Seizures

At Boston Children's Hospital, we believe that the more you know about your child's condition, the more in control and less anxious you'll feel. Below is some background on seizures that will help you understand this complex condition.

One of the most important ways that brain cells communicate is by transmitting electrical signals to each other. So the electrical firing of cells in the brain is a major part of how our bodies work and how we think and feel. A seizure happens when cells in the brain over-fire, temporarily disrupting the brain’s normal electrical signals.

Seizures can take a wide variety of forms, depending on things like what part of the brain has the abnormal electrical activity. Some seizures are easy to recognize, such as if your child’s body shakes and she temporarily loses consciousness. Other seizures are so mild that you might not even recognize them as seizures: They might involve only a visual hallucination, for example, or a moment of very strong emotions. In some cases, seizures have no outward signs at all.

Seizures are fairly common: About 5 percent of people in the United States experience at least one at some point in their lives. Our brains change dramatically from birth to adulthood, and seizure activity changes as we grow up, too.

• Children are more likely to experience seizures than adults.
• Newborns and young children have seizures most frequently. Their seizures are often caused by problems around the time of birth, including injuries during birth or infections.
• The types of seizures that children experience are different from those in adults. Visit Types to learn more about the types of seizures that children experience.

Many different diseases and injuries can cause children’s seizures. These include:

• head injuries
• birth trauma
• congenital conditions (conditions that your child is born with) such as brain development problems
• poisoning
• fever or infection
• brain tumors
• maternal illness during pregnancy
• heredity
• degenerative brain disorders
• stroke
• metabolic problems and chemical imbalances in the body
• alcohol or drugs
• medications

Often, however, the exact cause of seizures cannot be determined.

A child who has had multiple seizures may be considered to have epilepsy, a condition in which a person is more susceptible to having seizures.

Just as the types of seizures vary greatly, so do the effects that they may have on your child. Some are apparently harmless, whereas some can cause serious complications:

• Seizures sometimes produce side effects that remain even when your child isn’t actually having a seizure, such as dramatic changes in behavior and personality.
   
• Some seizures can also be associated with long-term neurological conditions and problems with learning and behavior.
   
• In addition, some children may fall or get injured during a seizure, and the episode can leave your child exhausted. Seizures may also cause your child to feel embarrassed or isolated from her friends.

Neurologists and other specialists work to identify these sorts of problems and intervene to help your child both physically and emotionally.

Types

Children experience many different types of seizures. They include:

• Focal seizures (also called partial seizures) happen when abnormal electrical activity occurs in one or more spots in the brain, all of which are on one side (“hemisphere”) of the brain. With focal seizures, your child may experience an aura—a strange feeling that involves changes in hearing, vision or sense of smell—before the seizure. Two types of focal seizures are:
  • Simple focal seizures involve different symptoms depending on which area of the brain has the abnormal activity. They usually affect the muscles, which can cause your child to have a variety of abnormal movements.
    • The seizure activity is limited to one muscle group, such as the fingers or the larger muscles in the arms and legs.
    • Your child does not lose consciousness with this type of seizure.
    • Your child may also experience sweating or nausea or become pale.
    • If the abnormal activity is in the occipital lobe (the back part of the brain that is involved in vision), your child may experience changes in vision.
    • These seizures usually last less than a minute.
  • Complex focal seizures may occur in any lobe of the brain.
    • Your child can experience a variety of behaviors, such as gagging, lip smacking, running, screaming, crying or laughing.
    • Children usually lose consciousness during these seizures.
    • After the seizure, your child may feel tired. This is called the postictal period.
    • These seizures usually last one to two minutes.
       
