Seizures occur when the brain’s normal communication of electrical activity is interrupted. Seizures in children can occur for several reasons, and the first time they need to go to the emergency department for urgent assessment as to why they’ve had a fit. If no clear cause is found and they have two or more seizures, this is diagnosed as epilepsy.
Seizures can either be focal or generalised. Focal seizures are also called partial seizures and occur in one area or several areas on the same side of the brain. Auras sometimes occur before these seizures, as a warning that they are about to occur. Examples of auras include feelings like déjà vu, fear, or euphoria or sensations like changes to your vision, hearing or pins and needles. Focal seizures can either be simple or complex (causing unusual movements and behaviours). Generalised seizures, on the other hand, occur on both sides of the brain. Your child will lose consciousness and go through a very tired phase, called the post-ictal phase. Subtypes of generalised seizures include absence seizures, where there is no visible fitting or loss of consciousness, but your child stares into space and doesn’t respond to you, atonic seizures, where there is sudden loss of muscle tone causing a fall, generalised tonic-clonic seizures, what most people think of, the rigid and jerking movements of arms, body and leg, and myoclonic seizures, with sudden jerks of muscles.
In many cases the cause of a seizure is unknown. Certain head trauma can cause it, such as a brain injury at birth or later, in an accident, an infection such as meningitis, a fever in what is called a febrile convulsion, or rarely a stroke or a brain tumour. High and low blood sugars and recreational drug use can also cause seizure activity.
The symptoms depend on which area of the brain is affected and the type of seizure. Symptoms that should alert you to a possible seizure include: going stiff or rigid or jerking movements of the arms and legs, loss of consciousness, soiling themself with urine or faeces, a sudden unexpected fall or loss of muscle tone, confusion, staring absentmindedly, not responding for brief periods, and you may notice something subtle during this such as a twitching eye muscle. After a seizure, especially if they have lost consciousness, they may feel tired, sleepy or confused. It's unlikely they will remember anything about the fit, and they may wonder where they are and look quite dazed for half an hour or an hour afterwards. Seeing a seizure is traumatic for any bystander, let alone if it’s your own child. Try to stay calm, get help as needed, and the call operator will talk you through how to make sure they are positioned safely so they can’t choke and they don’t injure themselves. You may be given medications to bring a seizure to a close if your child has repeated seizures – it will get easier to deal with them as you get more confident.
If your child has had a seizure for the first time, you should attend the emergency department with urgency. If they are continuing to fit, you should call for an ambulance. Once in the emergency department, the doctor will ask about what led up the seizure – were they unwell, did they have a fever, were they watching something exciting with lots of flashing lights. The doctor will examine their nervous system and take their vital signs, like their temperature, heart rate and breathing rate. They may request a urine sample and blood tests, looking for any markers of infection, sugar levels. Depending on the suspected cause a sample of spinal fluid may be taken too. Your child will most likely be sent for a brain scan. A specialist called a neurologist may also recommend an investigation called an electroencephalogram or EEG, which looks at the electrical activity in the brain. The treatment of seizures depends on the cause. Treating any underlying cause is imperative, such as an infection in the brain like meningitis, or a brain tumour if that’s appropriate. Otherwise, managing symptoms by reducing seizure activity is how anti-epileptic medications work. They are taken daily to prevent seizures. You may be given medications to bring a seizure to a close, if your team think that’s best. You will have a management plan, and may not need to attend the emergency department every time if your child has ongoing epilepsy. Your child’s neurology team will keep a close eye on them, and be on hand for regular follow-ups. It's important to take heart that your child may grow out of seizures, such as with febrile convulsions and sometimes epilepsy. Treating any cause like infection may mean that they have no ongoing seizure problems.