When a child has a seizure, it can scare parents and peers. But seizures are actually a fairly common occurrence of childhood. According to the American Academy of Family Physicians, 4 to 10 percent of children will have an unprovoked seizure — without recurrence. Each year, about 150,000 children and adolescents have their first seizure — but only 30,000 of them will be diagnosed with epilepsy.
Common enough, but Martin L. Kutscher, M.D. acknowledges parents’ concerns. “A little information can demystify the topic,” he says, and offers the following guide:
What can seizures look like?
—“Absence” seizures (previously called “petit mal”) typically consist of brief (3-30 second) staring spells. The person suddenly freezes in mid-activity, and stares with a vacant, glazed look; they will be unresponsive to being called or touched. Sometimes, there is some mild eye fluttering, mild lip movements, or twitches. There is neither an “aura” (warning before the seizure) nor a period of “post-ictal” confusion after the spell.
—”Tonic-clonic” seizures (previously called “grand-mal”) start with continuous muscle stiffening that is then followed by rhythmic jerks. There may be biting of the tongue and loss of urine control. Often, there is post-ictal confusion.
—“Myoclonic” seizures are brief, startle-like jerks, often occurring in irregular flurries. They might be quick, forward flexion movements that resemble a startle; or, may be quick, backward extension movements.
—“Atonic” seizures are also called “drop attacks”. It is as if someone momentarily cut the string to a marionette puppet.
—“Partial seizures” begin locally in one hemisphere of the brain. They may consist of virtually any task of which the brain is capable—such as jerking of just one extremity, abnormal sensation of one part of the body, seeing spots, a feeling of fear or déjà-vu. A “complex partial” seizure causes an alteration on the clarity of thinking during the spell. Partial seizures tend to have an aura, last for several minutes, and have a post-ictal state of confusion.
What to look for during a seizure?
You can help your doctors make an appropriate diagnosis by looking for the following:
—Was there an aura?
—Did the seizure start in just one part of the body and then spread?
—Were there stiffening (“tonic”) and/or later harsh jerking (“clonic”) movements?
—Were there smacking or licking of the lips, eyelid fluttering, picking, or fumbling hand movements?
—Was the person able to respond to any outside stimulus?
—Was there any color change or breathing problem?
—How long did the actual seizure last?
—Was there a “post-ictal” state?
—Was there headache, fever, neck pain, palpitations, or light-headedness?
What to Do During a Seizure?
For better or worse, there is not much that an observer can do to alter the outcome of a seizure. That being said, there are a number of measures to help assure safe passage through the spell. Don’t worry. It’s mostly common sense, and is not that complicated. The following suggestions are adapted from The Epilepsy Foundation of America:
—Stay calm!
—Provide safety from physical injury.
o Try to soften the fall.
o Cradle the person’s head with your hands, a towel, etc.
o Clear the area around the person of sharp objects.
o Do not try to physically stop the movements.
—Protect the airway.
o Loosen tight clothes around the neck.
o Turn the person on his/her side (if possible) to prevent choking on fluids or food in the mouth.
o DO NOT PLACE ANYTHING IN THEIR MOUTH.
—Do not attempt mouth-to-mouth or cardio-pulmonary resuscitation (CPR) except in the unlikely chance that breathing does not resume when the seizure stops. Failure to spontaneously resume effective breathing after a seizure indicates a complication such as choking, head or neck injury, or a heart attack. CPR will not effectively get air into the person’s lungs while they are still in an active tonic-clonic seizure.
–Stay with the person until the seizure stops. Be sure the person can get to a safe destination. Be aware that some types of seizure may cause the patient to be physically unpredictable.
–Call for medical assistance if:
o the seizure lasts more than 5 minutes.
o the seizure recurs.
o there is slow recovery or breathing problems afterwards.
o there is no way to know that there is a previous history of seizures (i.e., if there is no Medical Alert ID tag or anyone who knows about the person’s seizures).
o the patient is pregnant, has another medical problem, or is injured.
As always, each situation has to be individualized, and common sense should be used.
Should any restrictions be placed on a child with seizures?
Restrictions placed on a child with seizures need to be individualized, taking into account the status of the child’s seizure control. Areas to be discussed with your doctor include biking, driving, activities in or near water, and climbing.
Treatment
Fortunately, most children with seizures will either never have another seizure, or, can be well controlled with medications such as phenobarbital, Trileptal, or Depakote. For most of the 2,500,000 people with seizures in this country, the seizures do not define the person’s life.
MARTIN L. KUTSCHER, MD is a pediatric neurologist in White Plains, and author of ‘Children with Seizures: A Guide for Parents, Teachers, and other Professionals’ (Jessica Kingsley Publishers, 2006). More information can be found at www.PediatricNeurology.com or by calling (914) 997-1692. This information does not constitute medical advice.
