Watching a child having his or her first seizure – brief glitch in brain activity - is frightening for a parent. There are a number of emotions and thoughts racing through their mind at that point and recording the event is not on top of their list. However, it is of utmost importance to remember that the first-time eyewitness account that you give is absolutely essential for the doctor to make an accurate diagnosis. A doctor will try and figure out whether the event was an epileptic seizure i.e. brain disorder or not. As a neurologist, I often recommend that parents video these events (using their mobile phone). Especially in children with recurrent seizures, video assessments are probably the most important investigative tool in the diagnosis of epilepsy.
In children, tonic-clonic seizures are the most common. These begin with mild irritability and unusual behaviour, followed by the body stiffening and contracting, followed by a variable period of jerking of one or more limbs.
The diagnosis of epilepsy in children is difficult and there is no one single test that can give a confirmatory result. On top of this, there are a number of different conditions that may mimic epileptic seizures. The two most common examples of the mimics of epileptic seizures are:
- Febrile seizures and
- Breath-holding spells.
However, a child grows out of these episodic conditions with age.
For a physician, it’s of paramount importance to identify the type of seizure.
Generalized seizures affect both sides of the brain. These include:
Absence seizures, sometimes called petit mal seizures, can cause rapid blinking or a few seconds of staring into space.
Tonic-clonic seizures, also called grand mal seizures
Focal seizures are located in just one area of the brain. These seizures are also called partial seizures.
Simple focal seizures affect a small part of the brain. These seizures can cause twitching or a change in sensation, such as a strange taste or smell.
Complex focal seizures can make a person with epilepsy confused or dazed. The person will be unable to respond to questions or direction for up to a few minutes.
Secondary generalized seizures begin in one part of the brain, but then spread to both sides of the brain. In other words, the person first has a focal seizure, followed by a generalized seizure.
Seizures may last as long as a few minutes.
Source: CDC, US
In children, tonic-clonic seizures are the most common. These begin with mild irritability and unusual behaviour, followed by the body stiffening and contracting, followed by a variable period of jerking of one or more limbs. The child may cry out as they lose their balance or fall unconscious. They may have irregular breathing patterns, appear pale, drool, bite their tongue and lose bladder control. These symptoms are by no means a rule and variations are common. After the seizure has ended, the child goes into a period of drowsiness, confusion and sleep.
Once the type of seizure has been identified, the main aim of the bystander should be to keep the child as safe as possible. This includes putting them in a recovery position after the seizure (on their left lateral side with their head tilted back slightly). This helps to prevent the tongue from falling backwards and blocking the airway and also helps in free drainage of saliva and any blood products from the mouth (avoiding any lung aspiration).
Put something soft and flat under the child's head (pillow, folded jacket or sweater)
Turn the child gently to one side to prevent choking
Loosen anything around the child's neck
Keep track of how long the seizure lasts
Stay calm and comfort the child afterward
But it’s even more important to know ‘what not to do’ when these events happen.
- Do not try and move them unless they are in a physical danger.
- Do not put anything in their mouth or restrain them.
- Do not lift them and hug them as this will cause more harm to them.
- Once you have provided the first aid, try to get medical help as early as possible. Your doctor will be able to provide you with information and training on providing appropriate first aid to your child. Sometimes, if your child has had history of prolonged seizure, your doctor will prescribe a rescue medication for you to use in case of any further prolonged seizures. You will be required to undergo a brief training session in order to administer this medication.
Parents have a number of questions once epilepsy is diagnosed. Parents are keen to find out the reason for their child’s epilepsy and they are also keen to know if this can be passed onto the next generation. Although we as paediatricians and neurologists are able to answer most of these questions, there are many uncertainties in the world of epilepsy. Your doctor may be able to provide some explanation with regards to the underlying mechanism of your child’s epilepsy, however, a number of times it remains unexplained. Parents often also wonder whether it is their fault. No it is not.
If the cause of epilepsy remains unknown, it is called idiopathic epilepsy. Around 60 per cent of children with epilepsy fall into this group. This means that there might be an underlying genetic cause, but we are not able to identify it due to the lack of understanding of the genetic basis of epilepsies. Over the last decade or so, with new genetic tests, we are now able to diagnose more of these conditions – but it is still a growing field. In other types of epilepsies, the cause may be related to bacterial infections such as meningitis or disorders caused by brain malformations, electrolyte disturbances and disorders of metabolism, or even damage to the brain. These are called symptomatic epilepsies.
A child’s first seizure is a horrifying event for any parent and to ask a parent not to panic in that situation is asking a lot. However, if they are aware of this condition, and are armed with first aid skills, it will make the situation a little bit more manageable.
- UAE-based Dr Arif Khan, Paediatric Neurologist and Founder of Neuropedia, Children's Neuroscience Center.