Introduction

Epilepsy represents the most common serious neurologic problem affecting children, with an overall incidence approaching 2% for febrile seizures and 1% for idiopathic epilepsy. Diagnosis is complicated by protean clinical manifestations which are age-dependent and differ substantially from adult seizure disorders. For example, infantile spasms may be misinterpreted as a simple startle reflex and absence (petit mal) seizures are sometimes attributed to inattention or attention deficit. Effective treatment depends largely on the physician's ability to establish an accurate diagnosis and choose appropriate therapy based on the likelihood of clinical benefit as well as potential side effects.

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Ontogeny of Childhood Seizures

Childhood seizures represent paroxysmal clinical events characterized by abnormal, excessive discharges originating from populations of cortical neurons and resulting in some clinically evident alteration of function or behavior. Therefore, the clinical manifestations of childhood seizures need not include recognizable motor activity such as tonic-clonic movement; possible clinical manifestations may include staring, drop attacks, behavioral changes, or even autonomic disturbances. Classification of seizure disorders has evolved considerably over time. Use of such terms as "grand mal" or "petit mal" epilepsy have largely been supplanted by more detailed classifications based on specific clinical manifestations, mode of onset (i.e. focal or generalized) and discrete clinical syndromes. At present, the epilepsies of childhood are most frequently classified using variations of the International Classification of Epileptic Seizures. This nomenclature delineates seizures in three general categories: generalized, partial (focal), and special epileptic syndromes. Generalized seizures are thought to originate within the brain in a bilaterally symmetric fashion at onset. Convulsive varieties of generalized seizures may include tonic, clonic, and tonic-clonic moter activity. Nonconvulsive generalized seizures include such varieties as absence (petit mal) and atonic seizures, juvenile myoclonic epilepsy, and infantile spasms. Partial (focal) seizures begin focally within the brain at onset, although they may subsequently progress to a partially or fully generalized seizure. Simple partial seizures produce no alteration of consciousness despite clinical manifestations which may include sensory, motor, or autonomic activity. Complex partial seizures may produce similar sensory, motor, or autonomic symptoms, but are also characterized by some impairment or

alteration of consciousness during the event. It should be noted that this definition does not require complete loss of consciousness as a necessary clinical component for a complex partial seizure. Special epileptic syndromes include such entities as other myoclonic epilepsies, reflex epilepsies, and febrile seizures of infancy.

Causes of Epilepsy in Childhood

The etiologies which underlie the development of epilepsy in childhood vary in an agedependent fashion. Seizures in neonates, infants, and toddlers most frequently result from perinatal brain injury, congenital central nervous system malformations, and metabolic derangements. Central nervous system infection, genetic epilepsies, and neurodegenerative disorders are more likely to present with seizures beginning in later childhood. These causes stand in stark contrast to the adult population, where traumatic brain injury, cerebrovascular disease, and neoplasms represent the most frequent causes of seizures.

General Guidelines for Treatment

Determination of appropriate treatment for a child with epilepsy must be individualized based on the spcific type(s) of seizure, the child's age, and the likelihood of significant side effects. Anticonvulsant monotherapy is preferred when possible and is effective in a majority of children. Generalized seizures may be controlled using a variety of medications, including barbiturates, phenytoin, valproic acid, orEthosuximide

Seizures
A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. The term "seizure" is often used interchangeably with "convulsion." Convulsions are when a person's body shakes rapidly and uncontrollably. During convulsions, the person's muscles contract and relax repeatedly. There are many different types of seizures. Some have mild symptoms and no body shaking. See also: Generalized tonic clonic seizure Partial (focal) seizure Petit mal (absence) seizure Epilepsy Fever (febrile) convulsions (seizures in children with high fever)

Considerations It may be hard to tell if someone is having a seizure. Some seizures only cause a person to have staring spells. These may go unnoticed.

