If your infant or child is having a seizure now:
- Gently lay him on a soft surface such as a bed or carpet, away from any hard objects. Position the head to the side so that any saliva (or any material that comes up if he vomits) can drain from the mouth.
- If his mouth is empty, don’t put a finger, stick, or spoon in the child’s mouth because this may damage his teeth or cause him to vomit. If he has anything in his mouth, gently remove it with your finger. Do not try to pour a liquid into his mouth.
- Since he cannot swallow his tongue, don’t try to grab it with your fingers.
- Don’t restrain the child.
- Do not immerse him in a tub of water, even if he has a high fever.
- If you can, time the seizure’s length and carefully observe your child’s movements during the episode.
- If the seizure lasts for more than five minutes, call 911 for emergency medical assistance. Even if the seizure ends before help arrives, allow the paramedics to assess your child.
- If the seizure ends within five minutes, call your child’s physician immediately for further advice.
A seizure is a sudden abnormal surge of electrical activity in the brain, with manifestations that may range from subtle lapses in attention to terrifying convulsions. Tie word seizure is well chosen; during an episode it sterns as if the affected child’s thoughts and activity have teen abruptly seized or taken over by a hostile force.
Each of us has a seizure threshold. Given the right (or wrong) set of circumstances – an infection or tumor in- waiving the brain, a low level of sodium in the blood- scram, or a sudden withdrawal from certain types of medications – anyone can have a seizure. But some people, particularly in childhood, are much more vulnerable to this disturbance.
A seizure is a specific event. When seizures occur more than once without an immediate precipitating cause (such as a fever or injury), the condition is called epilepsy. The term epilepsy (derived from a Greek word meaning “seizure”) is synonymous with the term seizure disorder. Epilepsy is not truly a disease, but rather a complex of symptoms arising from disordered brain function, which itself may have a variety of pathological causes. In about 60 percent of diagnosed epileptics, no specific cause for the seizures is ever found, and the condition is referred to as idiopathic epilepsy. (Idiopathic is a medical term used when the cause of a condition is unknown.)
There are different kinds of seizures, each with characteristic behavioral patterns and usually specific brain- wave abnormalities that accompany it. It will be important for your doctor to classify them accurately because the type of seizure will often dictate which treatment approach (usually one of the antiepileptic or anticonvulsant medications) is appropriate to control the problem. Details of a given episode can help distinguish a true seizure from events and behaviors that are not seizures.
In the more common generalized seizures (sometimes identified by the older term grand mal), there is an abrupt loss of consciousness. The individual falls to the floor with both stiffness (or increased tonicity) and jerky movements. Uncontrolled jaw movements may cause injury to the tongue. Loss of control of the autonomic nervous system may cause the seizure victim to urinate or have a bowel movement.
This type of seizure may be preceded by an aura, an odd sensation (such as tingling or a strange aroma that no one else can smell) which the child may come to recognize. After the seizure there is nearly always a prolonged state (referred to as postictal) during which the child sleeps, is very sluggish, or has transient weakness of an arm or leg.
A generalized seizure is, without a doubt, extremely dramatic. Children seeing one of their classmates suddenly writhing on the floor may literally panic. Parents first observing their child in the throes of a full-blown convulsion are usually horrified and may be convinced that he is going to die before their eyes. But the seizure itself is not dangerous unless
- Food or vomited material is aspirated into the airway during episode
- It occurs in a situation where sudden loss of consciousness would be dangerous, such as while swimming or driving a car;
- It is extremely prolonged (more than 30 minutes).
If a single seizure (or multiple seizures without full recovery) lasts more than 30 minutes, a child is said to be in status epilepticus. This frightening situation occurs more commonly in children younger than five years of age. If not brought under control, status epilepticus can have serious consequences (including brain damage or even death); emergency medical assessment and treatment are very important.
Absence (also called petit mal) seizures are momentary lapses of awareness with no recollection of the event after it happens. The child may stop and stare for a few seconds. In some cases there may be brief jerks or fluttering of the eyelids. Absence seizures may occur frequently and be so brief that they escape detection. All children occasionally stare or daydream, but they can be aroused or spoken to during the lapse. In a true absence seizure, the child will be out of contact and cannot recall the event after it ends.
Myoclonic seizures are jerking or rhythmic muscle contractions involving a few (or many) muscle groupsand are sometimes accompanied by a fall. Complex partial seizures (previously known as psychomotor or temporal lobe seizures) begin with an aura that may involve a vague sensation of fear, an odd and usually unpleasant taste or smell, or hallucinations. Then comes the seizure, which may involve a minute or more of blank staring, chewing, or swallowing movements or purposeless activity, followed by a period of confusion.
In akinetic seizures (also called drop attacks) the child falls but does not shake or become stiff. Physical injuries (such as cuts on the head or face) occur more frequently as a direct consequence of this type of seizure than from any other.
Many unusual or even frightening behaviors of infant, or children may appear to be seizures, but are in fact other types of episodes. Some of the more common of these include:
- A fainting episode. Usually a child or adolescent who is about to faint feels dizzy, weak, or light-headed beforehand. Several circumstances could precede the episode: a has and/or crowded environment, lack of fresh air, hunger, an acute illness, an emotional incident, or a medical procedure (such as having blood drawn). Sweating, paleness, and a slow heartbeat are usually present also. Most important, the episode resolves quickly when the individual lies down, elevates the feet, and breathes fresh air. After a generalized seizure, on the other hand, there is a prolonged time during which the individual is first unconscious and then dazed and confused.
- Shuddering or shivering episodes in infants. These may occur frequently but without any apparent change in consciousness. Often there is a history of tremors among family members.
- Breath-holding spells. These incidents are frightening but harmless and are invariably brought on by physical or emotional incidents that provoke fear, anger, or frustration. They occur most commonly in children six months to three years of age. During the spell, the child may stiffen, make jerking movements of the arms and legs that resemble a brief seizure, and appear pale or blue in the face. Finally he will take a breath and very quickly regain color and responsiveness, after which there may be a brief period of inactivity or even sleep. When the episode is over he will be fully awake and aware, not confused or unresponsive as seen after a seizure (see breath-holding spells).
- Night terrors. During the early hours of sleep, a child may display intense crying, thrashing, sweating, and no apparent recognition of parents. After several minutes, he falls back to sleep and has no memory of the episode the following morning.
- Tics or Tourette’s syndrome. These are syndromes of involuntary muscle jerks, grunts, or vocalizations, which may worsen under stress. They are notable for being stereotyped-that is, the same over and over.
- Staring episodes. A parent or teacher may notice that a child is so preoccupied that he seems temporarily unresponsive as he stares into space. Distinguishing this from a petit mal seizure maybe difficult.
When in doubt about any of these behaviors or any other situation in which an infant or child shows sudden unusual body movements or changes in consciousness, medical evaluation is in order. Carefully describing the episode to the physician is the first, but in many ways the most important, step in arriving at a diagnosis