Should You Worry if Your Child has a Seizure?
Many parents are scared to death if their child has a seizure. It
is usually a young child who has a fever and has had a short seizure.
the parents have already taken the child to the emergency room,
but when they come to me later they want answers: Is it serious?
Will my child have seizures all her life?
Fawn Leigh, one of Dukes pediatric neurologists, discusses
childhood seizures and when to be concerned and when to be reassured.
Dennis Clements, MD, PhD, MPH
a pediatric neurologist, I see many young patients with seizures.
The first question usually asked is, What is a seizure?
seizure is a sudden alteration of behavior or consciousness caused
by abnormal electrical activity in the brain.
come in many forms. Some seizures involve convulsive activity such
as jerking movements or stiffening of the body. Other seizures are
exhibited by simply staring off into space.
most common seizure typically begins with sudden change in the childs
level of alertness, followed by shaking or stiffening of the body
lasting several minutes. Often, these seizures are followed by a
period of decreased activity, usually sleepiness, and may include
state can last anywhere from minutes to hours. While first-time
seizures that last less than three to five minutes may be frightening,
most are not serious and a visit with your childs doctor may
be all that is needed.
prolonged, persistent seizure activity that lasts longer than five
minutes, parents and caregivers should seek medical care. Seizures
that are longer than 15 minutes and recurrent are termed status
epilepticus. Status epilepticus is a medical emergency and
must be managed by skilled physicians and not by parents.
are divided into two major categories (based on 1981 international
seizures affect the whole brain or both hemispheres of the brain
Partial seizures, also known as focal seizures, affect one part
or one side of the brain
Generalized seizures are divided into convulsive and nonconvulsive.
Convulsive means that there is muscle movement such as stiffening
(also known as tonic) or jerking (clonic) activity. When these movements
are combined it may be called grand mal.
types of convulsive seizure activity include myoclonic and atonic
seizure activity. Myoclonus is usually characterized by sudden,
single jerks. Atonic seizure activity is typically characterized
by dropping quickly to the floor as if suddenly asleep or paralyzed.
The child then quickly recovers.
two latter convulsive seizure types can both be difficult to diagnose
and treat because often they are the manifestation of a mixed seizure
disorder. In infants these seizures may be called infantile spasms.
means that there is alteration of consciousness without muscle movement.
This form of seizure activity was formerly called petit mal,
and is now commonly referred to as absence.
seizures are unique in that typically they are characterized by
an abrupt onset of staring and end just as abruptly with no confused
state following the events. Parents usually report that the child
looks like they are spacing out. (Teenagers who look
like this often are not having seizures -- they are simply bored.)
Partial seizures can be simple or complex. Simple partial seizures
are focal seizures that involve movement or sensation on one side
of the body without altered consciousness. Simple partial seizures
are commonly localized to areas in the brain called the motor or
seizures may be with or without aura, which involves associated
states such as fear, or changes in heart rate, flushing, or abdominal
partial seizures commonly originate from the frontal and temporal
lobes of the brain where there are many complex interconnections,
resulting in alteration of conscious. Typical complex partial seizures
manifest as sudden change in level of alertness with or without
aura, blank stare, confusional state, or aimless movements such
as wandering around or repetitive behavior.
The above descriptions are broad characterizations of seizure types.
In the real world, seizure presentations are not always as clear-cut.
Commonly, there are overlapping signs and symptoms that make finding
the seizure origin challenging.
example, partial seizures starting on one side of the brain may
spread to the whole brain and can look like a generalized seizure
event with tonic-clonic activity of the entire body. This is why
doctors often ask numerous questions about how the seizure began.
parents and caregivers who are present during a seizure, the description
of the beginning of the seizure event can be very helpful in diagnosing
the seizure (and hence the treatment).
addition to the history, an electroencephalogram (EEG) can provide
functional assessment of the electrical activity in the brain and
a brain MRI can provide structural assessment of the brain when
they are indicated.
A common question that people ask when a child suddenly has a seizure
is Why did it happen? In most children, doctors do not
find a specific cause for the seizures. Children can have seizures
from excessive fever or an underlying medical condition.
it is frustrating not to be given a reason for the seizures, it
is actually good news, because it means that your doctor has not
found a serious cause of the seizure.
causes of seizures include:
Infection such as meningitis
Febrile seizures are the most common convulsive event in childhood.
This is a unique kind of seizure, which occurs in early childhood
in association with elevation in body temperature. These occur in
about 2 to 5 percent of children between the ages of six months
and five years when they have a high fever. This percentage means
that approximately one in 25 children will have at least one febrile
vast majority of febrile seizures are felt to be harmless and do
not require daily anticonvulsant therapy. A daily anticonvulsant
should only be considered for children with complex febrile seizures,
meaning febrile seizures that are focal, prolonged, or recur within
children who have had febrile seizures are at increased risk for
developing epilepsy, the risk is still in most cases very small.
However, children with a pre-existing neurological condition or
developmental delay have a greater risk of developing recurrent
an initial febrile seizure in children younger than 12 months, a
lumbar puncture is frequently considered to rule out meningitis,
as other signs and symptoms of this serious condition may be minimal
or absent in this age group.
children 12 to 24 months, a lumbar puncture may also be considered.
In children older than 24 months, the decision to perform a lumbar
puncture depends on the childs clinical presentation.
There is no specific test for the diagnosis of seizure. The diagnosis
is made by putting together a constellation of information. Tests
such as an EEG can be helpful in determining the type of seizure
and can assist the doctor in selecting a medication. The findings
on an EEG, taken together with the description of the seizure event,
recurrence and family history, all contribute to the diagnostic
For each seizure type, there are several anticonvulsants that may
be equally effective. The selection of medication is usually based
on many factors including the seizure type, side effects, your childs
medical history, interactions with other medications that your child
is taking, previous drug allergies, your childs age, convenience,
management of seizure disorder in children requires a team approach.
This team typically includes parents, caregivers, teachers, skilled
therapists, and the physician.
importantly, the well-being of the child should be the center focus.
Communication among these team members is invaluable in coordinating
a comprehensive treatment plan, which includes medication, education,
supportive interventions, and observation.
medication controls a majority of seizure disorders, there remains
the group of children with intractable epilepsy, such as uncontrollable
seizures, that can be devastating and associated with developmental
epilepsy research community continues to concentrate its efforts
on identifying causes of epilepsy, new technology for diagnosis,
drug development, and surgical techniques with hope for better treatment
options and potential cures.
Leigh, MD, is a pediatric neurologist at Duke Childrens Health
Center. Dr. Leigh evaluates and treats a wide spectrum of neurological
disorders in children, including seizures, movement, neuromuscular,
and neurocutaneous disorders. Dr. Leigh has a research interest
in Neurofibromatosis (NF) and has established a collaborative initiative
with the Neuroproteomics Laboratory to identify potential biomarkers
Clements, MD, PhD, MPH, is the chief medical officer of Duke Children's
more information, visit www.dukehealth.org
information presented on this site is intended solely as a general
educational aid, and is neither medical nor healthcare advice for
any individual problem, nor a substitute for medical or other professional
advice and services from a qualified healthcare provider familiar
with your unique circumstances. Always seek the advice of your physician
or other qualified healthcare professional regarding any medical
condition and before starting any new treatment.