What happens inside your child's brain during a seizure? Here is a simplified explanation: Your brain is made up of billions of nerve cells called neurons, which communicate with one another through tiny electrical impulses. A seizure occurs when a large number of the cells send out an electrical charge at the same time. This abnormal and intense wave of electricity overwhelms the brain and results in a seizure, which can cause muscle spasms, a loss of consciousness, strange behavior, or other symptoms.
Anyone can have a seizure under certain circumstances. For instance, a fever, lack of oxygen, head trauma, or illness could bring on a seizure. People are diagnosed with epilepsy when they have seizures that occur more than once without such a specific cause. In most cases -- about seven out of 10 -- the cause of the seizures can't be identified. This type of seizure is called "idiopathic" or "cryptogenic," meaning that we don't know what causes them. The problem may be with an uncontrolled firing of neurons in the brain that triggers a seizure.
Genetic research is teaching doctors more and more about what causes different types of seizures. Traditionally, seizures have been categorized according to how they look from the outside and what the EEG (electroencephalogram) pattern looks like. The research into the genetics of seizures is helping experts discover the particular ways different types of seizures occur. Eventually, this may lead to tailored treatments for each type of seizure that causes epilepsy.
Diagnosing a Seizure in a Child
Diagnosing a seizure can be tricky. Seizures are over so quickly that your doctor probably will never see your child having one. The first thing a doctor needs to do is rule out other conditions, such as nonepileptic seizures. These may resemble seizures, but are often caused by other factors such as drops in blood sugar or pressure, changes in heart rhythm, or emotional stress.
Your description of the seizure is important to help your doctor with the diagnosis. You should also consider bringing the entire family into the doctor's office. The siblings of children with epilepsy, even very young kids, may notice things about the seizures that parents may not. Also, you may want to keep a video camera handy so that you can tape your child during a seizure. This may sound like an insensitive suggestion, but a video can help the doctor enormously in making an accurate diagnosis.
Some kinds of seizures, such as absence seizures, are especially difficult to catch because they may be mistaken for daydreaming.
"Nobody misses a grand mal (generalized tonic-clonic) seizure," says William R. Turk, MD, chief of the Neurology Division at the Nemours Children's Clinic in Jacksonville, Florida. "You can't help but notice when a person falls to the ground, shakes, and sleeps for three hours." But absence or staring seizures may go unnoticed for years.
Turk says you shouldn't worry if your child gazes open-mouthed at cartoons on TV, or stares out the window in the car. Most kids who appear to be daydreaming really are just daydreaming. Instead, watch for spells that come at inappropriate times, such as when your child is in the middle of speaking or doing something, and suddenly stops.
Other kinds of seizures, such as simple or complex partial seizures, can be mistaken for different conditions, such as migraines, psychological illness, or even drug or alcohol intoxication. Medical tests are an important part of diagnosing seizures. Your child's doctor will certainly do a physical exam and blood tests. The doctor may also order an EEG to check the electrical activity in the brain, or request a brain scan such as an MRI with a specific epilepsy protocol.
The Risks of Seizures in Children
Although they may look painful, seizures don't really cause pain. But they may be frightening for children and the people around them. Simple partial seizures, in which a child may have a sudden, overwhelming sense of terror, are especially frightening. One of the problems with complex partial seizures, for instance, is that people have no control of their actions. They may wind up doing inappropriate or bizarre things that upset people around them. It's also possible for children to injure themselves during a seizure if they fall to the ground or hit other things around them. But the seizures themselves are usually not harmful.
Experts don't fully understand the long-term effects of seizures on the brain. In the past, most scientists thought that seizures did not cause any damage to the brain, attributing brain damage in an individual to an underlying illness. Now, however, some doubts are beginning to emerge.
Solomon L. Moshe, MD, director of Clinical Neurophysiology and Child Neurology at the Albert Einstein College of Medicine in New York, is researching the subject and remains cautious. "I don't think it's good to say one way or another whether seizures do long-term damage," he says. "I think it all depends on the individual case."
Moshe notes that the brains of children are very flexible. They are perhaps the least likely people with epilepsy to suffer any brain damage from a seizure.
Dangerous Seizures in Kids
Although the majority of seizures aren't dangerous and don't require immediate medical attention, one kind does. Status epilepticus is a life-threatening condition in which a person has a prolonged seizure or one seizure after another without regaining consciousness in between them. Status epilepticus is more common among people with epilepsy, but about one-third of the people who develop the condition have never had a seizure before. The risks of status epilepticus increase the longer the seizure goes on, which is why you should always get emergency medical help if a seizure lasts more than five minutes.
You may also hear about a condition called Sudden Unexplained Death, in which a person dies for no known reason. It can happen to anyone, but it's more likely to happen in a person with epilepsy. The causes aren't known, but parents of children with epilepsy should know that it's a very rare occurrence. Controlling seizures, especially those that occur in sleep, is the most effective plan for helping to prevent this tragedy from occurring.