Seizures and Epilepsy
What is a seizure?
The brain consists of nerve cells that normally communicate with each other through electrical activity. A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function.
What is epilepsy?
Epilepsy is a neurological condition involving the brain that makes people more susceptible to having seizures. When a person has two or more seizures, they are considered to have epilepsy.
It is one of the most common disorders of the nervous system and affects people of all ages, ancestry and ethnic background. More than 2.7 million Americans live with epilepsy. Pediatric epilepsy affects one to two percent of children worldwide.
Types of seizures
There are several different types of seizures in children, including:
Focal seizures, sometimes called partial seizures, take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. There are two types of partial seizures:
- Focal seizures with intact awareness: The seizures typically last less than one minute. The child may show different symptoms depending upon which area of the brain is involved. If the abnormal electrical brain function is in the occipital lobe (the back part of the brain that is involved with vision), the child's sight may be altered. The child's muscles are typically more commonly affected. The seizure activity is limited to an isolated muscle group, such as fingers or to larger muscles in the arms and legs. Consciousness is not lost in this type of seizure. The child may also experience sweating, nausea, or become pale.
- Focal seizures with altered awareness: This seizure usually lasts between one to two minutes. Consciousness is usually lost during these seizures and a variety of behaviors can occur in the child. These behaviors may range from gagging, lip smacking, running, screaming, crying, and/or laughing. When the child regains consciousness, the child may complain of being tired or sleepy after the seizure. This is called the postictal period.
Generalized seizures involve both sides of the brain. There is loss of consciousness and a postictal state after the seizure occurs. Types of generalized seizures include:
- Absence seizures (also called petit mal seizures): These seizures are characterized by a brief altered state of consciousness and staring episodes. Typically the child's posture is maintained during the seizure. The mouth or face may move or the eyes may blink. The seizure usually lasts no longer than 30 seconds. When the seizure is over, the child may not recall what just occurred and may go on with his/her activities, acting as though nothing happened. These seizures may occur several times a day. This type of seizure is sometimes mistaken for a learning problem or behavioral problem. Absence seizures almost always start between ages 4 to 12 years.
- Atonic or tonic (also called drop attacks): With atonic seizures, there is a sudden loss of muscle tone and the child may fall from a standing position or suddenly drop their head. During the seizure, the child is limp and unresponsive. With tonic seizures, there is a sudden increase in muscle tone and the child may extend their arms or legs, or may fall. Sometimes it is difficult to tell the difference between atonic and tonic seizures.
- Generalized tonic-clonic seizures (also called grand mal seizures): This seizure is characterized by three distinct phases that occur in the child. The body, arms, and legs will extend (straighten out, tonic), then contract and shake (clonic), followed by the postictal period. During the postictal period, the child may be sleepy, have problems with vision or speech, and may have a bad headache, fatigue, or body aches.
- Myoclonic seizures: This type of seizure refers to quick movements or sudden jerking of a group of muscles. These seizures tend to occur in clusters, meaning that they may occur several times a day, or for several days in a row.
- Infantile spasms: This rare type of seizure disorder occurs in infants from before six months of age. There is a high occurrence rate of this seizure when the child is awakening, or when they are trying to go to sleep. The infant usually has brief periods of movement of the neck, trunk, or legs that lasts for a few seconds. Infants may have hundreds of these seizures a day. This can be a serious problem, and can have long-term complications.
This type of seizure is associated with fever. These seizures are more commonly seen in children between 6 months and 5 years of age and there may be a family history of this type of seizure. Febrile seizures that last less than 15 minutes are called "simple," and typically do not have long-term neurological effects. Seizures lasting more than 15 minutes are called "complex" and there may be long-term neurological changes in the child.
Causes of epilepsy
There are many possible causes of epilepsy, including tumors, strokes, and brain damage from illness or injury. In many cases, there may be no detectable cause for epilepsy.
