By Takijah T. Heard, M.D. , Director, Pediatric Neurophysiology Program, Children’s Memorial Hermann Hospital
Seizures can manifest as jerking, foaming, staring, garbled speech, eye-blinking and going limp. They can last seconds, minutes or even hours. But what causes seizures and what’s the best way to handle them?
Seizures are the result of uncontrolled electrical activity in the brain that causes sudden, abnormal changes in behavior. Most people assume seizures are caused by epilepsy, but that’s not true. Epilepsy cannot be diagnosed unless there are two unprovoked seizures not caused by fever, head trauma, lack of oxygen, metabolic or electrolyte abnormalities, accidental poisoning or overdose of drugs or alcohol.
The lifetime risk of experiencing an unprovoked seizure is approximately 4 percent; an estimated 50 percent of patients experiencing this type of seizure will experience a second unprovoked seizure within six months.
How to respond to a seizure Call 911 if a child is experiencing his first seizure, which lasts longer than five minutes and/or the child is having trouble breathing, call 911. Otherwise, a seizure itself is not necessarily an emergency, nor is it life-threatening, if witnesses take the following precautions:
• Place the child on the ground.
• Remove nearby objects.
• Loosen clothing around head or neck.
• Roll the child onto his or her side to allow for vomit or drool to be passed and to allow the tongue to fall out of the mouth and open the airway.
• Do NOT put anything in the child’s mouth.
• Call the child’s physician or 911 to report the seizure.
As much as anything, it’s important that parents remain calm during the seizure and provide reassurance afterward, when the child may be disoriented and upset.
To help with diagnosis, parents should document as much as possible about the seizure:
• Was the child awake or asleep when it happened?
• What was the child doing right before the seizure began?
• Did you observe jerking motions, eye deviation, or loss of bladder control?
• How long did the seizure last?
• Did the child go to sleep or act confused after the seizure?
• Did the child have any warning or memory of the seizure?
Initial diagnostic testing may include electroencephalography, or EEG, to record and monitor electrical brain activity. Magnetic resonance imaging, or MRI, can identify structural abnormalities or malformations in the brain that may be causing seizures.
The main goal of treatment is to control the frequency and intensity of seizures. Most children respond well to medication and/or specialized diets, but in some cases, surgery is required to implant a device that interrupts seizures before they begin, or to remove the abnormal brain tissue where the seizures originate.
For the sake of safety, some activities must be limited or supervised until seizures are under control. These include driving, contact sports, climbing, bathing and swimming.
But this does not mean parents should discourage their children from enjoying a full and normal life, even in cases where seizures are more difficult to control. For some, seizures will lessen over time, and an estimated 50 percent of children will ultimately outgrow their epilepsy.
Fast facts about pediatric epilepsy:
• In the U.S., around 300,000 children under age 14 have epilepsy.
• The condition may be lifelong or may be outgrown.
• Seven out of 10 cases have no known cause.
• Certain types of epilepsy may be genetic.
Children’s Memorial Hermann Hospital has recently opened a first-time seizure clinic where children who have had a first-time seizure may be assessed and receive expert advice from epileptologists like Dr. Takijah Heard.