Pediatric seizures

Seizures are caused by excess firing of some or all parts of the brain, and they can manifest in a variety of ways (and some are easier to recognize as a seizure than others). Here are some common types of pediatric seizures and what to expect with each one.

Generalized tonic clonic seizure

Also called a “grand mal” seizure, this type is easy to recognize. The child may have some or all of the following symptoms:

• An ictal cry (sudden scream/vocalization)
• Stiffening of all extremities (tonic phase)
• Jerking or twitching of all limbs (clonic phase), usually accompanied by:
  • Color change (pallor or blueness of face)
  • Clenched mouth with excess drooling or foaming
  • Loss of control over bladder/bowel (in a child who is continent)
• Eyes are usually open and rolled upward
• Child will not be responsive during the seizure and appears sleepy for several minutes to hours after (post-ictal phase)

Absence seizures

Previously called “petit mal” seizures, these can be easily missed as they only last for a few seconds. The child may stop what they are doing, stare off or zone out, have some repeated eye blinking and then resume their activity. There is usually no post-ictal drowsiness.

Myoclonic seizures

These are sudden quick muscle jerks in different body parts, usually in the morning. This may result in the child dropping the object they are holding. This type of seizure may be triggered by sleep deprivation or flashing lights in some cases.

Infantile spasms

This seizure type causes spasms, most often in babies between 6 months and 1 year of age. The spasms usually occur in clusters around transition from sleep to awake state; the child may have flexion or extension of arms and legs quickly followed by crying. The child may start regressing in eye contact, social skills and other milestones. Infantile spasms are often mistaken for other issues, such as colic, being startled, teething pain or stomach issues. It’s important to recognize it as a seizure because early diagnosis and treatment are crucial.

Tonic seizures

These seizures usually occur in children with known neurologic disease. During sleep, the child will suddenly elevate arms or legs in a stiff position with clenched teeth for a few seconds. Tonic seizures can happen several times a night in some children with a condition called Lenox–Gestaut Syndrome.

Atonic seizures

The child loses tone in their neck/trunk muscles and slumps down. It can result in a head nod, leg wobbliness or a sudden fall to the floor.

Focal seizures

These are quite common and may not be recognized as seizures initially. A very young child may appear scared before/during the seizure; older children may be able to describe an aura (warning symptom before the seizure) that may include:

• A sudden sense of fear
• Butterflies in the stomach
• Vision change
• Weird taste or smell
• Tingling or numbness in a part of face or body

As the focal seizure progresses, there may be repeated lip smacking, confused behavior, purposeless grabbing and/or a picking motion of the hands. The child may or may not be able to speak during the event. The seizure may be followed by weakness on one side of the body or sleepiness.

Gelastic seizures

Not very common, these seizures can be a symptom of a benign tumor called hypothalamic hamartoma. The child has sudden mirthless laughter for no apparent reason.

Please remember that not everything that looks like a seizure is a seizure. There are many conditions in childhood that mimic seizures, such as breath holding spells, shuddering spells, sleep myoclonus and migraine variants.

If your child is having a seizure, go to the emergency room if it’s a grand mal seizure or if they don't recover directly after the episode. Otherwise, your first step should be visiting your child's pediatrician or an urgent care doctor for an evaluation as soon as possible. Try to make as many observations about what happens during the suspected seizure as you can, and write them down. If you can also record the event on video, it will provide the doctor with important information about the incident; they can use it to help determine whether the episode was a seizure and if so, the type of seizure.

Your child’s pediatrician may be able to rule out seizures as a possibility—or they may recommend setting up an appointment with a neurologist for further evaluation. Here are some useful tips and what you can expect at your initial consult with a Cohen Children’s neurologist:

• Bring video or any notes that you took of the seizure.
• Bring results of any testing you have from other docs if you went to one.
• An attending neurologist will do a very thorough one hour evaluation.
• Doctor will ask you to walk them through the event in great detail as if the doctor was a fly on the wall at that time. (Even seemingly insignificant details are important, such as a startling noise your child made that made you check on them to begin with.)
• Talk about child’s overall health, family history, medication history and any events such as car accident, head injury and medical procedures.
• Detailed physical examination will be done, including skin check (certain birthmarks and colored spots can be a clue), asymmetries on the face (such as positioning of the eyes and ears) any other system abnormalities (such as heart, stomach).
• Full neurological examination will be done. This will be observatory for young children. The observation actually begins as soon as the child steps into the exam room. We watch how they communicate non-verbally with parents, how they’re interacting with examiner, if they display age-appropriate social skills and other possible clues about their medical condition.
• Examination of the cranial lobes and motor system will be done, and we’ll look for any abnormalities on one side of the body or the other.
• Epilepsy is diagnosed when the child has experienced two unprovoked seizures. We may wait for the second occurrence to make an official diagnosis or we may recommend further tests (such as brain MRI) if we think the child is at a higher risk for epilepsy based on the evaluation.

If your child is diagnosed with epilepsy (a common chronic disorder marked by recurrent, unprovoked seizures), we’ll find a treatment plan that gets their seizures under control. For most children (about 70 percent), medication is enough to control their seizures, and many kids eventually outgrow their seizures. And for kids who don’t respond to medication, there are plenty of other innovative treatment options available, including robot-assisted surgery called ROSA.