A child may experience one or many seizures. While the exact cause of the seizure is often not known, the more common seizures are caused by the following:
In newborns and infants:
- Congenital (present at birth) problems
- Brain infection
In children, adolescents, and young adults:
- Trauma to the head
- Congenital conditions
- Genetic factors
- Unknown reasons
Other possible causes of seizures may include:
- Brain tumor
- Neurological problems
- Drug withdrawal
Signs and symptoms of seizures
Your child may have varying degrees of symptoms depending upon the type of seizure. The following are general symptoms of a seizure or warning signs that your child may be experiencing seizures:
- Jerking movements of the arms and legs
- Stiffening of the body
- Loss of consciousness
- Breathing problems or breathing stops
- Loss of bowel or bladder control
- Falling suddenly for no apparent reason
- Not responding to noise or words for brief periods
- Appearing confused or in a haze
- Sleepiness and irritable upon waking in the morning
- Nodding the head
- Periods of rapid eye blinking and staring
During the seizure, your child's lips may become bluish and breathing may not be normal. The movements are often followed by a period of sleep or disorientation.
The symptoms of a seizure may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.
Testing and diagnosis
At Children’s Hospital of Philadelphia’s Pediatric Epilepsy Program, your child’s care begins with a comprehensive, personalized assessment of their medical history, seizure types, and the cause of their epilepsy.
The diagnosis of a seizure is made with a physical examination and diagnostic tests. During the examination, your child's medical team obtains a complete medical history and asks when the seizures occurred.
Diagnostic tests may include:
- Blood tests
- Electroencephalogram (EEG) to measure the electrical activity in the brain and identify the source of seizures
- Most children experiencing seizures will undergo a routine EEG that typically lasts 30 to 60 minutes.
- For some children, longer EEG recordings are required. Using continuous 24/7 EEG recording, our epilepsy specialists can help manage acute seizures and identify how many seizures a child is having. EEG also helps us to identify children who may be candidates for epilepsy surgery.
- Stereoelectroencephalography (sEEG or stereo-EEG), a minimally invasive procedure where electrodes are placed directly in the brain to identify where seizures start
- Magnetic resonance imaging (MRI)
- Magnetoencephalography (MEG)
- Computed tomography scan (CT or CAT scan)
- Lumbar puncture (spinal tap) to determine if there is an infection or other problems
- Genetic tests may help us better understand each patient and their type of epilepsy
Seizures are sometimes related to neurological problems and require further medical follow up.
The goal of seizure management is to stop seizures without interfering with the child's normal growth and development, and with as few treatment-related side effects as possible.
The major goals of seizure management include:
- Proper identification of the type of seizure
- Using medication specific to the type of seizure
- Using the least amount of medication to achieve adequate control
- Maintaining optimal medication doses
After a comprehensive evaluation and careful diagnosis, we will work with your family to develop a personalized seizure management plan, using both anti-seizure medications and other therapies, which may include epilepsy surgery for some patients.
Specific treatment for seizures will be determined based on:
- Your child's age, overall health, and medical history
- Extent of the condition
- Type of seizure
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
Treatments for your child's seizures may include:
- Medications: There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, age of the child, side effects, the cost of the medication, and the adherence with the use of the medication.
- Ketogenic diet: Certain children who are having problems with medications, or whose seizures are not being well controlled, may be placed on a special diet called the ketogenic diet. This type of diet is low in carbohydrates and high in protein and fat.
- Vagus nerve stimulation (VNS): Some children, whose seizures are not being well-controlled with seizure medications, may benefit from a procedure called vagus nerve stimulation (VNS).
- Surgery: Surgery for epilepsy and seizures is a complex surgery performed by a specialized surgical team. The operation may remove the part of the brain where the seizures are occurring, or, sometimes, the surgery helps to stop the spread of seizures through the brain. If your child may benefit from epilepsy surgery, you will first have a detailed epilepsy surgery evaluation in order to determine if all the seizures are coming from a location that is safe to remove. We use modern minimally invasive technologies to develop a personalized epilepsy surgery plan for each child to optimize seizure control and minimize pain.
If your child’s care is managed at a hospital or doctor’s office closer to your home, we will collaborate with local providers to ensure coordinated care and the best possible seizure management for your child.
Children's Hospital of Philadelphia is actively engaged in epilepsy genetics and translational therapeutics research. New advances have led to the identification of specific genes that cause seizures, allowing us to more effectively target therapies and provide more personalized epilepsy care.
Reviewed by Dennis Dlugos, MD, MSCE