A seizure occurs when the brain functions abnormally, resulting in a change in movement, attention, or level of awareness.

Different types of seizures may occur in different parts of the brain and may be localized (affect only a part of the body) or widespread (affect the whole body). Seizures may occur for many reasons, especially in children. Seizures in newborns may be very different than seizures in toddlers, school-aged children, and adolescents. Seizures, especially in a child who has never had one, can be frightening to the parent or caregiver.

Seizures in Children Causes
 
Although seizures have many known causes, for 3 out of 4 children, the cause remains unknown. In many of these cases, there is some family history of seizures. The remaining causes include infections such as meningitis, developmental problems such as cerebral palsy, head trauma, and many other less common causes.
 
About one fourth of the children who are thought to have seizures are actually found to have some other disorder after a complete evaluation. These other disorders include fainting, breath-holding spells, night terrors, migraines, and psychiatric disturbances.

Seizures in Children Symptoms
 
Seizures in children have many different types of symptoms. A thorough description of the type of movements witnessed, as well as the child's level of alertness, can help the doctor determine what type of seizure your child has had.

• The most dramatic symptom is generalized convulsions. The child may undergo rhythmic jerking and muscle spasms, sometimes   with difficulty breathing and rolling eyes. The child is often sleepy and confused after the seizure and does not remember the seizure   afterward. This symptom group is common with grand mal (generalized) and febrile seizures.
• Children with absence seizures (petit mal) develop a loss of awareness with staring or blinking, which starts and stops quickly.   There are no convulsive movements. These children return to normal as soon as the seizure stops.
• Repetitive movements such as chewing, lip smacking, or clapping, followed by confusion are common in children suffering from a   type of seizure disorder known as complex partial seizures.
• Partial seizures usually affect only one group of muscles, which spasm and move convulsively. Spasms may move from group to  group. These are called march seizures. Children with this type of seizure may also behave strangely during the episode and may or  may not remember the seizure itself after it ends.

When to Seek Medical Care
 
All children who seize for the first time and many with a known seizure disorder should be evaluated by a doctor.

• Most children with first seizures should be evaluated in a hospital's emergency department. However, if the seizure lasted less than  2 minutes, if there were no repeated seizures, and if the child had no difficulty breathing, it may be possible to have the child  evaluated at the pediatrician's office.
• After the seizure has stopped and the child has returned to normal, contact your child's doctor for further advice. Your pediatrician  may recommend either an office or an emergency department visit. If you do not have a pediatrician or none is available, bring the  child to the emergency department. If you are worried about possible absence seizures, evaluation at the pediatrician's office is   appropriate.
• Caregivers of children with epilepsy should contact the child's pediatrician if there is something different about the type, duration, or   frequency of the seizure. The doctor may direct you to the office or to the emergency department.
• Take the child to the emergency department or call 911 if you are concerned that your child was injured during the seizure or if you   think that he or she may be in status epilepticus (seizures of any kind that do not stop).

Most children who have seized for the first time should be taken to the emergency department for an immediate evaluation.

• Any child with repeated or prolonged seizures, trouble breathing, or who has been significantly injured should go to the hospital by  ambulance.
• If the child has a history of seizures and there is something different about this one, such as duration of the seizure, part of body   moving, a long period of sleepiness, or any other concerns, the child should be seen in the emergency department.

Exams and Tests
 
For all children, a thorough interview and examination should occur. It is important for the caregiver to tell the doctor about the child's medical history, birth history, any recent illness, and any medications or chemicals that the child could have been exposed to. Additionally, the doctor asks for a description of the event, specifically to include where it occurred, how long any abnormal movements lasted, and the period of sleepiness afterward. A wide variety of tests can be performed on a child who is thought to have seizures. This testing depends on the child's age and suspected type of seizures.