Specific symptoms depend on what part of the brain is involved. They occur suddenly and may include: Brief blackout followed by period of confusion (the person cannot remember a period of time) Changes in behavior such as picking at one's clothing Drooling or frothing at the mouth Eye movements Grunting and snorting Loss of bladder or bowel control Mood changes such as sudden anger, unexplainable fear, panic, joy, or laughter Shaking of the entire body Sudden falling Tasting a bitter or metallic flavor Teeth clenching Temporary halt in breathing Uncontrollable muscle spasms with twitching and jerking limbs

Symptoms may stop after a few seconds minutes, or continue for 15 minutes. They rarely continue longer. The person may have warning symptoms before the attack, such as: Causes Seizures of all types are caused by disorganized and sudden electrical activity in the brain. Causes of seizures can include: Abnormal levels of sodium or glucose in the blood Brain infection, including meningitis Brain injury that occurs to the baby during labor or childbirth Brain problems that occur before birth (congenital brain defects) Brain tumor (rare) Choking Drug abuse Electric shock Epilepsy Fever (particularly in young children) Head injury Heart disease Heat illness (see heat intolerance) High fever Illicit drugs, such as angel dust (PCP), cocaine, amphetamines Kidney or liver failure Low blood sugar Phenylketonuria (PKU), which can cause seizures in infants Poisoning Stroke Fear or anxiety Nausea Vertigo Visual symptoms (such as flashing bright lights, spots, or wavy lines before the eyes)

Toxemia of pregnancy Uremia related to kidney failure Very high blood pressure (malignant hypertension) Venomous bites and stings (see snake bite) Use of illegal street drugs, such as cocaine or amphetamines Withdrawal from alcohol after drinking a lot on most days Withdrawal from certain drugs, including some painkillers and sleeping pills Withdrawal from benzodiazepines (such as Valium)

Sometimes no cause can be identified. This is called idiopathic seizures. They usually are seen in children and young adults but can occur at any age. There may be a family history of epilepsy or seizures. If seizures repeatedly continue after the underlying problem is treated, the condition is called epilepsy. Home Care Most seizures stop by themselves. However, the patient can be hurt or injured during a seizure. When a seizure occurs, the main goal is to protect the person from injury. Try to prevent a fall. Lay the person on the ground in a safe area. Clear the area of furniture or other sharp objects. Cushion the person's head. Loosen tight clothing, especially around the person's neck. Turn the person on his or her side. If vomiting occurs, this helps make sure that the vomit is not inhaled into the lungs. Look for a medical I.D. bracelet with seizure instructions. Stay with the person until he or she recovers, or until you have professional medical help. If a baby or child has a seizure during a high fever, cool the child slowly with tepid water. Do not place the child in a cold bath. You can give the child acetaminophen (Tylenol) once he or she is awake, especially if the child has had fever convulsions before. For information on how to help someone who is having a seizure, see: Seizure first aid

Generalized tonic-clonic seizure

A generalized tonic-clonic seizure is a seizure involving the entire body. It is also called a grand mal seizure. The terms "seizure," convulsion," or "epilepsy" are most often associated with generalized tonic-clonic seizures. For more information see: Causes Generalized tonic-clonic seizures may occur in people of any age. They may occur once (single episode), or as part of a repeated, chronic condition (epilepsy). Seizures Epilepsy

Symptoms Many patients with generalized tonic-clonic seizures have vision, taste, smell, or sensory changes, hallucinations, or dizziness before the seizure. This is called an aura. The seizures usually involve muscle rigidity, followed by violent muscle contractions, and loss of alertness (consciousness).Other symptoms that occur during the seizure may include: Biting the cheek or tongue Clenched teeth or jaw Loss of urine or stool control (incontinence) Stopped breathing or difficulty breathing Blue skin color

After the seizure, the person may have: Normal breathing Sleepiness that lasts for 1 hour or longer Loss of memory (amnesia) regarding events surrounding the seizure episode Headache Drowsiness Confusion Weakness of one side of the body for a few minutes to a few hours following seizure (called Todd's paralysis)

Partial (focal) seizure

All seizures are caused by abnormal electrical disturbances in the brain. Partial (focal) seizures occur when this electrical activity remains in a limited area of the brain. The seizures may sometimes turn into generalized seizures, which affect the whole brain. This is called secondary generalization. Partial seizures can be further characterized as: Simple -- not affecting awareness or memory Complex -- affecting awareness or memory of events before, during, and immediately after the seizure, and affecting behavior

For more information, see: Epilepsy Seizures Generalized tonic clonic seizure (grand mal seizure) Petit mal seizure

Symptoms Patients with focal seizures can have any of the symptoms below, depending on where in the brain the seizure starts. Patients with simple focal seizures do not lose consciousness. They will be aware of and remember the events that occur at the time.

