Many people in the community have seizures. 1 in 20 children (5%) will
have a seizure of some form during childhood. About 1 in 200 children (0.5%) have epilepsy, a neurological condition where children have a
predisposition to recurrent, unprovoked seizures.
There are many different types of epilepsy, especially in infancy,
childhood and adolescence. Epilepsy can be thought of in terms of
Genetic epilepsies (formerly called idiopathic or primary epilepsies) occur in an otherwise normal person and are due to a
genetic predisposition to seizures. Some epilepsies are due to an underlying abnormality of the brain
structure or chemistry (formerly called symptomatic or secondary epilepsies). Other epilepsies have no known cause.
Seizures occur when there is a momentary 'imbalance'
within electrical and chemical circuits in the brain, such that
groups of brain cells act in an excessive fashion.
This may create a temporary disturbance in the way the brain
controls awareness and responsiveness and may cause unusual
sensations or abnormal movements and postures. What happens during
a seizure reflects what parts of the brain are involved.
There are many different types of seizures, but the major
distinction that doctors try to make is between focal seizures,
where the seizure arises in one part of the brain (usually on one side of the brain) and generalised seizures, where epileptic
activity begins all over the brain (on both sides of the brain) simultaneously.
Focal seizures occur when the seizure arises in a
localised part of the brain, usually on one side. Focal seizures
used to be called partial seizures. Consciousness may or may not be
impaired. The manifestations of a focal seizure depend on
the part of the brain involved with the abnormal brain cell
activity. Focal seizures used to be classified
according to whether there is impairment of consciousness or
Formerly called simple partial seizures, these arise in parts of the brain not responsible
for maintaining consciousness, typically the movement or sensory
areas. Consciousness is NOT impaired and the effects of the seizure
relate to the part of the brain involved. If the site of origin is
the motor area of the brain, bodily movements may be abnormal (e.g.
limp, stiff, jerking). If sensory areas of the brain are involved
the person may report experiences such as tingling or numbness,
changes to what they see, hear or smell, or very unusual feelings
that may be hard to describe. Young children might have difficulty
describing such sensations or may be frightened by these.
Formerly called complex partial seizures, these arise in parts of the brain responsible
for maintaining awareness, responsiveness and memory, typically
parts of the temporal and frontal lobes. Consciousness is lost and
the person may appear dazed or unaware of their surroundings.
Sometimes the person experiences a warning sensation or 'aura'
before they lose awareness , essentially the simple partial phase
of the seizure. Behaviour during a complex partial seizure relates
to the site of origin and spread of the seizure. Often the person's
actions are clumsy and they will not respond normally to questions
and commands. Behaviour may be confused and they may exhibit
automatic movements and behaviours e.g. picking at clothing,
picking up objects, chewing and swallowing, trying to stand or run,
appearing afraid and struggling with restraint. Colour change,
wetting and vomiting can occur in complex partial seizures.
Following the seizure the person may remain confused for a
prolonged period and may not be able to speak, see, or hear if
these parts of the brain were involved. The person has no memory of
what occurred during the complex partial phase of the seizure and
often needs to sleep.
Focal seizures may
progress due to spread of epileptic activity over one or both
sides of the brain. Formerly called secondarily generalised seizures, bilaterally convulsive seizures look like generalised tonic-clonic
The distinction between simple and complex partial seizures is
often unclear and the terminology may be confusing. For these
reasons those terms are falling out of favour and more descriptive
terminology is used for focal seizures.
Generalised seizures occur when epileptic activity begins all
over the brain simultaneously. Consciousness is always impaired in
Tonic-clonic seizures produce sudden loss of consciousness, with
the person commonly falling to the ground, followed by stiffening
(tonic) and then rhythmic jerking (clonic) of the muscles. Shallow
or 'jerky' breathing, bluish tinge of the skin and lips, drooling
of saliva and often loss of bladder or bowel control generally
occur. The seizures usually last a couple of minutes and normal
breathing and consciousness then returns. The person is tired
following the seizure and may be confused.
