Seizures in Children
Learn about seizures in children, including the causes, symptoms, types and how they are treated at Children's Hospital of Philadelphia's Neuroscience Center.
What is a seizure?
The brain is made up of nerve cells that communicate with each other through electrical signals. Seizures in children 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 in children are often part of epilepsy, which involves experiencing at least two or more seizures. 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.
What causes seizures in children?
A child may experience one or many seizures. While the exact cause of the seizure is often not known, the more common seizures in children are caused by the following:
Seizures in newborns and infants:
- Genetic factors
- Brain infection
- Brain malformation or developmental difference
Seizures in children, adolescents and young adults:
- Genetic factors
- Brain malformation or developmental difference
- Trauma to the head
- Unknown reasons
Other possible causes of seizures in children may include:
- Brain tumor
- Brain blood vessel abnormalities
- Drug withdrawal
Symptoms of seizures in children
Your child may have a variety of symptoms depending upon the type of seizure they experience.
The following are general 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 irritability 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 irregular. 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.
First-Time Seizure: How to prepare for an evaluation
If your child has experienced seizures for the first time, they should be evaluated by a neurologist. Here are some helpful things pieces of information to prepare to get the most out of the evaluation:
- When did seizures begin?
- Is there a known health condition that may be the cause of seizures?
- How would someone who witnessed the seizure describe the event(s)?
- How often do seizures occur?
- Is there anything that you are aware of that can trigger a seizure?
- Is there a family history of seizure?
- Below is a list of questions you should be able to answer to get the most out of the evaluation. It is also helpful to keep a diary of your child's seizure frequency and bring it to the appointment. Click here to print a seizure diary.
Types of seizures in children
There are several different types of seizures in children.
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; these seizures usually last less than two minutes. Focal seizures are classified depending on whether unusual body movements are present and awareness is altered.
Focal seizures with intact awareness
A child may show different symptoms of focal seizures 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 types of 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 stop, stare and pause in activity, along with subtle eye or face movements. Absence seizures typically start between ages 4 to 12 years.
Typically, a child's posture is maintained during the seizure. Their mouth or face may move, or their 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, the child may extend their arms or legs, and they 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. Duration is usually a few seconds. Sometimes it is difficult to tell the difference between atonic and tonic seizures.
Generalized tonic-clonic seizures (also called grand mal seizures)
This type of seizure is characterized by three distinct phases.
- The body, arms and legs will extend or straighten out, also known as tonic stiffening)
- Then the body, arms and legs will contract and shake (also called clonic shaking)
- This is followed by a post-ictal period. During the postictal period, the child may be sleepy, have problems with vision or speech, and have a bad headache, fatigue, or body aches. Duration is usually less than two minutes.
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 seizure is less than one second; a cluster may last for minutes and include many seizures each lasting less than one second.
This type of seizure occurs in infants between 4 and 18 months of age, and usually occurs 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 last for a few seconds and usually occur in clusters.
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 five minutes.
How are seizures in children treated?
At the Neuroscience Center, the goal of seizure management is to stop seizures without interfering with a child's normal growth and development, and with as few treatment-related side effects as possible.
The major goals of seizure treatment 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
Treatments for your child's seizures may include:
- Medications for seizures: 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 ability to adhere to 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.
- Surgery: Surgery for epilepsy is 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 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. Other types of surgery include neuromodulation devices (see VNS, RNS, DBS bullets below).
- 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).
- Responsive NeuroStimulation (RNS): Some patients with focal seizures coming from an area that is not safe to remove undergo responsive neurostimulation (RNS), which can reduce seizures by stimulating the area where the seizure starts to prevent seizures.
- Deep Brain Stimulation (DBS): Some patients with focal or multifocal epilepsy will respond to stimulation of part of the thalamus, deep in the brain, which can reduce seizures.
After a comprehensive evaluation and careful diagnosis, we work closely with families to develop a personalized seizure treatment plan, using both anti-seizure medications and other therapies, which may include epilepsy surgery for some patients.
Specific treatment for seizures in children will be determined based on:
- A child's age, overall health and medical history
- Extent of the condition
- Type of seizure
- A child's tolerance for specific medications, procedures or therapies
- Expectations for the course of the condition
- The parents' opinion or preference
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.
Why choose CHOP for seizure treatment?
Dedicated pediatric epilepsy experts
The Pediatric Epilepsy Program within Children’s Hospital of Philadelphia’s Neuroscience Center is one of the largest epilepsy programs in the world. We have been recognized by the National Association of Epilepsy Centers as a Level 4 (highest) Epilepsy Center. This means we have the expertise and facilities to provide the highest-level medical and surgical evaluation and treatment for infants, children and adolescents with seizures and epilepsy.
From initial diagnosis and testing to the most complex and technologically advanced epilepsy surgeries, we use an interdisciplinary approach and state-of-the-art technology to provide individually tailored treatments for children to reduce seizures and improve related neurobehavioral conditions.
Our program offers patients and families several distinct advantages:
- A multidisciplinary team including neurologists, neurosurgeons, certified nurse practitioners, clinical nurses, psychologists, neuropsychologists, neuropathologists, neuroradiologists, dieticians, genetic counselors, and social workers, all with expertise and deep experience in caring for children with epilepsy.