Patients with complex partial seizures may or may not remember any or all of the symptoms or events during the seizure. Abnormal muscle contraction o Muscle contraction/relaxation (clonic activity) -- common o Affects one side of the body (leg, part of the face, or other area) o Abnormal head movements o Forced turning of the head Staring spells, with or without complex, repetitive movements (such as picking at clothes) -- these are called automatisms and include: o Abnormal mouth movements o Lip smacking o Behaviors that seem to be a habit o Chewing/swallowing without cause Forced turning of the eyes Abnormal sensations o Numbness, tingling, crawling sensation (like ants crawling on the skin) o May occur in only one part of the body, or may spread o May occur with or without motor symptoms Hallucinations Abdominal pain or discomfort Nausea Sweating Flushed face Dilated pupils Rapid heart rate/pulse

Other symptoms include: Blackout spells -- periods of time lost from memory Changes in vision Sensation of deja vu Changes in mood or emotion

Petit mal seizure

A petit mal seizure is the term commonly given to a staring spell, most commonly called an "absence seizure." It is a brief (usually less than 15 seconds) disturbance of brain function due to abnormal electrical activity in the brain. For more information, see: Causes Petit mal seizures occur most commonly in people under age 20, usually in children ages 6 to 12. Epilepsy Seizures Generalized tonic-clonic seizure Partial (focal) seizure

They may occur with other types of seizures, such as generalized tonic-clonic seizures (grand mal seizures), twitches or jerks (myoclonus), or sudden loss of muscle strength (atonic seizures). Symptoms Most petit mal seizures last only a few seconds. Most commonly they involve staring episodes or "absence spells." The episodes may: Occur many times a day Occur for weeks to months before being noticed Interfere with school and learning Be mistaken for lack of attention or other misbehavior

Unexplained difficulties in school and learning difficulties may be the first sign of petit mal seizures. During the seizure, the person may: Stop walking and start again a few seconds later Stop talking in mid-sentence and start again a few seconds later

The person usually does not fall during the seizure. Immediately after the seizure, the person is usually: Wide awake Thinking clearly Unaware of the seizure

Specific symptoms of typical petit mal seizures may include: Changes in muscle activity, such as: o No movement o Hand fumbling o Fluttering eyelids o Lip smacking o Chewing Changes in alertness (consciousness), such as: o Staring episodes o Lack of awareness of surroundings o Sudden halt in movement, talking, and other awake activities o May be triggered by hyperventilation or flashing lights, in some cases

Atypical petit mal seizures begin slower and last longer. Symptoms are similar but muscle activity changes may be more noticeable.

Epilepsy

Epilepsy is a brain disorder in which a person has repeated seizures (convulsions) over time. Seizures are episodes of disturbed brain activity that cause changes in attention or behavior.

See also: Seizures Causes Epilepsy occurs when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals. This results in repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.) Epilepsy may be due to a medical condition or injury that affects the brain, or the cause may be unknown (idiopathic). Common causes of epilepsy include: Stroke or transient ischemic attack (TIA) Dementia, such as Alzheimer's disease Traumatic brain injury Infections, including brain abscess, meningitis, encephalitis, and AIDS Brain problems that are present at birth (congenital brain defect) Brain injury that occurs during or near bith Metabolism disorders that a child may be born with (such as phenylketonuria) Brain tumor Abnormal blood vessels in the brain Other illness that damage or destroy brain tissue

Epilepsy seizures usually begin between ages 5 and 20, but they can happen at any age. There may be a family history of seizures or epilepsy. Symptoms Symptoms vary from person to person. Some people may have simple staring spells, while others have violent shaking and loss of alertness. The type of seizure depends on the part of the brain affected and cause of epilepsy. Most of the time, the seizure is similar to the previous one. Some people with epilepsy have a strange sensation (such as tingling, smelling an odor that isn't actually there, or emotional changes) before each seizure. This is called an aura. For a detailed description of the symptoms associated with a specific type of seizure, see: Absence (petit mal) seizure Generalized tonic-clonic (grand mal) seizure Partial (focal) seizure

Exams and Tests The doctor will perform a physical exam, which will include a detailed look at the brain and nervous system. An EEG (electroencephalogram) will be done to check the electrical activity in the brain. People with epilepsy will often have abnormal electrical activity seen on this test. In some cases, the test may show the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures. To diagnose epilepsy or plan for epilepsy surgery: You may need to wear an EEG recorder for days or weeks while you go about your everyday life. You may need to stay in a special hospital where brain activity can be be watched on video cameras. This is called video EEG.

