Seizures and Seizure Control

Not all individuals with Cerebral Palsy have seizures, but for many, these seizures are a fact of life. Today, medications and treatments can potentially limit the number and severity of seizures, but parents will always need to know how to recognize when one is occurring, and be prepared to act when one begins.

Understanding seizures
and how to control them

The word “seizure” sometimes conjures up frightening thoughts and images, especially when it involves a child.

There are medications and other treatments to control the frequency, and ongoing research that may someday prevent them. Unfortunately, children with Cerebral Palsy, especially those with severe forms, are at risk.

Statistics from the National Institute of Neurological Disorders and Stroke, Cerebral Palsy: Hope Through Research, report that as many as half of all children with Cerebral Palsy have one or more seizures, primarily because they have epilepsy.

There are many types of seizures that have a host of different symptoms, but all seizures have one thing in common: if not addressed promptly and properly, they can be life-threatening.

What is a seizure?

A seizure is a term that applies to a sudden or unexpected malfunction in the brain that causes the body to lose consciousness, convulse or seize. The disturbance that leads to a seizure can be the result of a temporary disturbance in an uninjured brain, or it can be the result of misfires in the brain caused by a medical condition, external factor or by existing brain damage.

Neurons throughout the brain transmit electrical information that inform activity. When electrical information, or impulses, misfire, or are misinterpreted, a seizure can occur. These interfere with the core functions of the human body, turning a seizure into a dangerous medical situation.

Some of the most common triggers of seizures are:

• Brain damage
• Drug reactions
• Electrolyte imbalance
• Fever
• Genetic malformations of the brain
• Head injury
• Holding breath (in children)
• Infection
• Lead poisoning
• Low blood sugar
• Tumors

Although seizures are most commonly identified with epilepsy, the occurrence of seizures is not limited to individuals with epilepsy. Anyone can have a seizure at any time – adult or infant, healthy or unhealthy – if the conditions are favorable. In some cases, doctors are unable to identify a specific cause, which makes treatment difficult.

Seizures are broken into two categories:

• Generalized seizures
• Partial seizures

When a child has Cerebral Palsy, he or she is likely to have one or both of these types during a lifetime. Generalized seizures involve electrical impulses throughout the entire brain; partial seizures involve only one side of the brain.

Generalized seizures

Generalized seizures have been further broken down into several categories, each of which has different symptoms that affect a child in a variety of ways. Generalized incidents are generally more serious than partial seizures.

The types of generalized seizures are:

Tonic-clonic seizures, or grand mal seizures

Tonic-clonic are the most common type of generalized seizures and the most severe of all seizures. Symptoms include unconsciousness, convulsions and body rigidity. Violent shaking and loud noises are common symptoms. Prior to a tonic-clonic seizure, an individual may have smell, sensory, taste or vision change. Dizziness and hallucinations can also occur.

During the tonic seizure phase, a person will appear to be stiff. The eyes roll, arms will extend, chest/arm/leg muscles will contract, the back will arch, and breathing may decrease or cease. He or she will have loss of consciousness with lips and face appearing blue.

The clonic seizure phase includes convulsions, muscle spasms and jerks. Limbs may shake or flex rapidly. Other symptoms include incontinence, and biting of the cheek or tongue. As the spasms gradually subside, the individual may sigh before breathing resumes. It may take a few minutes for the brain to bring the seizure under control.

As the person resumes consciousness, he or she may have a headache and body weakness and feel tired, drowsy, confused and lethargic. Regurgitation is likely. Full recovery can take a few minutes or an hour.

For those who convulse for more than five minutes, experience a second seizure shortly after the first, or are pregnant, injured or diabetic, immediate medical attention is recommended. Individuals that do not resume breathing after a tonic-clonic seizure may have complications such as a blocked airway, heart attack or severe head or neck injury and may require cardiopulmonary resuscitation, or CPR, and emergency medical attention. To view a tonic-clonic seizure, visit My Tonic Clonic/Grand Mal Seizure or Toddler Tonic-Clonic Seizure

Petit mal seizures, or absence seizures

Symptoms include a very brief lapse in awareness – 20 seconds or less. The seizure is abrupt and sudden, often brought on by hyperventilation in more than 90% of those affected.

