Seizures in Children

When a child has a convulsion, parents or other caregivers should do the following to try to protect the child from harm:

After the seizure ends, parents or other caregivers should do the following:

Fever can be lowered by giving the child acetaminophen by suppository placed in the rectum if the child is unconscious or too young to take medications by mouth or by giving acetaminophen or ibuprofen by mouth if the child is conscious. Also, warm clothing should be removed.

An ambulance should be called if any of the following occur:

All children should be taken to the hospital emergency department the first time they have a seizure. For children who are already known to have a seizure disorder Seizure Disorders In seizure disorders, the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction. Many people have unusual sensations just before a seizure... read more , parents should discuss in advance with the doctor when, where, and how urgently evaluation is required if another seizure occurs.

Doctors usually give medications to end a seizure that lasts 5 minutes or more to prevent status epilepticus. Medications include a sedative and antiseizure medications. These medications are usually given by vein (intravenously). If a medication cannot be given intravenously, a sedative gel may be put into the rectum or a sedative liquid may be put into the nose (intranasally). Children who have received these medications or who have a prolonged seizure or status epilepticus are carefully monitored for problems with breathing and blood pressure.

If children continue to have seizures after the cause is treated, they are given antiseizure medications intravenously. They are then closely observed to check for possible side effects, such as slowed breathing.

If antiseizure medications control the seizures, they may be stopped before children are discharged from the nursery or hospital. Whether antiseizure medications are stopped depends on the cause of the seizures, their severity, and the results of the EEG.

If children have only one seizure, they usually do not need to take an antiseizure medication (see sidebar Using Medications to Treat Seizures in Children Using Drugs to Treat Seizures in Children ). Antiseizure medications are used if seizures recur or are likely to recur.

The antiseizure medication dose is usually increased if a standard dose does not adequately control seizures. The dose may also be adjusted as children grow and their weight increases. Another antiseizure medication may be added or substituted if the first one was only partly effective or had bothersome side effects. Antiseizure medications can interact with other medications, so parents should tell their child's doctor all the medications and supplements the child is taking.

At times, doctors do blood tests to measure the level of the medication, which helps determine whether the dose is correct and whether the child is taking the medication. These tests are sometimes repeated when the dose is changed, when the child has grown significantly, or when a new medication is started.

The need to continue taking antiseizure medications depends on what caused the seizures and how long children have been seizure-free. Most children continue taking antiseizure medications until they have had no seizures for 2 years. The risk of having a seizure after 2 seizure-free years is less than 50%. However, having another disorder that affects the brain and nerves (such as cerebral palsy Cerebral Palsy (CP) Cerebral palsy refers to a group of conditions that involve difficulty moving and muscle stiffness (spasticity). It results from brain malformations that occur before birth as the brain is developing... read more ) increases the risk of having another seizure.

When antiseizure medications are to be stopped, the dose is reduced over a period of time rather than stopping it all at once.

Surgery occasionally may be an option for children (but generally not for newborns or infants) if they continue to have seizures while taking two or more antiseizure medications or if side effects are intolerable. This operation involves surgically removing an area of the brain. It is usually done only when seizures are caused by only one area in the brain and that one area can be removed without significantly affecting the child's ability to function. Sometimes this operation substantially reduces the number of seizures a child has. Tests may be done to help locate the area in the brain that is causing seizures. These tests include the following:

Before surgery is done, a neurosurgeon and a neurologist (usually one who specializes in caring for people with epilepsy) explain the risks and benefits of surgery to the parents. Even when surgery reduces the frequency and severity of seizures, many children need to continue to take antiseizure medications. However, they can usually take lower doses or fewer medications.

Stimulating the vagus nerve (the 10th cranial nerve Overview of the Cranial Nerves Twelve pairs of nerves—the cranial nerves—lead directly from the brain to various parts of the head, neck, and trunk. Some of the cranial nerves are involved in the special senses (such as seeing... read more ) can sometimes reduce the number of seizures children have. The vagus nerve is thought to have indirect connections to areas of the brain that are often involved in causing seizures. This procedure can be used in children as young as 4 years old. Doctors consider using this procedure when antiseizure medications are ineffective and epilepsy surgery is not possible.

To stimulate the vagus nerve, doctors implant a device that resembles a heart pacemaker under the left collarbone and connect it to the vagus nerve in the neck with a wire that runs under the skin. The device causes a small bulge under the skin. The device turns on and off all the time and thus periodically stimulates the vagus nerve. The doctor can easily and painlessly change the settings for stimulating the nerve using a magnetic wand placed over the device. Also, when the child senses that a seizure is starting or when a family member sees a seizure begin, a magnet (often worn in a bracelet) can be used to set the device to stimulate the nerve more often.

Vagus nerve stimulation is used in addition to antiseizure medications. Possible side effects include hoarseness, cough, and deepening of the voice when the nerve is stimulated. Vagus nerve stimulation usually makes the child more alert. Increased alertness may improve attention but sometimes interferes with sleep.

Sometimes, giving electrical stimulation to the part of the brain in which seizures start can interrupt a seizure before it begins or shorten a seizure that has started. The responsive neurostimulation system is a device that looks like a heart pacemaker. It is implanted within the skull. The device is connected by wires to one or two areas in the brain that are causing the seizures. This system monitors the brain's electrical activity. When it detects unusual electrical activity, it stimulates the areas of the brain that are causing the seizures.

The responsive neurostimulation system is used in addition to antiseizure medications.

Surgery to implant the system requires general anesthesia General anesthesia Surgery is the term traditionally used to describe procedures (called surgical procedures) that involve manually cutting or stitching tissue to treat diseases, injuries, or deformities. However... read more . Children need to stay in the hospital overnight. Many children return to their normal daily activities within a few days.

Children cannot feel the device or the stimulation, and the device can be removed if needed.

A ketogenic diet may be prescribed by the doctor in some situations. This strict diet is typically medically supervised by a dietician, a neurologist, and perhaps other health care personnel at a specialized center.

The ketogenic diet is very low in carbohydrates and very high in fat. When the body breaks down fat to use for energy, substances called ketones are formed. In some children, the ketones help control seizures.

The ketogenic diet must be carefully followed and requires that the amounts of foods be measured precisely. Even one bite or taste of a restricted food can lead to a seizure. Children may have difficulty following such a strict diet. If children who are following a ketogenic diet improve substantially, the diet is often continued for at least 2 years.

Side effects of a ketogenic diet may include a low blood sugar level, sluggishness (lethargy), and weight loss.

Sometimes the Atkins diet is used instead. It is a less strict form of the ketogenic diet.