Tests that may be done include: Blood chemistry Blood sugar CBC (complete blood count) Kidney function tests Liver function tests Lumbar puncture (spinal tap) Tests for infectious diseases

Head CT or MRI scan often done to find the cause and location of the problem in the brain. Treatment Treatment for epilepsy may involve surgery or medication. If epilepsy seizures are due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery to treat these disorders may make the seizures stop. Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures. These drugs are taken by mouth. Which type you are prescribed depends on the type of seizures you have. Your dosage may need to be changed from time to time. You may need regular blood tests to check for side effects. Always take your medication on time and as directed. Missing a dose can cause you to have a seizure. Never not stop taking or change medications without talking to your doctor first. Many epilepsy medications cause birth defects. Women wishing to become pregnant should tell the doctor in advance in order to adjust medications.

Epilepsy that does not get better after two or three anti-seizure drugs have been tried is called "medically refractory epilepsy." Surgery to remove the abnormal brain cells causing the seizures may be helpful for some patients. Surgery to place a vagus nerve stimulator (VNS) may be recommended. This device is similiar to a heart pacemaker. It can help reduce the number of seizures.

Sometimes, children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults. Lifestyle or medical changes can increase the risk for a seizure in a person with epilepsy. Talk with your doctor about: New prescribed medications, vitamins, or supplements Emotional stress Illness, especially infection Lack of sleep Pregnancy Skipping doses of epilepsy medications Use of alcohol or other recreational drugs

Other considerations:

Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs. Persons with poorly controlled epilepsy should not drive. Each state has a different law about which people with a history of seizures are allowed to drive. Also avoid machinery or activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.

See also: Seizures - first aid. Support Groups The stress caused by having epilepsy (or being a caretaker of someone with epilepsy) can often be helped by joining a support group. In these groups, members share common experiences and problems. See: Epilepsy - support group Outlook (Prognosis) Some people with epilepsy may be able to reduce or even stop their anti-seizure medicines after having no seizures for several years. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s. For many people, epilepsy is a lifelong condition. In these cases, the anti-seizure drugs need to be continued. There is a very low risk of sudden death with epilepsy. However, serious injury can occur if a seizure occurs during driving or when operating equipment. Possible Complications Difficulty learning Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia Injury from falls, bumps, self-inflicted bites, driving or operating machinery during a seizure Permanent brain damage (stroke or other damage) Side effects of medications

When to Contact a Medical Professional Call your local emergency number (such as 911) if: This is the first time a person has had a seizure A seizure occurs in someone who is not wearing a medical ID bracelet (which has instructions explaining what to do)

In the case of someone who has had seizures before, call 911 for any of these emergency situations: This is a longer seizure than the person normally has, or an unusual number of seizures for the person Repeated seizures over a few minutes Repeated seizures where consciousness or normal behavior is not regained between them (status epilepticus)

Call your health care provider if any new symptoms occur, including possible side effects of medications (drowsiness, restlessness, confusion, sedation, or others), nausea or vomiting, rash, loss of hair, tremors or abnormal movements, or problems with coordination. Prevention

Generally, there is no known way to prevent epilepsy. However, proper diet and sleep, and staying away from illegal drugs and alcohol, may decrease the likelihood of triggering seizures in people with epilepsy. Reduce the risk of head injury by wearing helmets during risky activities; this can help lessen the chance of developing epilepsy. Persons with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of seizures are allowed to drive. If you have uncontrolled seizures, you should also avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.

