Children with seizures...a fact of life for 3% of them!

Seizures:

Three percent of children will have oneBy Mary Christine Bailey, MD, FAAP/ What’s Going Around?Friday, May 19, 2006A mother brings her 2-year-old son to the emergency room. His whole body was shaking and she says it lasted two to three minutes. He’s got a high fever and it’s determined he had a simple seizure caused by his high temperature - known as a febrile seizure.

What is a seizure?

Approximately three percent of children will have a seizure before they are 15 years old and half of these seizures will be a febrile seizure. This is the most common type of seizure in children. These seizures occur during an illness accompanied by a fever and affect approximately five percent of children. Generally, children who have a febrile seizure will have their first one by age 2 and 25 percent of children who have one will have more than one. Seizures happen when the electrical system in the brain fires abnormally.

There are many types of seizure disorders. Some involve the whole body and result in generalized convulsions or contraction of the muscles without convulsions. Others involve only one portion of the body. Sometimes this type can move from one portion of the body to another during the seizure.

Children can also experience absence seizures. In this type of seizure the child stares or blinks for a period of time and returns to normal when the seizure stops but has no memory of the episode. Another common type of seizure results in repetitive movements. The child is often confused and dazed when the activity stops. Epilepsy is the name given to seizure disorders that are recurring.

What should you do?

1. Check to make sure your child is breathing and call 911 immediately if they are not breathing or if you cannot tell.

2. Lie the child down away from anything that could hurt them.

3. Do not put anything into your child’s mouth.

4. Lay your child on his or her side after the seizure stops to prevent choking should they vomit.

5. Rectal Tylenol can be given for a fever.

6. Do not give your child anything by mouth until they are fully awake and acting normally again.

How is it treated?

All children who seize for the first time need medical evaluation. The type of testing required depends on the type of seizure the child experienced. For febrile seizures that last a short time and are generalized, blood testing for infection may be all that is needed. Other types of seizures often require a more extensive evaluation and may include: blood work, CT Scan and/or Magnetic Resonance Imaging (MRI) and often an electroencephalogram (EEG).

Many children who seize will only do so once, so the decision to start seizure medication will depend on the type of seizure and the findings during testing. The child’s pediatrician and a pediatric neurologist will work together to decide if a seizure medication is necessary.

In addition to consulting with a pediatrician, school-aged children diagnosed with epilepsy will need to have special instructions given to their teachers and the school nurse. Your pediatrician will help you develop a plan for the school should a seizure occur. Children with epilepsy are able to participate in sports and other normal activities, but keep in mind they should never swim without a fully trained lifeguard or responsible, knowledgeable adult present.

Is it hereditary?

Although some types of seizures are more common in certain families, for example children who have one or more first-degree relatives with a history of febrile seizures do have an increased incidence of febrile seizures during childhood, in general epilepsy is not an inherited problem. There is evidence that some people have a low seizure threshold, which can be passed onto their children. Epilepsy can also be a symptom of other inherited problems. In addition, certain types of epilepsy do seem to run in families.

These types include:

Temporal Lobe Epilepsy

Benign Rolandic Epilepsy

Juvenile Myoclonic Epilepsy

Since epilepsy and inheritance is such a complicated topic, you should discuss any concerns and questions with your child’s pediatrician. If they decide it is appropriate they may then refer your family to a genetic counselor.

Mary Christine Bailey, MD, FAAP, is Director of Pediatric Emergency Medicine at Newton-Wellesley Hospital. Board certified in pediatric emergency medicine, she has written for various medical textbooks. Dr. Bailey lives in Newton with her husband and is the mother of three grown sons.