Absence seizures produce a brief cessation of activity and loss of
consciousness, usually lasting 5-30 seconds. Often the momentary
blank stare is accompanied by subtle eye blinking and mouthing or
chewing movements. Awareness returns quickly and the person
continues with the previous activity. Falling and jerking do not
occur in typical absences.
Myoclonic seizures are sudden and brief muscle contractions that
may occur singly, repeatedly or continuously. They may involve the
whole body in a massive jerk or spasm, or may only involve
individual limbs or muscle groups. If they involve the arms they
may cause the person to spill what they were holding. If they
involve the legs or body the person may fall.
Tonic seizures are characterised by generalised muscle stiffening,
lasting 1-10 seconds. Associated features include brief cessation
of breathing, colour change and drooling. Tonic seizures
often occur during sleep. When tonic seizures occur suddenly with
the child awake they may fall violently to the ground and injure
themselves. Fortunately, tonic seizures are rare and usually
only occur in severe forms of epilepsy.
Atonic seizures produce a sudden loss of muscle tone
which, if brief, may only involve the head dropping forward ('head
nods'), but may cause sudden collapse and falling ('drop
From these descriptions, it can be appreciated that the exact
type of seizure may be difficult for a witness to determine. For
example, a seizure with stopping and staring could be a complex
partial (focal) seizure or an absence (generalised) seizure. A
convulsive seizure may be a generalised tonic-clonic seizure
or focal seizure which became bilaterally convulsive. A
sudden fall to the ground ('drop attack') can occur with myoclonic,
tonic or atonic seizures or a focal seizure involving the
movement areas. Determination of the exact type of seizure is
important and is obtained from patient and observer descriptions,
home video recordings, EEG testing and sometimes video EEG
It is also important to remember that many episodic behaviours
and disorders in children can mimic epilepsy, including breath
holding spells, sleep movements, day dreaming, fainting, migraine,
heart and gastrointestinal problems, and psychological
The most important aspect of the evaluation of a child or
adolescent with a suspected seizure disorder is the clinical
assessment by a specialist paediatrician or child neurologist. This
clinical assessment typically involves obtaining a detailed
description of the child's episodes, medical history, development,
learning and behaviour. Crucial outcomes of the assessment are to
Paediatricians are often the most accessible and experienced
child health specialists when it comes to assessing a child with a
suspected seizure disorder. The Neurology Department
provides a consultative service to general practitioners and
paediatricians for children with uncertain, poorly characterised or
Special tests are performed in many children with epilepsy. The need for tests is
determined following the detailed clinical assessment by
a paediatric specialist experienced in seizure disorders.
Tests are generally performed to:
Tests are not performed to determine if a child has epilepsy or
not. This is a clinical judgement made by a specialist.
Children who present to their doctor or an emergency department
with a first major seizure will usually have a blood test to
check the sugar, calcium, magnesium and salt levels, as
abnormalities of body chemistry can lead to seizures.
In a child
with epileptic seizures, a recording of brainwave activity (EEG) and a picture of the
brain (MRI) may be
obtained, where necessary. In special circumstances, some children
with seizures may have an examination of the spinal fluid (lumbar
puncture), metabolic testing of the blood or urine, or genetic
tests. Children with uncontrolled epilepsy sometimes undergo
detailed EEG (video-EEG monitoring) and more specialised imaging studies (SPECT and/or PET), to accurately localise the source and determine the cause of their
seizures, with a view to specialised treatments.
Children with seizures do not always need treatment. In many
instances, explanation and reassurance by the doctor and advice
about safety precautions and first aid management for possible
future seizures is all that is required. Many children with
epilepsy have only a single seizure and do not require
For children with recurrent seizures, the decision to prescribe
medication depends on the type of epilepsy and seizure, the age of the
child, the presence of associated developmental and behavioural
problems, and the attitudes and lifestyle of the child and family.
Medical treatment usually means prescription of antiepileptic
medication to prevent further seizures, but occasionally medication
is prescribed to treat seizures only when they occur.
General treatment options for children with epilepsy include:
For children with uncontrolled epilepsy, that is epilepsy in
which seizures are not adequately controlled by medication, other
treatments are available, including:
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