Introduction

Seizures in children are a neurological condition characterised by abnormal electrical activity in the brain, leading to temporary disruptions in normal brain function. It can cause changes in behaviour, movements, or consciousness. Seizures are relatively common in children, affecting approximately 4-10% of children before the age of 16.¹

Types of seizures

A seizure is a sudden, abnormal electrical disturbance in the brain that can cause temporary changes in behaviour, movements, or consciousness.² Seizures can vary in severity, duration, and symptoms, depending on the type and the area of the brain affected.

Types³

Generalised Seizures: Generalized seizures involve the entire brain and can cause loss of consciousness, muscle stiffening, and jerking movements.

Focal Seizures (Partial Seizures): Focal seizures originate in a specific brain area and can cause symptoms such as involuntary movements, sensory disturbances, or altered consciousness, depending on the affected brain region.

Absence Seizures: Absence seizures, also known as petit mal seizures, are characterised by brief episodes of staring or blank expression, often accompanied by subtle movements like eye blinking or lip-smacking.

Causes and risk factors

Common causes⁴

• Genetic Factors: Certain genetic conditions or inherited disorders can increase the risk of seizures in children
• Brain Injuries: Head trauma, stroke, or brain tumours can disrupt normal brain function and lead to seizures
• Infections: Infections such as meningitis, encephalitis, or certain viral illnesses can cause inflammation in the brain and trigger seizures
• Metabolic Imbalances: Imbalances in electrolytes, glucose levels, or other metabolic processes can contribute to seizure activity

Risk factors

• Family History of Seizures: Children with a family history of seizures or epilepsy have a higher risk of developing seizures
• Developmental Disorders: Conditions like autism, cerebral palsy, or intellectual disabilities can increase the risk of seizures
• Fever (Febrile Seizures): High fevers, especially in young children, can sometimes trigger febrile seizures

Symptoms of seizures

• Convulsions: Uncontrolled jerking or shaking movements of the body
• Staring Spells: Periods of blank staring or lack of awareness
• Loss of Consciousness: Temporary loss of consciousness or responsiveness
• Muscle Stiffness: Stiffening or rigidity of the muscles
• Uncontrollable Jerking Movements: Involuntary jerking or twitching of the limbs or body
• Symptoms Specific to Different Types of Seizures: The symptoms can vary depending on the type of seizure and the area of the brain affected

Diagnosis

The diagnosis of seizures in children typically involves a combination of the following:⁵

• Medical History and Physical Examination: A detailed medical history, including a description of the seizure event, family history, and any potential triggers or underlying conditions, is essential for diagnosis
• Electroencephalogram (EEG): An EEG is a test that measures and records the brain's electrical activity, helping to identify abnormal patterns associated with seizures
• Neuroimaging Tests: Imaging tests like magnetic resonance imaging (MRI) or computed tomography (CT) scans can help identify structural abnormalities or lesions in the brain that may be causing seizures
• Blood Tests: Blood tests can help rule out metabolic disorders, infections, or other underlying conditions that may cause seizures

Treatment options

Conventional treatments

• Antiepileptic Drugs (AEDs): These medications are the primary treatment for controlling and preventing seizures. Common AEDs include valproic acid, lamotrigine, and levetiracetam.Pros: Effective in controlling seizures, well-established safety profiles. Cons: Potential side effects, drug interactions, and long-term use may be required
• Ketogenic Diet: A high-fat, low-carbohydrate diet that can help control seizures, particularly in children with drug-resistant epilepsy.Pros: Can be effective when medications fail, with no significant side effects. Cons: Strict dietary restrictions, potential nutrient deficiencies, and may not be suitable for all children⁶
• Surgery: In some cases, surgical interventions like resective surgery (removing the brain area causing seizures) or neurostimulation devices may be considered for drug-resistant epilepsy.Pros: Can potentially cure or significantly reduce seizures. Cons: Invasive procedures with risks, are not suitable for all cases⁸
• Neurostimulation Therapies: Researchers are investigating the use of neurostimulation techniques, such as vagus nerve stimulation (VNS) and responsive neurostimulation (RNS), as alternative or adjunctive treatments for drug-resistant seizures in children⁷

 Alternative and complementary treatments

• Herbal Remedies: Some herbs, such as cannabis (CBD oil), have been studied for their potential anticonvulsant properties.⁹ Pros: Natural alternatives, may have fewer side effects. Cons: Limited scientific evidence, potential interactions with medications, and inconsistent quality and dosing
• Acupuncture: This traditional Chinese medicine practice involves inserting thin needles into specific points on the body and has been explored for seizure management.¹⁰ Pros: Non-invasive, few side effects. Cons: Limited scientific evidence, effectiveness may vary, and requires trained practitioners
• Stress Management and Relaxation Techniques: Practices like yoga, meditation, and deep breathing exercises may help reduce stress and anxiety, which can be seizure triggers.¹¹ Pros: Non-invasive, no side effects, and can improve overall well-being. Cons: May not directly treat the underlying cause of seizures, and effectiveness may vary

Management and care

Effective management and care for children with seizures involve:

• Day-to-Day Management: Ensuring medication adherence, making necessary lifestyle adjustments, and providing a safe and supportive environment
• Emergency Response: Knowing how to respond appropriately during a seizure, including first aid measures and when to seek emergency medical help
• Long-Term Care: Regular monitoring, adjusting treatment plans as needed, and addressing any associated developmental, behavioural, or educational challenges

Impact on daily life

Seizures in children can have a significant impact on various aspects of daily life, including:

• School and Learning: Seizures may affect a child's ability to concentrate, learn, and participate in educational activities
• Physical Activity and Sports: Certain precautions or restrictions may be necessary to ensure the child's safety during physical activities or sports
• Social Interaction and Support: Children with seizures may face social challenges or stigma, highlighting the importance of support systems and educational efforts
• Coping Strategies for Families: Families of children with seizures may benefit from counselling, support groups, and strategies to manage the emotional and practical challenges associated with the condition

Prognosis

The prognosis for children with seizures can vary depending on several factors, including:

• Cause and Type of Seizures: The underlying cause and specific type of seizure can influence the long-term outlook and potential for remission
• Age of Onset: Children who develop seizures at a younger age may have a higher likelihood of outgrowing them as they get older
• Response to Treatment: Children who respond well to medication or other treatments may have a more favourable prognosis

It is important to note that many children with seizures can lead fulfilling lives with proper management and support.

FAQ’s

What should I do if my child has a seizure? 

• Remain calm and ensure the child's safety by removing nearby objects that could cause injury.
• Do not restrain the child or put anything in their mouth
• Time the duration of the seizure and note any specific symptoms
• Seek emergency medical help if the seizure lasts more than 5 minutes or if the child has difficulty breathing or sustained injury

Can my child live a normal life with seizures?

With proper management and support, many children with seizures can lead fulfilling lives. However, certain precautions and accommodations may be necessary depending on the severity and frequency of seizures.

What are the risks and side effects of anti-seizure medications?

Common side effects of anti-seizure medications may include drowsiness, dizziness, nausea, and cognitive or behavioural changes. Regular monitoring and dosage adjustments may be required to reduce side effects. It is also important to seek medical advice from qualified healthcare professionals if you suspect your child may be experiencing seizures. With proper care and support, many children with seizures can lead fulfilling lives and reach their full potential.

Summary

Seizures in children are a complex neurological condition that requires a comprehensive understanding of the causes, symptoms, diagnosis, and treatment options. Early detection and appropriate management are crucial for improving the quality of life for affected children and their families. Ongoing research and advancements in the field aim to provide better treatment strategies and support for those living with seizures.