• Generalized seizures involve both sides of the brain. Children lose consciousness during these seizures and have a postictal period after the seizure. The types of generalized seizures include:
  • Absence seizures (also called petit mal seizures) involve episodes of staring and an altered state of consciousness.
    • Your child’s posture usually is not affected. Her mouth or face may move or her eyes may blink.
    • These seizures usually don’t last longer than 30 seconds.
    • After an absence seizure, your child may not recall the seizure and may go on with her activities as if nothing happened.
    • These seizures may happen several times a day.
    • They almost always start between ages 4 and 12.
    • Absence seizures are sometimes mistaken for a learning or behavioral problem. 
  • Atonic seizures (which may cause drop attacks) involve a sudden loss of muscle tone. Your child may fall from a standing position or suddenly drop her head. During the seizure, your child is limp and unresponsive.
  • Tonic seizures involve a sudden stiffening of parts of the body or of the entire body. Brief tonic seizures may also cause drop attacks.
  • Generalized tonic-clonic seizures (also called GTC or grand mal seizures) are characterized by five distinct phases:
    • flexing in your child’s body, arms and legs
    • a straightening out of her body
    • tremors (shakes)
    • contracting and relaxing of the muscles (the clonic period)
    • a period in which your child may be tired and sleepy, have problems with vision or speech or have a bad headache or body aches (the postictal period)
  • Myoclonic seizures involve sudden jerking in a group of muscles. These seizures tend to occur in clusters, meaning that they may happen several times a day or for several days in a row.
    • Infantile spasms are a rare type of seizure disorder that occurs in infants from 3 months to 12 months old.
      • Infantile spasms usually involve brief periods of movement in the neck, trunk or legs. They often happen when a child is waking up or trying to go to sleep. They usually last for a few seconds.
      • Infants may have hundreds of these seizures a day. This can be a serious problem and can have long-term complications.
      • Spasms may also occur later throughout life, and they can also cause drop attacks.
         
• Status epilepticus is a situation in which seizures develop into one non-stop seizure. This condition is a medical emergency; if this happens to your child, she needs to be hospitalized.
   
• Febrile seizures involve contractions in your child’s muscles—either mild (such as stiffening of your child’s limbs) or severe (convulsions). They are triggered by fever.
  • These seizures are fairly common: About 2 to 5 percent of children in the United States experience a febrile seizure. These seizures usually happen in children between 6 months and 5 years of age. Children who have febrile seizures often have a family history of this type of seizure.
  • Febrile seizures that last less than 15 minutes are called “simple.”
  • Seizures that last more than 15 minutes are called “complex.”

Symptoms

A child may have a wide variety of symptoms depending of her type of seizures. Some signs that your child may be experiencing seizures include:

• staring
• jerking movements in the arms and legs
• stiffening of the body
• loss of consciousness
• breathing problems
• loss of bowel or bladder control
• falling suddenly for no apparent reason
• not responding to noise or words for short periods of time
• appearing confused or in a haze
• extreme sleepiness and irritability when waking up in the morning
• head nodding
• periods of rapid eye blinking and staring

The symptoms of a seizure may resemble other problems or medical conditions. See Tests to learn about how doctors evaluate suspected cases of seizures.

In an emergency

• If your child is having a seizure, it can be very frightening. The most important thing to do is to protect her from hurting herself. Here are some guidelines:
  • If your child is sitting or standing, gently ease her to the floor.
     
  • Keep your child’s head from falling backward. You can place a soft object under her head.
     
  • Turn your child on her side. Don’t let her turn over on her back. This will prevent your child from choking in case she vomits.
     
  • Move tables, chairs or other hard objects away so that your child won’t bump into them. (If you can’t move them, gently slide your child away from them.)
     
  • Loosen tight clothing.
     
  • Do not try to open your child’s mouth or place anything between her teeth. This could injure her gums or break her teeth.
     
  • Do not try to stop your child’s movement or try to “shake her out of it.”
     
  • Stay with your child until the seizure stops.

Contact your child’s doctor right away or call 911 for emergency help if:

• your child has trouble breathing or if her skin becomes blue
• the seizure lasts more than five minutes
• your child remains unresponsive for 30 minutes after the seizure

You will need to tell your child’s doctor what the seizure was like. Look for such things as:

• What time is it when the seizure starts? When does it stop? (Time the seizure with a watch, if possible.)
• Where did the seizures start? (hands, arms, legs, eyes)
• Did the seizure stay in that part of your child’s body or did it move to other areas?
• What type of movement did you see? (jerking, twitching, stiffness)
• Is there anything that you think might have triggered your child’s seizure?
• Did your child experience anything unusual before the seizure started?
• Has there been a change in how often your child’s seizures happen or in the type of seizure activity?