Febrile seizures

A febrile seizure is a convulsion in a child triggered by a fever. These convulsions occur without any brain or spinal cord infection or other nervous system (neurologic) cause. Causes About 3 - 5% of otherwise healthy children between ages 9 months and 5 years will have a seizure caused by a fever. Toddlers are most commonly affected. Febrile seizures often run in families. Most febrile seizures occur in the first 24 hours of an illness, and not necessarily when the fever is highest. The seizure is often the first sign of a fever or illness Febrile seizures are usually triggered by fevers from: Ear infections Roseola infantum (a condition with fever and rash caused by several different viruses) Upper respiratory infections caused by a virus

Meningitis causes less than 0.1% of febrile seizures but should always be considered, especially in children less than 1 year old, or those who still look ill when the fever comes down. A child is likely to have more than one febrile seizure if: There is a family history of febrile seizures The first seizure happened before age 12 months The seizure occurred with a fever below 102 degrees Fahrenheit

Symptoms A febrile seizure may be as mild as the child's eyes rolling or limbs stiffening. Often a fever triggers a full-blown convulsion that involves the whole body. Febrile seizures may begin with the sudden contraction of muscles on both sides of a child's body -- usually the muscles of the face, trunk, arms, and legs. The child may cry or moan from the force of the muscle contraction. The contraction continues for several seconds, or tens of seconds. The child will fall, if standing, and may pass urine. The child may vomit or bite the tongue. Sometimes children do not breathe, and may begin to turn blue. Finally, the contraction is broken by brief moments of relaxation. The child's body begins to jerk rhythmically. The child does not respond to the parent's voice.

A simple febrile seizure stops by itself within a few seconds to 10 minutes. It is usually followed by a brief period of drowsiness or confusion. A complex febrile seizure lasts longer than 15 minutes, is in just one part of the body, or occurs again during the same illness. Febrile seizures are different than tremors or disorientation that can also occur with fevers. The movements are the same as in a grand mal seizure. Exams and Tests The health care provider may diagnose febrile seizure if the child has a grand mal seizure but does not have a history of seizure disorders (epilepsy). In infants and young children, it is important to rule out other causes of a first-time seizure, especially meningitis. In a typical febrile seizure, the examination usually shows no abnormalities other than the illness causing the fever. Typically, the child will not need a full seizure workup, which includes an EEG, head CT, and lumbar puncture (spinal tap). To avoid having to undergo a seizure workup: The child must be developmentally normal. The child must have had a generalized seizure, meaning that the seizure was in more than one part of the child's body, and not confined to one part of the body. The seizure must not have lasted longer than 15 minutes. The child must not have had more than one febrile seizure in 24 hours. The child must have a normal neurologic exam performed by a health care provider.

Treatment During the seizure, leave your child on the floor. You may want to slide a blanket under the child if the floor is hard. Move him only if he is in a dangerous location. Remove objects that may injure him. Loosen any tight clothing, especially around the neck. If possible, open or remove clothes from the waist up. If he vomits, or if saliva and mucus build up in the mouth, turn him on his side or stomach. This is also important if it looks like the tongue is getting in the way of breathing.

Do NOT try to force anything into his mouth to prevent him from biting the tongue, as this increases the risk of injury. Do NOT try to restrain your child or try to stop the seizure movements. Focus your attention on bringing the fever down: Insert an acetaminophen suppository (if you have some) into the child's rectum. Do NOT try to give anything by mouth. Apply cool washcloths to the forehead and neck. Sponge the rest of the body with lukewarm (not cold) water. Cold water or alcohol may make the fever worse. After the seizure is over and your child is awake, give the normal dose of ibuprofen or acetaminophen.

After the seizure, the most important step is to identify the cause of the fever. Outlook (Prognosis)

The first febrile seizure is a frightening moment for parents. Most parents are afraid that their child will die or have brain damage. However, simple febrile seizures are harmless. There is no evidence that they cause death, brain damage, epilepsy, mental retardation, a decrease in IQ, or learning difficulties. A small number of children who have had a febrile seizure do go on to develop epilepsy, but not because of the febrile seizures. Children who would develop epilepsy anyway will sometimes have their first seizures during fevers. These are usually prolonged, complex seizures. Nervous system (neurologic) problems and a family history of epilepsy make it more likely that the child will develop epilepsy. The number of febrile seizures is not related to future epilepsy. About a third of children who have had a febrile seizure will have another one with a fever. Of those who do have a second seizure, about half will have a third seizure. Few children have more than three febrile seizures in their lifetime. Most children outgrow febrile seizures by age 5. Possible Complications Biting oneself Breathing fluid into the lungs Complications if a serious infection, such as meningitis, caused the fever Injury from falling down or bumping into objects Injury from long or complicated seizures Seizures not caused by fever Side effects of medications used to treat and prevent seizures (if prescribed)