- A dedicated, 24-bed inpatient Neuroscience Unit staffed by a team with specialized training in pediatric neuroscience. This state-of-the-art unit is specially equipped to meet the unique medical and surgical needs of infants, children and young adults with neurological and neurosurgical conditions. The unit’s dedicated family-focused rounds improve our team’s ability to collaborate with families and one another to provide the best care for our patients.
- State-of-the-art inpatient and outpatient video-EEG monitoring unit with an experienced team of EEG technologists accredited by the American Board of Registration of Electroencephalographic Technologists (ABRET) who provide 24/7 in-house EEG technologist coverage. The unit provides advanced epilepsy monitoring including intracranial stereotactic EEG monitoring.
- Access to the latest minimally invasive surgery techniques and technologies that allow us to develop a personalized epilepsy surgery plan for each child that will optimize seizure control and minimize pain, which results in a better recovery and overall outcome.
- Thorough evaluation of potential epilepsy surgery candidates
- Support group that connects current and future epilepsy surgery families with those who have already experienced epilepsy surgery.
- Largest ketogenic diet program in the world with internationally known expertise and a network of support groups.
- Participation in antiseizure medication clinical trials.
- Support for transitioning to adult care through our outpatient program in partnership with Penn Medicine, which has successfully transitioned more than 200 patients with epilepsy since 2018.
- Close collaboration with providers outside of CHOP, both across the United States and internationally, in order to provide each child streamlined access to all of our resources for advanced diagnostic evaluation and treatment options.
- Opportunities to participate in research and discovery.
Our philosophy is to be guided by the goals of each unique patient and family, and to partner with each family to embark on personalized, comprehensive treatment plans to achieve those goals. We work hard to help children and their families enjoy lives unaffected by seizures.
Full array of surgical solutions for seizure treatment
We offer the most advanced surgical techniques available in the treatment of seizures in children. The depth of our experience and technical expertise underlies our outstanding outcomes. Our surgical seizure treatment outcomes are well above what is typically achieved at other centers, with 87% seizure freedom in focal resections and 92% seizure freedom in hemispherotomy in 2022.
Procedures we offer include:
- Minimally invasive, Rosa robot-assisted stereoelectroencephalography (sEEG) to pinpoint the precise source of the seizure activity in the brain
- Laser ablation brain surgery, a minimally invasive approach to corpus callosotomy, hypothalamic hamartoma, and other small seizure foci
- Functional hemispherotomy to disconnect parts of the brain through a small craniotomy
- Robotic-assisted responsive neurostimulation (RNS) for children with seizures coming from areas of the brain that control language, motor or sensory function
- Deep brain stimulation (DBS) for children with focal or multifocal epilepsy
- Vagus nerve stimulation (VNS) to send small electrical pulses from the vagus nerve in the neck to the brain
- Resection with a dedicated pediatric neuroanesthesia team
- Awake craniotomy with cognitive testing performed in the operating room by a dedicated intraoperative neuropsychology team to precisely identify essential brain regions that cannot be resected
Our Family Connection Through Trust, Information, Empathy and Support (Family TIES) program connects families that have already experienced pediatric epilepsy surgery with current and prospective patients and their families.
Nonsurgical seizure treatment approaches
Our Ketogenic Diet Program uses food to treat seizures in children. The program is recognized for its cutting-edge approach to education, parent support and research.
We have the largest cohort in the world of children with epilepsy treated with diets. Since 1999, we have started more than 900 patients on dietary treatments, and we currently have about 250 children actively treated.
Our inpatient Keto Kitchen is a teaching kitchen where parents and caregivers of children in our program can learn to prepare the foods their child will need when following a dietary treatment for epilepsy. Opened in 2013, the Keto Kitchen is the first of its kind, equipped with all the necessary appliances, tools, and ingredients to teach families hands-on how to prepare ketogenic recipes.
Offering genetic testing to all
Epilepsy is the most common chronic neurological condition of childhood, affecting 500,000 children in the United States. More than 50% of children with epilepsy have an underlying genetic etiology. Research advances in this area have led to the identification of genes that cause seizures, allowing us to target therapies more effectively to deliver personalized care.
Our Epilepsy Neurogenetics Initiative (ENGIN) integrates genetic testing into the diagnosis and treatment of children with difficult-to-treat or unexplained epilepsies, and provides access to expert care for children with genetic epilepsy syndromes and other genetic neurodevelopmental disorders.
ENGIN’s interdisciplinary clinics are staffed by 13 neurologists specializing in neurogenetic diseases, two physical therapists, two occupational therapists, six genetic counselors, three genetic counseling assistants, and one social worker.
To date, the ENGIN program has evaluated more than 3,000 patients with epilepsy and other neurodevelopmental disorders from 29 states and has made more than 281 unique genetic diagnoses, making it the largest pediatric epilepsy genetics program in the country.
Bringing the power of research to patients
Our Pediatric Epilepsy Program team includes both clinical and basic scientists dedicated to finding better explanations for why seizures develop, finding better treatments for seizures, and preventing seizures from starting in the first place. We strive to bring advances from the laboratory to the clinic and the hospital to improve patient care in real time.
Our team works with the National Institutes of Health (NIH) and colleagues around the USA and the world on a wide variety of research projects, including evaluation of investigational seizure medications and clinical trials. We also continually collaborate with patient-family partners to improve health outcomes and the quality of care for children and youth with epilepsy.
Reviewed by Dennis Dlugos, MD, MSCE