain Bleeding within the brain Brain malformations or tumors Head injury Infections, such as encephalitis or meningitis Stroke Metabolic disorders Hereditary disorders of amino acid processing (metabolism) Temporary abnormalities in blood levels of sugar (glucose), calcium, magnesium, vitamin B6, or sodium Drugs Use of drugs (such as cocaine, heroin, or the sedative diazepam) by the mother during pregnancy

Emergency Treatment : When children have a seizure, parents or other caregivers should try to make sure children do not hurt themselves by doing the following:

• Laying the child down on one side
• Keeping the child away from potential hazards (such as stairs or sharp objects)
• Not putting anything in the child's mouth or trying to hold the child's tongue

After the seizure ends, the following can help:

• Staying with the child until the child is fully awake
• Checking whether the child is breathing and if breathing is not apparent, starting mouth-to-mouth rescue breathing (attempting rescue breathing during a convulsive seizure is unnecessary and can injure the child or the rescuer)
• Not giving any food, liquid, or drug by mouth until the child is fully awake
• If the child has a fever, giving acetaminophen rectally

An ambulance should be called if the seizure lasts more than 5 minutes, if children are injured during the seizure, if they have difficulty breathing after the seizure, or if another seizure occurs immediately. All children should be taken to the hospital the first time they have a seizure. For children who are already known to have a seizure disorder, parents should discuss in advance with the doctor when, where, and how urgently evaluation is required if another seizure occurs.

Using Drugs to Treat Seizures in Children
When their child has had a seizure, parents are often concerned that the child may need to take a drug to control seizures (an anticonvulsant). Parents are concerned about side effects, and they know that getting children to take a drug on a regular basis is difficult.Learning more about anticonvulsants can help parents better participate in decisions about treatment of their child. Positives: Most children who have had only one seizure do not need to take anticonvulsants. Doctors can choose from more than 20 anticonvulsants in their search for one that is appropriate for a particular child. Anticonvulsants stop or control the seizures in 80% of children. Many children need to take only one anticonvulsant. Most children can eventually stop taking anticonvulsants. Negatives: Most anticonvulsants have side effects, such as dizziness, nausea, unsteadiness, drowsiness, double vision, or rash. Some anticonvulsants may affect attention span and school performance while children are taking the drug. Some children who have taken anticonvulsants for a long time have mild problems with memory and attention. Children who take certain anticonvulsants must have regular blood tests to determine whether the dose is correct. Some newer anticonvulsants have not been tested in children (although these drugs often are used in children and results of that experience are published). In weighing concerns, parents should remember that preventing further seizures is most important. To be sure drugs are taken on a regular schedule, parents can do the following: Use a pill box (which contains compartments for each day of the week, for different times of each day, or both). Refill prescriptions before they run out. Encourage the child to take responsibility for taking the drug. Discuss in advance with the doctor what to do if the child misses a dose.

Febrile Seizures

Febrile seizures (convulsive seizures) are seizures triggered by a fever.

Febrile seizures occur in about 2 to 5% of children younger than 6 years but most often occur in children aged 6 months to 3 years. Febrile seizures tend to run in families. Most children who have a febrile seizure have only one, and most seizures last less than 15 minutes.

Febrile seizures may be simple or complex.

• Simple: The entire body shakes (called a generalized seizure) for less than 15 minutes.
• Complex: The entire body shakes for more than 15 minutes, only one side of the body shakes (called a partial seizure), or seizures occur at least twice within 24 hours. Children who have complex febrile seizures are slightly more likely to develop a seizure disorder later in life.

Febrile seizures usually result from the fever itself. Most often, the fever is caused by an otherwise minor infection such as a viral respiratory infection. In such cases, the infection and the seizure are harmless. However, life-threatening brain infections such as meningitis (see see Meningitis: Acute Bacterial Meningitis) or encephalitis (see see Brain Infections: Encephalitis) also sometimes cause seizures (as well as fever). Because parents cannot tell whether children have such a brain infection, children who have a fever and who have a seizure for the first time or are very sick should be taken to the emergency department for evaluation. Doctors examine the children and sometimes do tests to check for these disorders.

Did You Know... Most children who have a febrile seizure have only one.

Treatment

Usually, seizures last less than 15 minutes, and no treatment is given other than drugs to reduce the fever. If seizures last 15 minutes or more, drugs such as the sedative lorazepam or the anticonvulsant fosphenytoin are given, usually by vein (intravenously), to end them, and children are carefully monitored for problems with breathing and blood pressure.

Children who have had only a few simple febrile seizures are usually not given drugs to prevent additional seizures. Children who have had several febrile seizures or seizures lasting a long time may be given drugs.

Infantile Spasms

In infantile spasms (salaam seizures), children who are lying on their back suddenly raise and bend their arms, bend their neck and upper body forward, and straighten their legs.

• Many children who have infantile spasms also develop abnormally or have intellectual disability.
• Electroencephalography and analysis of samples of blood, urine, and the fluid around the spinal cord as well as brain imaging help doctors diagnose the disorder and identify the cause.
• Injecting adrenocorticotropic hormone or a corticosteroid into the muscle often helps control the seizures.

Infantile spasms last for only a few seconds but may recur many times a day. They usually occur in children younger than 3 years. In many children, the spasms evolve into another type of seizure later in life.

Symptoms

Spasms usually consist of a sudden jerk, followed by stiffening. They typically occur after children wake up and rarely occur during sleep. In most affected children, intellectual development, including development of language skills, is slow, and intellectual disability is present. Children may lose developmental skills that they have learned, such as being able to sit up or roll over.

Diagnosis

Doctors base the diagnosis on symptoms. Electroencephalography (EEG) is done to check for abnormal electrical activity in the brain.

Samples of blood, urine, and the fluid around the spinal cord (cerebrospinal fluid) are usually analyzed to check for disorders that may be causing the seizures. Cerebrospinal fluid is obtained by doing a spinal tap (lumbar puncture). Magnetic resonance imaging (MRI) of the brain is usually done.

Treatment

Because early control of infantile spasms is associated with a better developmental outcome, early identification and treatment of seizures are essential. Sometimes adrenocorticotropic hormone, injected into a muscle once a day, or a corticosteroid (such as prednisone) is used.

Many anticonvulsants are not effective in stopping the spasms. However, clonazepam, nitrazepam, topiramate, valproate, vigabatrin, or zonisamide may help.

Last full review/revision February 2009 by Margaret C. McBride, MD