When to Contact a Medical Professional Children should see a doctor as soon as possible after their first febrile seizure. If the seizure is lasting several minutes, call 911 to have an ambulance bring your child to the hospital. If the seizure ends quickly, drive the child to an emergency room when it is over. Take your child to the doctor if repeated seizures occur during the same illness, or if this looks like a new type of seizure for your child. Call or see the health care provider if other symptoms occur before or after the seizure, such as: Abnormal movements Agitation Confusion Drowsiness Nausea Problems with coordination Rash Sedation Tremors

It is normal for children to sleep or be briefly drowsy or confused right after a seizure. Prevention

Because febrile seizures can be the first sign of illness, it is often not possible to prevent them. A febrile seizure does not mean that your child is not getting the proper care. Occasionally, a health care provider will prescribe diazepam to prevent or treat febrile seizures that occur more than once. However, no medication is completely effective in preventing febrile seizures. Alternative Names Seizure - fever induced

Seizure Basics
Most seizures are caused by abnormal electrical discharges in the brain or by fainting (decrease in blood flow to the brain). Symptoms may vary depending on the part of the brain involved, but often include unusual sensations, uncontrollable muscle spasms, and loss of consciousness.

Some seizures may be the result of another medical problem, such as low blood sugar, infection, a head injury, accidental poisoning, or drug overdose. They also can be due to a brain tumor or other health problem affecting the brain. And anything that results in a sudden lack of oxygen or a reduction in blood flow to the brain can cause a seizure. In some cases, a seizure's cause is never discovered.

When seizures occur more than once or over and over, it may indicate the ongoing conditionepilepsy. Some kids under 5 years old have febrile seizures, which can occur when they develop a medium or high fever usually above 100.4 F (38 C). While terrifying to parents, these seizures are usually brief and rarely cause any lifethreatening, serious, or long-term problems, unless the fever is associated with a serious infection, such as meningitis. In kids under 5 years old, breath-holding spells can cause seizures. These aren't the spells where kids hold their breath to get back at their parents. Instead, these occur in kids who have an exaggerated reflex so that when they're hurt or emotionally upset they stop taking in a breath (with or without crying hard first). They then turn blue or very pale, often pass out, and might have a full convulsion-like seizure in which the body is stiff and they're unconscious and not breathing. While scary to parents, these spells usually stop on their own and the kids almost never suffer any harm from them. Call your doctor if such a spell occurs. In older kids, about 10% or more have standard fainting spells (also called syncope), which is often associated with a brief seizure or seizure-like spell. A child may stiffen or even twitch or convulse a few times. Fortunately, this rarely indicates epilepsy. Most kids recover very quickly (seconds to minutes) and don't require specialized treatment.

If Your Child Has a Seizure

A child who is having a seizure should be placed on the ground or floor in a safe area, preferably on his or her right side. Remove any nearby objects. Loosen any clothing around the head or neck. Do not try to wedge the child's mouth open or place an object between the teeth, and do not attempt to restrain movements. Once the seizure seems to have ended, gently comfort and protect your child. It's best for kids to remain lying down until they have recovered fully and want to move around.

Call 911 immediately if your child:

has difficulty breathing turns bluish in color has sustained a head injury seems ill has a known heart condition has never had a seizure before might have ingested any poisons, medications, etc.

If your child has previously had seizures, call 911 if the seizure lasts more than 5 minutes or is for some reason very alarming to you and you're worried for your child's safety.

If your child is breathing normally and the seizure lasts just a few minutes, you can wait until it lets up to call your doctor.

Following the seizure, kids are often be tired, confused, or exhausted and may fall into a deep sleep (called the postictal period). You do not need to try to wake your child as long as he or she is breathing comfortably. Do not attempt to give food or drink until your child is awake and alert. For a child who has febrile seizures, the doctor may suggest giving fever-reducing medicine (such as ibuprofen or acetaminophen), followed by a lukewarm sponge bath if medication doesn't bring the fever down.

After a seizure particularly if it is a first or unexplained seizure call your doctor or emergency medical services for instructions. Your child will usually need to be evaluated by a doctor as soon as possible.

