If a child has a seizure, it can be a frightening event not only for a caregiver, but also for other adults and children who witness the event. Fortunately, most seizures are brief episodes without complications.

What Is a Seizure?

The brain consists of bundles of nerves called neurons. Neurons communicate with each other using electrical impulses along pathways. These impulses allow muscles and other organs to operate smoothly.

Usually, the impulses fire in a smooth-flowing manner; however, pathways can “short-circuit” due to disease conditions or brain injury. When this occurs, the electrical system begins firing at random causing the muscles of the body to twitch and spasm.

This event is called a seizure. Generally, the misfiring is brought under control by the body’s defense mechanisms, causing the twitching to slow and eventually stop.

Seizure disorder is a generalized term which means that people have recurrent seizures. Another term is epilepsy, which is perhaps the most familiar name for seizure disorder. Epilepsy affects people of all ages, nationalities, and races.

Types of Seizures

The brain is divided into two hemispheres, the left hemisphere and the right hemisphere. Seizures can occur within one hemisphere or both simultaneously.

Generalized seizures occur in both hemispheres at the same time, while partial seizures start in one hemisphere. Sometimes, just a small area in one of the hemispheres has a seizure. This type is called a focal seizure.

With a focal seizure, the electrical impulses in a tiny part of the brain misfire. If the seizure occurs in a small, well-defined area, the only physical sign may be that the child demonstrates unusual actions for a short period of time. Therefore, it is important for caregivers to be familiar with the usual behavior of each child in your care and to recognize any unusual activity or behavior.

In contrast, a generalized seizure is a dramatic event. The child will fall down, many of the muscle groups will spasm, and the child may lose bowel and bladder control. After the seizure passes, the child may awaken tired and groggy. He probably will not remember anything about having the seizure. This is called the “post-ictal state.”

Seizures are categorized in three types:

Absence seizures (also called petit mal seizures) are lapses of awareness or brief consist of brief staring spells that last up to about 30 seconds. These seizures may be associated with minor twitching of the lips or eyelids, and are not accompanied by a post-ictal state.

Tonic-clonic seizures (commonly called “grand mal seizures”) begin with a stiffening of the limbs (“tonic” phase), followed by jerking of the limbs and face (“clonic” phase).

Partial seizures include three types: simple, complex, and partial complex with secondary generalization. Simple partial seizures do not impair the level of consciousness. Any part of the body may be affected, such as twitching of an arm or leg or and abnormal feeling in one part of the body.

Complex partial seizures begin in one hemisphere and do not impair the level of consciousness. These types of seizures are preceded by an aura, followed by confusion, and may last for several minutes. They are followed by a post-ictal state.

Partial seizures with secondary generalization occur focally, spread throughout one hemisphere, then move into the other hemisphere. The visible signs of this type of seizure are unusual. Twitching may begin on one area of the body, and then spreads to other body parts on one side of the body. As the seizure moves into the other hemisphere, the child will lose consciousness.

Causes of Seizures

Febrile seizures can occur when a child has a high fever. Most febrile seizures occur with a body temperature of 102°F or higher, usually during the first day of the fever.

When a child has a febrile seizure, he will lose consciousness and his body will shake, though occasionally the child’s body becomes rigid and only a part of the body may twitch. The duration of a febrile seizure can range from a few seconds to 10 minutes or longer. Approximately one in 25 children will have at least one febrile seizure in their life.

Febrile seizures usually occur in children between 6 months and 5 years old. There may be a family history of febrile seizures, so childcare providers should include this question on intake forms and be aware of which children have febrile seizures in their family history. There is no evidence that febrile seizures cause brain damage; even in a prolonged febrile seizure, children usually recover without incident.

Seizures also can be caused by other factors. Some people have a strong family history of epilepsy, so they may have a genetic predisposition. Head injuries may cause seizures, either at the time of injury or years later.

Metabolic disturbances, such as low blood sugar, kidney failure or liver failure can cause seizures. Though rarely seen in children, toxic substances, such as illicit drugs, narcotics and alcohol can cause seizures. Abrupt withdrawal of these substances also can initiate a seizure. Infections, tumors and brain injury can cause seizures in children, adolescents and adults as well.

First Aid for Seizures

As in all emergencies, remain calm. Your goal is to prevent injury to the child. First, have someone call 911. Then place the child on the floor, preferably on a mattress or, if outside, on the grass. Do not hold the child down or restrain him in any way if convulsions are occurring.

Prevent injury by removing furniture or other objects from the area. Place your hand or a towel under his head.

Turn the child on his side or on his stomach to prevent choking. Never place anything in the child’s mouth during a seizure; the objects can be broken and cause an airway obstruction. If fingers are placed in the mouth during a seizure, involuntary biting can cause severe lacerations.

Remain with the child until emergency medical services (EMS) arrive. Even if the child recovers completely before the arrival of EMS, he should continue to lie down, under observation, and should not be given anything to eat or drink.

If a child has a seizure while in your care, inform the child’s family of the situation including any possible triggers that preceded the seizure, as well as the physical signs during the seizure.

This information can help the child’s health care provider in diagnosing the type of seizure and prescribing appropriate treatment. For example, one of the questions the clinician will ask is if the seizure affected the body as a whole, or if only one part of the body was twitching.

Joe Knight
Family Practice Physician Assistant and Medical Writer, Fresno, California

Internet Resources

Emedicine, www.emedicinehealth.com/seizures_in_children/article_em.htm

Epilepsy Therapy Project, www.epilepsy.com/epilepsy/types_seizures

Kid’s Health, www.kidshealth.org/parent/firstaid_safe/emergencies/seizure.html

Resources

Epilepsy Foundation, 8301 Professional Pl., Landover, MD 20785; 800-332-1000; www.epilepsy.com/epilepsy/types_seizures

NIH Neurological Institute, PO Box 5801, Bethesda, MD 20824; 800-352-9424; www.ninds.nih.gov/disorders/febrile_seizures/detail_febrile_seizures.htm