For Epilepsy Awareness Month, Know the Basics of Childhood Seizures

Article ID: 609822

Released: 1-Nov-2013 3:00 PM EDT

Source Newsroom: Johns Hopkins Medicine

  • Credit: Johns Hopkins Children's Center

    Pediatric neurologist Adam Hartman, left, and neurosurgeon George Jallo, two members of a multidisciplinary team that evaluates and treats patients with epilepsy

Newswise — Few things scare parents more than witnessing their child suffer a seizure. November is Epilepsy Awareness Month, and pediatric neurologists at the Johns Hopkins Children’s Center offer a quick primer on pediatric seizures to help parents navigate this often-terrifying experience.

Is my child having a seizure?

First and foremost, all seizures are not created equal, and no two children with seizures are alike, says Adam Hartman, M.D., a pediatric neurologist and epilepsy expert at Johns Hopkins. Some seizures are more serious than others, and not all seizures portend lifelong epilepsy. Different types of seizure present differently and not all of them involve the classic manifestation of thrashing or convulsing. Some seizures are nothing more than a staring spell or fleeting unresponsiveness. Seizures triggered by infection or high fever are typically isolated, resolve as soon as the underlying cause is corrected and do not qualify as epilepsy, Hartman says.

By contrast, a true seizure disorder involves recurrent episodes. They stem from faulty cell-to-cell communication in the brain, not unlike chaotic, misfiring electrical signals in a short circuit. Depending on their location, and the number of nerve cells they involve, such seizure-triggering “short-circuits” can cause a variety of symptoms that range from loss of consciousness and falling down, to convulsions to nothing more than a blank stare, experts say. In fact, epilepsy is an umbrella term that encompasses more than 40 seizure disorders.

Should I take my child to the ER?

Not necessarily, and not always, but as a rule all first seizures must be evaluated.“If this is the first time your child is having a seizure, seek emergency medical care,” Hartman says. Children with established epilepsy who happen to have a break-through seizure — one that occurs despite treatment — do not typically require urgent medical attention unless:• The seizure lasts more than 5 minutes• The seizure looks different from previous seizures • Several seizures occur in a cluster• The child remains unconscious for a few minutes following a seizure• The child struggles for air and is not getting enough oxygen, signaled by bluish lips or complexion

The above symptoms may mean that the child is going into status epilepticus, an unremitting, severe and life-threatening seizure that always requires emergency treatment, Hartman notes.

What should I do in the midst of a seizure and after it?

Above all, Hartman warns, do not put anything in the child’s mouth, do not try to hold him down and clear the surrounding area. Also, ensure the child is lying on one side, rather than flat on the back. You may want to put a small pillow under the child’s head. Note the length of the seizure and the date and time it occurred.

After the episode is over, allow the child to rest and check for injuries. Do not give the child anything to eat or drink until fully alert.

Keep a seizure diary and let the child’s neurologist or primary care pediatrician know about all seizures. Pay attention to what might have triggered the seizure. Sleep deprivation, emotional or physical stress, high fever and illness increase seizure risk among children with epilepsy, experts say.

“Children respond individually to stressors, so it’s important to notice the factors that precipitate a seizure in your child and avoid them when and if possible,” Hartman says.

My child has been diagnosed with epilepsy. Now what?

No two children with epilepsy are the same, Hartman says, and each patient has idiosyncrasies that demand precisely tailored therapy. For example, a medication that works wonders in some children may be only partly effective or completely useless in others. Indeed, a quarter of children with epilepsy do not respond to anti-seizure medication, experts say.

Parents should not settle for suboptimal treatment because incomplete seizure control can lead to cognitive delays or physical injury, Hartman says. Keep in mind though that even the best-tailored therapy is rarely 100 percent effective 100 percent of the time.

“If a child has tried two or more medications but continues to have seizures, it’s time to explore other treatments,” Hartman adds.

Fortunately, today’s therapeutic repertoire is far greater than ever before, experts say.

For some children, surgery to remove brain tissue that sparks seizure activity can be a long-term solution that allows some to stop medication altogether.

When surgery is not an option, children with drug-resistant epilepsy may benefit from a high-fat diet, called the ketogenic diet. Made up of high-fat foods, some protein and barely any carbohydrates, the diet is believed to work by triggering biochemical changes that alter seizure-causing short circuits in the brain’s signaling system.

Traditionally used mainly in children, a modified, easier-to-follow version of the ketogenic diet is now successfully used in teens and adults with comparable results. Also, some recent studies and case reports show the diet may hold promise for a wider range of seizure disorders than previously believed. However, the diet should be administered only under strict physician supervision, Hartman says.

Epilepsy affects nearly three million people in the United States, more than 320,000 of whom are children under 15, according to the Epilepsy Foundation. In addition, 45,000 children develop epilepsy each year.

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