Epileptic seizures in children may appear alarming,
but they’re not necessarily dangerous.
With the proper knowledge, parents can help
their kids manage and cope more effectively
with the challenges of childhood epilepsy.
Witnessing a seizure’s dramatic symptoms – body stiffness, frenetic muscle spasms, muscle convulsions – can be a frightening experience, especially when the victim is a young child. Though the desire to help is borne of sheer goodwill, intervening during a seizure may do far more harm than good. Better Health addresses the need for correct knowledge and understanding to make a positive difference in the lives of children with epilepsy.
Why seizures happen
“Seizures are caused by a disruption in neural electrical transmission in the brain, which can lead to altered mental status and loss of physical control,” says Dr. Prinyarat Burusnukul, a US board certified pediatric neurologist at Bumrungrad. “Epilepsy refers to at least two episodes of unprovoked seizures (i.e. those not resulting from fever, infection or another known treatable cause). It’s a popular misconception that having a seizure is the same as having epilepsy because the two terms are often mentioned together.”
“When a child who has a history of first seizures is brought to the hospital, an epilepsy diagnosis isn’t automatically assumed; a diagnostic check-up must be done. Seizures may be the result of imbalances in glucose or electrolytes or certain infections such as meningitis.”
Dr. Prinyarat Burusnukul
“If signs are pointing to epilepsy,” Dr. Prinyarat continues, “the health history of the child and the family plays a vital role in the diagnosis process. We review pregnancy history, birth delivery information, details of the child’s development, school performance and prior medical histories of the child and the family. Doctors also consider conducting brain tests, such as an EEG and MRI, which help classify epilepsy by type, enabling more effective treatment planning.”
“When a child who has a history of first seizures is brought to the hospital, an epilepsy diagnosis isn’t automatically assumed,” notes Dr. Prinyarat. “A thorough diagnostic check-up must be done to accurately determine what’s causing the seizures. Seizures may be the result of imbalances in glucose or electrolytes, or they may be the result of certain infections such as meningitis or encephalitis, in which case a cere-brospinal fluid test may be required together with a CT or MRI scan of the brain.
Help or harm
It’s a normal human reaction to want to help a child in the throes of an epileptic seizure. “Normally a brief seizure itself is not a dangerous event,” notes Dr. Charcrin Nabangchang, a US board certified pediatric neurologist at Bumrungrad with extensive experience caring for children with epilepsy. “A seizure episode is usually over within a few minutes.”
“Before deciding on a treatment plan for an epileptic child, other possible correctable seizure provoking factors must be ruled out. Some epileptic seizures may allow for treatment to be put on hold until after the patient undergoes a thorough physical examination.”
Dr. Charcrin Nabangchang
Once the seizure has ended, parents are advised to take the child to a doctor as a normal precaution to allow the doctor to monitor the child’s condition and determine if treatment is necessary, particularly for recurring or prolonged seizures. “As I said before, the brief seizure itself is not dangerous,” adds Dr. Charcrin. “However, suffering repeated seizures can have a negative impact on a child in terms of development, socialization and cognitive ability.
“Children who suffer seizures repeatedly can end up feeling overly self-conscious about how different they are because of the seizures; they end up isolating themselves from other ‘normal’ children. That puts them at a risk for learning dis-abilities, behavioral problems and difficulty concentrating in school.”
Dangerous seizures are those that last more than five minutes, and those that are accompanied by choking that causes the patient to stop breathing. Both cases can be life-threatening due to the cut-off of the brain’s oxygen supply. In addition, suffering repeated seizures multiple times a day can turn out to represent a much greater threat that’s more difficult to bring under control.
It’s also important to be mindful that seizures can pose significant danger when they occur during certain activities or situations. Because the seizure causes the patient to experience a loss of awareness of their surroundings, the danger goes up significantly when a seizure begins while the patient is taking a swim, or climbing.
There are times when doctors recommend ‘watchful waiting’ rather than beginning medical treatment. Despite that, earlier diagnosis of epilepsy can have a major positive impact on a child’s healthy development. “Suffering repeated seizures without any medical intervention can affect the child’s brain development,” Dr. Charcrin cautions, “and seizures can become more severe and less controllable.”