Seizure Disorder

Also known as convulsions, epileptic seizures, and if recurrent, epilepsy. It is a sudden alterations in normal brain activity that cause distinct changes in behavior and body function. They are thought to result from abnormal, recurrent, uncontrolled electric discharges of neurons in the brain. Pathophysiology of seizures is poorly understood but seems to be related to metabolic and electrochemical factors at the cellular level. Predisposing factors include head or brain trauma, tumors, cranial surgery, metabolic disorders (hypocalcemia, hypoglycemia or hyperglycemia, hyponatremia, anoxia); central nervous system infection; circulating disorders; drug toxicity; drug withdrawal states

(alcohol, barbiturates); and congenital neurodegenerative disorders. Seizures are classified as partial or generalized by the origin of the seizure activity and associated clinical manifestations. a. Simple partial seizures manifest motor, somatosensory, and psychomotor symptoms without impairment of consciousness. b. Complex partial seizures manifest impairment of consciousness with or without simple partial symptoms.

c. Generalized seizures manifest a loss of consciousness with convulsive or nonconvulsive behaviors and include tonic-clonic, myoclonic, atonic, and absence seizures.

Simple partial seizures can progress to complex partial seizures, and complex partial seizures can secondarily become generalized.

Seizures affect all ages. Most cases of epilepsy are identified in childhood, and several seizure types are particular to children. Assessment: 1. Generalized tonic-clonic (grand mal) seizure a. May be preceded by an aura such as a peculiar sensation or dizziness; then sudden onset of seizure with loss of consciousness. b. Rigid muscle contraction in tonic phase which clenched jaw and hands; eyes open with pupils dilated; lasts 30 to 60 seconds. c. Rhythmic, jerky contraction and relaxation of all muscles in clonic phase with incontinence and frothing at the lips; may bite tongue or cheek, lasts several minutes. d. Sleeping or dazed postictal state for up to several hours. 2. Absence ( petit mal) seizure a. Loss of contact with environment for 5 to 30 seconds. b. Appears to be day dreaming or may roll eyes, nod head, move hands, or smack lips. c. Resumes activity and is not aware of seizure. 3. Myoclonic seizure (infantile spasm) a. Seen in children or infants, caused by cerebral pathology, often with mental retardation. b. Infantile spasms usually disappear by age 4, but child may develop other types of seizures. c. Brief, sudden, forceful contractions of the muscles of the trunk, neck, and extremities. d. Extensor type infant extends head, spreads arms out, bend body backward in spread eagle position. e. Mixed flexor and extensor types may occur in clusters or alternate. f. May cause children to drop or throw something. g. Infant may cry out, grunt, grimace, laugh, or appear fearful during an attack. 4. Partial (focal) motor seizure a. Rhythmic twitching of muscle group, usually hand or face. b. May spread to involve entire limb, other extremities and face on that side, known as jacksonian seizure. 5. Partial (focal) somatosensory seizure a. Numbness and tingling in a part of the body. b. May also be visual, taste, auditory, or olfactory sensation. 6. Partial psychomotor (temporal lobe) seizure a. May be aura of abdominal discomfort or bad odor or taste. b. Auditory or visual hallucinations, dj vu feeling, or sense of fear or anxiety. c. Repetitive purposeless movements (automatisms) may occur, such as picking at clothes, smacking lips, chewing, and grimacing. d. Lasts seconds to minutes. 7. Complex partial seizures begin as partial seizures and progress to impairment of consciousness or impaired consciousness at onset. 8. Febrile seizure a. Generalized tonic-clonic seizure with fever over 101.8 degrees Fahrenheit. b. Occurs in children younger than age 5. c. Treatment is to decrease temperature, treat source of fever, and control seizure. d. Long-term treatment to prevent recurrent seizures with fever is controversial. Diagnostic Evaluation:

1. 2. 3. 4. 5.

EEG, with or without video monitoring, locates epileptic focus, spread, intensity, and duration, helps classify seizure type. CT scanning or MRI identifies lesion that may cause of seizure. Single photon emission CT scanning (SPECT) or positron emission tomography (PET) identifies seizure foci. Neuropsychological studies evaluate for behavioral disturbances. Serum electrolytes, glucose, and toxicity screen determine the cause of first seizure.

