Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes
Seizures have many causes, and are either generalized or focal. Within these categories, several types may affect children.
About 1 in 10 people will have a seizure at some point during their life. Seizure disorders can begin in childhood. About one in 150 children receive an epilepsy diagnosis before the age of 10 years old. The types of seizures in children fall into the same broad categories as seizures in adults. These are generalized seizures, which affect both sides of the brain; and focal seizures, which affect one side of the brain. It may be impossible to diagnose the reason for a child’s seizure based solely on the symptoms they display or the type of seizure they have. A doctor may ask about seizure symptoms because this can help narrow down the regions of the brain the seizure affects, which may ultimately help with diagnosis.
While epilepsy is a common cause of childhood seizures, a wide range of medical conditions can cause seizures. Sometimes a child has a seizure for no clear reason. The child might never have a seizure again, or could continue having seizures.
Keep reading to learn more about different types of seizures that can affect children, including the causes, what to expect, and how to treat them.
CAUSES OF SEIZURES IN CHILDREN
Many different medical conditions can trigger a seizure, though one of the most common is the seizure disorder epilepsy. The type of seizure a person has is not always helpful for discerning its cause, so it is important to talk with a doctor.
Some non-epilepsy causes of seizure include:
• Poisoning, including from drugs or alcohol.
• Electrolyte imbalances
• Hypoglycemia
• Brain injuries
• Cancer
• Fever
• Infections
Seizures in children fall into two general categories, based on whether they involve the entire brain, or just one side of the brain. Within these two categories, there are many different subtypes of seizure.
• Generalized seizures.
Generalized seizures affect both sides of the brain. Some of the most common types include:
• Absence seizures
An absence seizure causes a person to temporarily be unaware of, or unresponsive to, their surroundings. They may blink rapidly or seem to be absent. Doctors used to call them petit mal seizures. Most absence seizures last just a few seconds.
Some people experience atypical absence seizures, which may last longer, or cause additional symptoms such as smacking the lips or other unusual movements. Absence seizures are more common in children than in adults. Because the symptoms are subtle, adults might not recognize that children experiencing absence seizures are having a seizure.
Anti-seizure medication can help prevent absence seizures, or reduce their frequency. In most children, absence seizures disappear on their own in adulthood.
• Tonic-clonic seizures
Tonic-clonic seizures most resemble the stereotypical seizure: with shaking, twitching, and lack of awareness. Some people cry out or make unusual noises right before or during the seizure. These seizures typically last less than 5 minutes, though a person may have temporary neurological changes after the seizure ends. The tonic phase happens first, causing the muscles to stiffen. This can cause a person to fall or make noise. A person might also bite their tongue. During the next phase, the clonic phase, a person may begin convulsing, with their arms and legs jerking or twitching. Doctors used to call tonic-clonic seizures grand mal seizures.
During this seizure, the only treatment is to keep the child safe. Do not shake them or move them, but monitor them to ensure they are breathing, and are not able to injure themselves. If a tonic-clonic seizure lasts longer than 5 minutes, call 911, even if the child has had a seizure before.
Epilepsy usually causes tonic-clonic seizures. Long-term treatment involves anti-epilepsy or anti-seizure drugs. If these drugs do not work, implantable devices or surgery may help reduce the frequency of seizures.
• Atonic seizures
Atonic seizures, which some people call drop attacks, cause a sudden loss of muscle control and tone. A child may suddenly flop to the floor or go limp. Their head may drop. These seizures can be focal, starting in one side of the brain; or generalized, affecting both sides of the brain.
Atonic seizures commonly begin in childhood because of epilepsy. Seizure medication, diet changes, nerve stimulation devices, and surgery may help.
• Focal seizures
Focal seizures affect just one side of the brain. Some doctors call them partial seizures. Some examples of focal seizures include:
• Simple focal seizures
Simple focal seizures, also called simple partial seizures, affect a single part of the brain, causing small and subtle changes in consciousness, such as twitching or unusual perceptions. Some doctors call them partial seizures or focal aware seizures. A child remains aware during a simple focal seizure.
Anti-seizure medication may help. If it does not, implantable devices, dietary changes, or brain surgery may help reduce the frequency of these seizures.
• Complex focal seizures
Complex focal seizures, or focal impaired awareness seizures, are similar to simple focal seizures. They may cause twitches, unusual facial movements, tics, or cause a person to seem confused or distant. Unlike simple focal seizures, a child is not aware during the seizure. Some children wander.
Anti-seizure medications may help prevent these seizures. When medication is ineffective, diet changes, surgery, or nerve stimulation devices may help.
• Secondary generalized focal seizures
A secondary generalized seizure begins as a focal seizure and then spreads to other areas of the brain, eventually affecting both sides of the brain. This type of seizure may become a tonic-clonic seizure.
Treatment depends on the type of seizure or seizure disorder that causes the seizure to spread. It often involves anti-seizure medication.
• Infantile spasms
Infantile spasms are specific types of spasms and seizures in children younger than 2 years old. They are very brief, lasting just 1–3 seconds, and cause a child to stiffen or jerk their arms and legs every few seconds for 5–10 minutes. Many parents may not recognize these spasms as seizures.
These seizures often signal a more serious type of epilepsy, so it is important to seek early treatment to help prevent neurological damage and improve a child’s development. Anti-seizure medications do not usually work. Instead, doctors may recommend other treatments, such as steroids. If medications do not work, a doctor may recommend surgery or other interventions.