• Febrile seizures
  • Children should receive medication for the fever such as acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil).
  • Depending on the age of the child, the doctor may order blood or urine tests or both, looking for the source of the fever.
  • If the child has had his or her first febrile seizure, then the doctor may want to perform a lumbar puncture (spinal tap) to test for  possible meningitis. The lumbar puncture should be performed in children younger than 6 months, and some doctors perform  them in children as old as 18 months.
  • Most children do not get a CT scan of the head, unless there was something unusual about the febrile seizures, such as the  child not returning to his or her normal self shortly afterward.
  • Very few children with febrile seizures are admitted to the hospital. The treatment for febrile seizures is keeping the temperature   down, and possibly a medication if a specific infection is found such as an ear infection. Follow up with the child's doctor in a few   days.
• Movement seizures
  • Movement seizures, which include partial seizures and generalized (grand mal) seizures, can be very dramatic. If the child is   having a seizure in the emergency department, he or she is given medications to stop the seizure.
  • If the child has returned to normal in the hospital, then the child will probably have a few tests performed. Blood is drawn to   check the child's sugar, sodium, and some other blood chemicals.
  • If the child is on antiseizure medications, then the medication's levels in the blood are checked (if possible).
  • Most children undergo a CT scan or MRI (studies looking at the structure of the brain), but this may be scheduled for several  days later rather than in the emergency department. In children, these imaging studies are usually normal but are performed to   look for unusual causes of seizure such as bleeding or tumor.
  • Most children eventually undergo an EEG, which is a study looking at the brain waves or electrical activity of the brain. An EEG is  almost never performed in the emergency department but is performed later.
  • The child will probably be admitted if he or she is very young, has another seizure, has abnormal physical examination findings   or lab test results, or if you live far from a hospital. Children in status epilepticus are admitted to an intensive care unit.
  • If the child is doing well, doesn't have recurring seizures, and has a normal physical examination findings and blood test results,  then the child will most likely be sent home to follow up with a pediatrician in a few days to continue the evaluation and arrange  other tests, such as the EEG.
• Absence seizures (petit mal)
  • These can be evaluated without going to an emergency department. Most likely, the doctor will only order an EEG. If the EEG tells   the doctor that the child is having absence seizures, then the child will most likely be placed on medications to control them.
• Neonatal seizures and infantile spasms
  • Seizures of this type occur in young children and are often associated with other problems such as mental retardation. Children  suspected of having these seizures may have multiple lab tests done in the emergency department. They would include blood  and urine samples, lumbar puncture, and possibly a CT scan of the head. These children are usually admitted to the hospital  and may even be referred to a pediatric specialty hospital. In the hospital, these children undergo several days of testing to look  for the many possible causes of the seizures.

Seizures in Children Treatment
 
Self-Care at Home
 
Your initial efforts should be directed first at protecting the child from additionally injuring himself or herself.

• Help the child to lie down.
• Remove glasses or other harmful objects in the area.
• Do not try to put anything in the child's mouth. In doing so, you may injure the child or yourself.
• Immediately check if the child is breathing. Call 911 to obtain medical assistance if the child is not breathing.
• After the seizure ends, place the child on one side and stay with the child until he or she is fully awake. Observe the child for  breathing. If he or she is not breathing within 1 minute after the seizure stops, then start mouth-to-mouth rescue breathing (CPR). Do  not try to do rescue breathing for the child during a convulsive seizure, because you may injure the child or yourself.
• If the child has a fever, acetaminophen (such as Tylenol) may be given rectally.
• Do not try to give food, liquid, or medications by mouth to a child who has just had a seizure.
• Children with known epilepsy should also be prevented from further injury by moving away solid objects in the area of the child. If you   have discussed use of rectal medication (for example, Valium) with your child's doctor, give the child the correct dose.

Medical Treatment
 
Treatment of children with seizures is different than treatment for adults. Unless a specific cause is found, most children with first-time seizures will not be placed on medications.

• Important reasons for not starting medications
  • During the first visit, many doctors cannot be sure if the event was a seizure or something else.
  • Many seizure medications have side effects including damage to your child's liver or teeth.
  • Many children will have only one, or very few, seizures.
• If medications are started
  • The doctor will follow the drug levels, which require frequent blood tests, and will watch closely for side effects. Often, it takes   weeks to months to adjust the medications, and sometimes more than one medicine is needed.
  • If your child has status epilepticus, he or she will be treated very aggressively with antiseizure medications, admitted to the   intensive care unit, and possibly be placed on a breathing machine.

Next Steps
 
Prevention
 
Most seizures cannot be prevented. There are some exceptions, but these are very difficult to control, such as head trauma and infections during pregnancy.

• Children who are known to have febrile seizures should have their fevers well controlled when sick.
• The biggest impact caretakers can have is to prevent further injury if a seizure does occur.
• The child can participate in most activities just as other children do. Parents and other caretakers must be aware of added safety   measures, such as having an adult around if the child is swimming or participating in any other activities that could result in harm if   a seizure occurs.
• One common area for added caution is in the bathroom. Showers are preferred because they reduce the risk of drowning more than   baths.

Outlook
 
The prognosis for children with seizures depends on the type of seizures. Most children do well, are able to attend regular school, and have no limitations. The exceptions occur with children who have other developmental disorders such as cerebral palsy and in children with neonatal seizures and infantile spasms. It is important to talk with your child's doctor about what to expect with your child.

• Many children "outgrow" seizures as their brains mature. If several years pass without any seizures, doctors often stop the child's  medications and see if the child has outgrown the seizures.
• A seizure in general is not harmful unless an injury occurs or status epilepticus develops. Children who develop status epilepticus  have a 3-5% risk of dying from the prolonged seizure.
• Children with febrile seizures "outgrow" them, but they often have repeated seizures when they develop fevers while they are young.  Some children with febrile seizures go on to have epilepsy, but most doctors believe the epilepsy was not caused by the febrile  seizures