6. Lumbar puncture and blood cultures may be necessary if fever is present. Pharmacologic Interventions: 1. 2. Antiepileptic drugs (AEDs) may be used singly or in combination to increase effectiveness, treat mixed seizure types, and reduce adverse effects. A wide variety of adverse reactions may occur, including hepatic and renal dysfunction, vision disturbances, drowsiness, ataxia,

anemia, leukopenia, thrombocytopenia, psychotic symptoms, skin rash, stomach upset, and idiosyncratic reactions. Surgical Interventions: 1. 2. Surgical treatment of brain tumor or hematoma may relieve seizures caused by these. Temporal lobectomy, extratemporal resection, corpus callosotomy, or hemispherectomy may be necessary in medically intractable

seizure disorders. Nursing Interventions: 1. 2. 3. 4. 5. 6. 7. 8. Monitor the entire seizure event, including prodromal signs, seizure behavior, and postictal state. Monitor complete blood count, urinalysis, and liver function studies for toxicity caused by medications. Provide safe environment by padding side rails and removing clutter. Place the bed in low position. Do not restrain the patient during seizure. Do not put anything in the patients mouth during seizure. Maintain a patent airway until the patient is fully awake after a seizure. Provide oxygen during the seizure if the patient become cyanotic.

9. Place the patient on side during a seizure to prevent aspiration. 10. Protect the patients head during the seizure. 11. Teach stress reduction techniques that will fit into the patients lifestyle. 12. Tell the patient to avoid alcohol because it interferes with metabolism of AEDs and adds to sedation. 13. Encourage the patient to determine existence of triggering factors for seizures, such as skipped meals, lack of sleep, and emotional stress. 14. Remind the family the importance of following medication regimen and maintaining regular laboratory testing, medical check ups, and visual examinations. 15. Encourage patient to follow a moderate lifestyle routine, including exercise, mental activity, and nutritious diet.

Symtoms of Seizure
A seizure is usually defined as a sudden alteration of behavior due to a temporary change in the electrical functioning of the brain, in particular the outside rim of the brain called the cortex. Below you will find some of the symptoms people with epilepsy may experience before, during and after a seizure. Seizures can take on many different forms and seizures affect different people in different ways. It is not implied that every person with seizures will experience every symptom described below.

Seizures have a beginning, middle, and end

When an individual is aware of the beginning, it may be thought of as a warning or aura. On the other hand, an individual may not be aware of the beginning and therefore have no warning.

Sometimes, the warning or aura is not followed by any other symptoms. It may be considered a simple partial seizure by the doctor.

The middle of the seizure may take several different forms. For people who have warnings, the aura may simply continue or it may turn into a complex partial seizure or a convulsion. For those who do not have a warning, the seizure may continue as a complex partial seizure or it may evolve into a convulsion.

The end to a seizure represents a transition from the seizure back to the individuals normal state. This period is referred to as the post-ictal period (an ictus is a seizure) and signifies the recovery period for the brain. It may last from seconds to minutes to hours, depending on several factors including which part(s) of the brain were affected by the seizure and whether the individual was on antiseizure medication. If a person has a complex partial seizure or a convulsion, their level of awareness gradually improves during the post-ictal period, much like a person waking up from anesthesia after an operation. There are other symptoms that occur during the post-ictal period and are detailed below.

Please note: Below is only a partial list, some people may experience other symptoms not listed below. These lists are meant to help patients communicate with their physicians.

Early seizure symptoms (warnings) Sensory/Thought:

Deja vu Jamais vu Smell Sound Taste Visual loss or blurring Racing thoughts Stomach feelings Strange feelings Tingling feeling

Emotional:

Fear/Panic Pleasant feeling

Physical:

Dizziness Headache Lightheadedness Nausea Numbness

No warning:

Sometimes seizures come with no warning

Seizure symptoms Sensory/Thought:

Black out Confusion

Deafness/Sounds Electric Shock Feeling Loss of consciousness Smell Spacing out Out of body experience Visual loss or blurring

Emotional:

Fear/Panic

Physical:

Chewing movements Convulsion Difficulty talking Drooling Eyelid fluttering Eyes rolling up Falling down Foot stomping Hand waving Inability to move Incontinence Lip smacking Making sounds Shaking Staring Stiffening Swallowing Sweating Teeth clenching/grinding Tongue biting Tremors Twitching movements Breathing difficulty Heart racing

After-seizure symptoms (post-ictal)

Thought:

Memory loss Writing difficulty

Emotional:

Confusion Depression and sadness Fear Frustration Shame/Embarrassment

Physical:

Bruising Difficulty talking Injuries Sleeping Exhaustion Headache Nausea Pain Thirst Weakness Urge to urinate/defecate