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Pediatric First Unprovoked Seizure

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Summary

Seizures occur when a large number of nerve cells in the brain send out an electrical signal at the same time, overwhelming the brain and causing the body to seize.

Expanded overview

The brain is comprised of billions of nerve cells called neurons, which use electrical impulses to communicate with each other. When too many neurons send out an electrical impulse simultaneously, the brain is overwhelmed, and a seizure occurs.

Causes

Anyone can have a seizure under the right circumstances. Fever, lack of oxygen, low blood sugar, head trauma or illness can cause a seizure. Approximately 3 to 5 percent of all children may experience a seizure. While most of these children will never experience a recurrence, an unprovoked seizure may be an initial sign of a more serious medical condition or epilepsy. Children with epilepsy have recurrent seizures.

The Epilepsy Center at Children’s Health is a Level 4 Epilepsy Center, providing the highest level of treatment for children with epilepsy. We were the first such program in the country to be certified by the Joint Commission, the nation’s preeminent standard-setting accrediting and certifying regulatory body in healthcare. Our interdisciplinary medical team has the experience to not only comprehensively diagnose children with this condition, but we remain the area’s only center to perform the most advanced procedures and therapies for the treatment of epilepsy.

Because this condition affects your child and your family, you will be glad to know we provide care for the whole family, including education and support.

In addition, the Epilepsy Center works with referring doctors and area Emergency Departments to:

  • Provide seizure safety education programs
  • Expedite appointments in order to get your child evaluated quickly

Types of seizures

Several types of seizures can impact babies and children. Some of the main types include:

  • Febrile seizure – This type of seizure occurs when a child has an illness accompanied by a fever. These are the most common type of seizures.
  • Neonatal seizure – This type of seizure occurs within the first 28 days of life, usually soon after the baby is born.
  • Partial seizure – This type of seizure involves only part of the child’s brain, and only a part of the body.
  • Generalized seizure – This type of seizure involves a larger part of the brain, and usually a larger part of the body.
  • Convulsive seizure – A type of generalized seizure, a convulsive seizure involves uncontrollable muscle jerking lasting for a few minutes (usually less than five minutes) followed by a time of drowsiness.
  • Tonic seizure – This type of seizure can involve shaking (called convulsions) combined with the body getting rigid, clenching the jaw, and biting the tongue. Some people still know this type of seizure as a grand mal seizure.
  • Absence seizure – This type of seizure may involve staring into space. Or your child may stop talking abruptly and then start talking again, or start repetitious movements like chewing their lips or moving a hand. These types used to be known as petit mal seizures.

Symptoms

Though the symptoms of the seizure depend on the type of seizure it is, the following are some general symptoms of seizures in children:

  • Difficulty breathing
  • Eyes going in different directions
  • Eyes rolling back into the head
  • Generalized convulsions
  • Repetitive movements such as chewing, lip smacking or clapping
  • Sleepiness and confusion
  • Staring or blinking

Sometimes, before a seizure, your child may experience an aura, which results in your child smelling something that isn’t there, or in numbness or a tingling sensation. 

Tests and Diagnosis

Tests and Diagnosis

If your child has an unprovoked seizure, your doctor will want to do a detailed physical exam of your child, understand your child’s past medical history and family history, and learn as much as possible from you about how the seizure started and what you observed.

The physical exam may include age-appropriate tests that are designed to determine the risk of seizure reoccurrence and to pinpoint any abnormalities that would help identify an underlying neurological disease, including epilepsy.

One test your child may need is an electroencephalogram (EEG), This test provides the doctor with a picture of the brain. An EEG is performed by placing electrodes on your child’s scalp and recording the electrical activity of the brain.

Treatments

Treatments

Unless tests indicate a high risk for another seizure, observation is the most effective course once an unprovoked seizure is diagnosed. Your doctor will also provide you with information about how to keep your child safe if another seizure should occur. If there is a high risk for another seizure, medication may be prescribed.

FAQs

FAQs

What is a seizure?
When the brain receives a burst of abnormal electrical signals, normal brain function is interrupted and a seizure may occur. A seizure may include shaking combined with the body getting rigid, clenching the jaw, and biting the tongue. Some seizures may include staring into space, or you may notice your child stops talking abruptly and then starts talking again, or start repetitious movements like chewing their lips or moving a hand. Sometimes a child may experience smelling something that isn’t there, numbness or a tingling sensations before the seizure.

What is an unprovoked seizure?
An unprovoked seizure has no known cause, such as a head injury, high fever, an infection, a reaction to medication, or low blood sugar.

Does a seizure mean my child has epilepsy?
A seizure doesn’t necessarily mean epilepsy. Doctors first need to be sure that a seizure isn’t due to something else before they diagnose epilepsy. Simple blood work and/or kidney tests might find that there is an infection causing seizures, and that might be cured easily. Otherwise there are a variety of brain-related tests, including an electroencephalogram (EEG), CT scan and MRI that can show the electrical activity in the brain that indicates epilepsy.

What are the symptoms of a seizure?
The epilepsy symptoms most people recognize are shaking (called convulsions) combined with the body getting rigid, clenching the jaw, and biting the tongue. These are called tonic-clonic seizures and many people still know them as grand mal seizures. But some seizures are barely noticeable. Children may stare into space, stop talking abruptly and then start talking again, or start repetitious movements like chewing their lips or moving a hand. These types of seizures are called absence seizures, which used to be known as petit mal seizures. Sometimes a child may experience smelling something that isn’t there, numbness or a tingling sensations before the seizure. These are called auras.

What should I do while my child is having a seizure?
If the seizure is small twitching or staring, they should come out of it easily. For convulsions, make sure your child is in a chair that they can’t fall out of or lying on the floor with a pillow under their head. Turn their head to the side, but NEVER try to put anything into their mouth. Do not shake or hit them or shout at them. If the seizure lasts for more than five minutes or seems violent, call 9-1-1.

After a seizure, your child may be confused, foggy or tired. If they want to lie down, let them.

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