Before deciding on a treatment plan for an epileptic child, other possible seizure causes must be ruled out before a diagnosis of epilepsy can be confirmed. Dr. Charcrin emphasizes that seizures don’t always require treatment. “Some epileptic seizures may not call for treatment.”
Treatment for epileptic seizures is one aspect of the process of managing the condition. Doctors will discuss the full range of issues – diagnosis, nature and type of seizures, medication options and potential side effects, details of the treatment process, seizure precaution and first-aid for seizures. “I usually explain to parents that the purpose of medication is to reduce the chances of future seizures,” Dr. Charcrin says. “Some patients taking medication turn out to be seizure-free, while others still experience them. It truly does vary from one patient to another. For patients on medication who still have seizures, doctors will evaluate the patient’s situation and may recommend adjustments of the medication aimed at better controlling the epilepsy.”
Besides seizure-prevention medications, taking steps to avoid seizure triggers is an important element to help prevent future seizures. The most common seizure triggers include fever, lack of sleep, and missing the medication. “Once treatment with epilepsy medication is begun,” Dr. Charcrin explains, “the child needs to be closely and frequently monitored by the doctor – at least once every few months – to check the medication’s efficacy in bringing seizures under control, to look for possible side effects, and to confirm the child’s development is progressing normally.”
Both doctors agree that it’s very important for parents to remain calm and keep emotions under control when their child is having a seizure. Don’t panic. Lay the child on the floor and turn the child’s face to the side to guard against choking and to prevent their airway from becoming blocked. Avoid putting anything into the child’s mouth while they’re having a seizure, to avoid the risk of a harmful injury.
A seizure that ends within a few minutes is typically not a medical emergency. With knowledge and professional care, a child’s seizures can be brought under control and can be eventually cured.
The many causes of seizures
Seizures have many possible causes. Anything that disturbs the brain's normal pattern of neuron activity – from illness to brain injury to abnormal brain development – can lead to seizures. In people with normal brain development, seizures can be triggered by the following factors:
- Very high fever;
- Electrolyte imbalance;
- Certain medications;
- Lack of sleep.
For people with abnormal brain development, factors contributing to seizures include:
- Genetic abnormalities;
- Congenital abnormality or pregnancy complications, including maternal infection, malnutrition, drug abuse, or accidents;
- Head injuries from accidents occurring during childhood or adulthood;
- Brain tumors or cancer metastasizing to the brain;
- Genetic conditions that result in brain dysfunction, i.e. tuberous sclerosis;
- Infections including meningitis and encephalitis;
- Stroke or any other event causing damage to the brain.
First-aid Tips for Epileptic Seizures
- Stay calm, don’t panic;
- If the child is in a sitting position, try to lay him flat and turn his head to the side to prevent choking and airway blockage;
- Remove any sharp or solid objects from the child’s reach during the seizure;
- Loosen any tight clothing, clear the surrounding area to allow better ventilation;
- Try to lower the temperature if the child is feverish;
- Do not hold down or restrain the child;
- Do not put any objects into the child’s mouth. Objects can cause dental injury and lead to potentially-deadly airway blockage;
- Take note of how long the seizure lasts and specific symptoms that occurred. Make a video recording if possible, as this can be helpful for the doctor;
- Take the child to a doctor after the seizure;
- If the seizure lasts more than five minutes, or if the child doesn’t resume breathing/doesn’t regain consciousness when the seizure ends, get immediate medical help.
Though it’s common for seizures to produce symptoms like convulsions, jerking motions, muscle rigidity, spasms and head-turning, some seizures produce much more subtle symptoms. So-called absence seizures are most common in children between the ages of five and ten.
It’s common for these children to have learning-related difficulties that lead parents to consult their doctor. Absence seizures involve a brief, sudden lapse of consciousness. During an absence seizure, the child can appear to be staring into ‘space’ or having a ‘black out’ lasting a matter of seconds. Many children who experience absence seizures go untreated because teachers and parents are often unaware of what to look for. So it’s helpful to make others aware of this very subtle type of seizure, and keep a watchful eye on your child just to be safe.