After the seizure:

• If your child has soiled her pants or vomited, help your child get cleaned up.
• Let your child rest. She may be very tired and sleep for a few hours.
• Your child may complain of a headache or soreness. Talk to your child’s doctor about what you can do for her if she’s feeling pain.
• If your child feels cold, keep her warm with a blanket or coat. Some seizures can be caused by fever, so it’s a good idea to check your child’s temperature (rectally). Contact your child’s doctor any time she has an unexplained fever.
• Write down your observations about your child’s seizure.

If this was your child’s first seizure, call her doctor.

• Your child’s doctor may evaluate your child or have you go to an emergency room.
• Ask your doctor how you can protect your child in case she has another seizure, and what you should do if she does have one. The guidelines on the What you can do at home tab of our Epilepsy page can also help.

FAQ

Q: What is a seizure?

A: Seizures happen when cells in the brain over-fire, disrupting the brain’s normal electrical signals. Seizures can take many different forms: Some are easy to recognize, such as if your child’s body shakes and she becomes temporarily less aware, whereas some seizures are invisible.

Q: How common are seizures?

A: They’re very common. About 5 percent of people experience at least one seizure at some point in their lives, generally during childhood.

Q: What is epilepsy?

A: Epilepsy is a condition that makes people more susceptible to having seizures. A child may have epilepsy if she has had two or more unprovoked seizures. There are many possible causes, such as head injuries, brain development disorders, infections or heredity. Usually, however, there is no detectable cause for a child’s epilepsy.

Q: Are seizures harmful?

A: They can be. Even small seizures can impact children’s brains. Some children may experience dramatic changes in their behavior and personality. Children can also get injured while they’re having a seizure, and seizures can make them feel very embarrassed. The goal of treatment is to minimize any potential impacts on your child from seizures and to help your child live seizure-free.

Q: What do I do if my child has a seizure?

A: There are many different types of seizures; it’s best to talk to your child’s doctor about the right way to respond if she has a seizure. Your doctor may also ask you to keep a record of when the seizure occurs and what your child’s specific symptoms are. For some guidelines about what to do when a child has a seizure, see In an emergency.

Q: Is there anything I can do at home to prevent my child’s seizures?

A: Your child may be able to help control her seizures through measures such as getting enough sleep and avoiding stress and flashing lights. Talk to your child’s neurologist about what may be helpful in your child’s case. The guidelines on the What you can do at home tab of our Epilepsy page may also be helpful.

Q: Will my child’s seizures affect her behavior or school performance?

A: They could. Seizures are sometimes associated with learning or behavior difficulties or other neurological or psychiatric issues. Talk with your child’s medical team about any difficulties she may be having.

Q: My child has to come to the hospital for an appointment, testing or a procedure. Should I talk to her about it ahead of time?

A: Yes. It’s important to talk with children—even young children—if you know a test or procedure is about to happen. Make sure your child gets the information that’s appropriate for her age and level of understanding.

To read more about talking to your child and getting ready to come to the hospital, go to The hospital experience on the Boston Children’s Hospital's For Patients and Families website. 

If you’re coming for an electroencephalogram (EEG), you and your child may also find it helpful to view this walkthrough of an EEG study together.

Questions to ask your doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s medical team and that you, in turn, understand their recommendations and any treatment options they may present to you.

If your child is having seizures, you probably already have a lot of questions on your mind. But at a medical appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need.

If your child is old enough, you may want to suggest that she write down what she wants to ask, too.

Some of the questions you may want to ask include:

• Is my child having seizures or some other condition?
• What could be causing my child’s seizures?
• Are the seizures harmful to my child?
• What kind of testing is my child going to need? What’s going to happen at the test?
• What can I do to protect my child in case she has a seizure again?
• What do I do if she does have a seizure?
• What are the treatment options?
• If medications are prescribed: How much should I give my child? How often?
• What is the long-term outlook for her condition?
• When does my child need to see you or another specialist again?

If you’ve been keeping notes about your child’s seizures, be sure to bring those with you to your appointment.