Seizures in Children

What is a seizure?

The brain is made up of nerve cells that communicate with each other through electrical signals. Seizures are caused by disturbances in these electrical signals that temporarily interrupt typical brain function. Seizures have many different looks, but usually involve unusual movements, a change in level of awareness or both.

The term “seizure” is sometimes incorrectly used to refer to episodes like fainting, panic attacks or physical signs of stress and anxiety. In children, it is usually straightforward to distinguish such non-seizure episodes from actual seizures, and it is extremely important to do so.

Seizures are often part of epilepsy (two or more seizures), but it is possible to have a single seizure in childhood and not have epilepsy. Also, seizures exclusively triggered by fevers or some transient medical illnesses are called provoked seizures and are not considered epilepsy.

Symptoms of seizures

Your child may have a variety of symptoms depending upon the type of seizure. The following are general or warning signs that may help identify a seizure:

  • Staring, sudden pause in activity, not responding
  • 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 appear different than typical. The episodes 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.

Types of seizures

There are several different types of seizures in children.

Focal seizures

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, and usually last less than two minutes. Focal seizures are classified depending on whether unusual body movements are present and on whether awareness is altered

Focal seizures with intact awareness

The child may show different symptoms depending upon which area of the brain is involved. Most often, some of the child's muscles are affected. The seizure activity is limited to an isolated muscle group, such as fingers or to larger muscles in the arms and legs. 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. Consciousness is not lost in this type of seizure. The child may also experience sweating, nausea, or become pale.

Focal seizures with altered awareness

Consciousness is altered or 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

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 stop, stare and pause in activity, along with subtle eye or face movements. Absence seizures typically start between ages 4 to 12 years.

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 20 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 difference, difficulty with attention or a behavioral problem.

Tonic or atonic (also called drop attacks)

  • With tonic seizures, there is a sudden increase in muscle tone and the child may extend their arms or legs, and may fall. Duration is usually a few seconds.
  • 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. Sometimes it is difficult to tell the difference between atonic and tonic seizures.  Duration is usually a few seconds.

Generalized tonic-clonic seizures (also called grand mal seizures)

This seizure is characterized by three distinct phases. The body, arms, and legs will extend (straighten out, tonic stiffening), then contract and shake (clonic shaking), followed by a post-ictal 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.  Duration is usually less than 2 minutes.

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 back-to-back. Duration of each seizures is less than 1 second; a cluster may last for minutes and include many seizures each lasting less than 1 second.

Infantile spasms

This type of seizure occurs in infants between 4 and 18 months of age, and usually occur when the child is awakening or 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, and usually occur in clusters.

Febrile seizures

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 usually involve stiffening and shaking on both sides of the body, but sometimes only one side of the body is involved. Duration is usually less than 5 minutes.

Reviewed by Dennis Dlugos, MD, MSCE

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