Seizures and HI/HA

Seizures result from abnormal electrical activity of neurons. There are many types of seizures that generally relate to the locations in the brain in which they occur.

While most people picture a stiffening and shaking episode (called a tonic-clonic seizure), other seizure types may involve more subtle behavior changes or alterations in consciousness. Unusual events that occur in a repeated and stereotyped way may suggest seizure occurrence. These can include staring with no response despite calling the child’s name or poking them, episodic changes in cognition or emotion, stiffening, or shaking.

The diagnosis of seizure can often be established in a visit with a neurologist. However, for subtle events, sometimes children need prolonged EEG (brain wave) monitoring to allow assessment of brain activity while the child is experiencing a seizure event. This type of EEG assessment is sometimes performed in an inpatient EEG monitoring unit and sometimes at home using at-home EEG equipment.

Provoked or Unprovoked

Seizures are generally classified as either provoked or unprovoked seizures. Provoked seizures signal the existence of an underlying medical problem requiring treatment. For example, hypoglycemia (low blood sugar) can cause seizures, and patients require quick recognition and management of the underlying cause for the seizure. Alternatively, seizures can be unprovoked, and repeated unprovoked seizures define epilepsy.

Both provoked and unprovoked seizures (epilepsy) may occur in patients with HI/HA. Hypoglycemia (low blood sugar) can lead to provoked seizures. There is some evidence children with HI/HA may be at an increased risk of unprovoked absence seizures. Absence seizures are trickier to notice and present as staring, sometimes with twitching of eyelids or other body parts.

While only very long seizures are thought to result in injury to the brain, frequent seizures can lead to be problematic by impacting learning. That is why patients with unprovoked seizures are generally treated with antiseizure medications to reduce the risk of recurrence. Many antiseizure medications exist, and they are generally very well tolerated. The mantra of many neurologists is “no seizures and no side effects,” reflecting our goal of eliminating seizures while ensuring prescribed medications are well tolerated.

What to do? If your child has a clear seizure, call 911 for urgent evaluation in an emergency department. Clinicians will rapidly evaluate for causes of provoked seizures since some problems require rapid intervention. If your child appears to have unusual episodes of movement or behavior that could indicate absence seizure activity, then tell your endocrinologist so they can consider whether additional management, including a referral to a neurologist, is needed.