Petit mal seizures are characterized by a blank stare and a brief upward roll of the eyes or eyelids, sometimes myoclonic jerking of the eyelids or facial muscles. The upper body may slump with arms dropping and head falling to one side. The affected individual will likely seem unresponsive during the episode, but awake immediately after the episode. Symptoms that follow include slowed speech, transfixed state when walking or relaxed grip when using hands. Skin can appear pallor, flushed, sweaty, and pupils can be dilated. Some individuals experience incontinence.

Petit mal seizures usually begin between ages 4 and 14. The children who get them usually have normal development and intelligence. In approximately 70% of cases, children will outgrow absence seizures by 18 years old, especially if they had their first seizure before age 9. Often, petit mal seizures can occur multiple times per day; it’s not uncommon for a child to seize 50 to 100 times a day, or more, which can have an adverse impact on his or her ability to concentrate.

Petit mal seizures can lead to a restricted driver’s license in teens and require careful supervision when in and around water. Individuals experiencing petit mal seizures can also experience tonic-clonic seizures. Petit mal seizures should not be confused with complex partial seizures as they require differing drug therapy – the most effective drugs for complex partial seizures, for example, can increase the frequency of absence seizures if incorrectly diagnosed and treated.

To view an petit mal seizure, visit Atypical Absence Seizures – Eye Fluttering.

Myoclonic seizures

Myoclonic seizures include brief, involuntary, shock-like jerks to the arms, face, legs or torso muscles. It usually occurs without warning and resembles the reaction to an electrical shock. The episode lasts a second or two and causes an abnormal startle movement that often occurs on both sides of the body at the same time. Occasionally, only one side of the body, or one arm or foot is involved.

Consciousness is not lost when the rhythmic or random jerk pattern occurs. Jerks can occur as a singular event, in a sequence, in a pattern, or without a pattern. The jolt can be powerful enough to cause a child to fall to the ground. Myoclonic seizures can occur as a single seizure, or as a cluster of seizures.

Myclonic seizures are not considered life-threatening. In the most severe cases, they can cause serious and debilitating impairment. This type usually begins in childhood, but can also occur in adulthood. There are many different forms of myoclonic seizures that can be characterized by differing causes and effects and they respond to therapy in different ways. In children with juvenile myoclonic epilepsy, seizures primarily occur upon waking or when falling asleep.

To see a myoclonic seizure, visit Sixteen-month-old with myoclonic seizure.

Atonic seizures, also known as astatic seizures, akinetic seizures or drop attack seizures

Atonic seizures are indicated by limp muscles and temporary loss of muscle tone that lasts less than one minute. The head will drop, posture will be lost, and the body will suddenly, forcefully collapse. Children and adults who experience atonic seizures may opt to wear protective headgear to guard against head and face injuries caused by the abrupt seizure that has little to no advance warning. A child’s level of awareness may be altered. These seizures can occur several times a day.

To view an atonic seizure, visit Drop seizure.

Infantile spasms, or West Syndrome

Infantile spasms cause babies to experience a cluster of quick and sudden movements. The head falls forward and the arms flex when sitting, or when a baby positioned in a lying position appears to double up and jerk forward as if reaching for support. Infantile spasms occur when a child is between three months to two-years-old. Children with infantile spasms may also have developmental delay and develop other forms of epilepsy later in life.

To view an infantile spasm, visit Six-month-old with infantile spasms.

Partial seizures

Partial seizures are not as dangerous as generalized seizures because they only involve one cerebral hemisphere. Unfortunately, this type can serve as a gateway to severe, generalized seizures.

Typically, partial seizures don’t last long, end naturally, and can’t be stopped. They produce vague, unorganized behavior. This is the most common type for individuals with epilepsy, and comes with a myriad of emotions, movements and sensory symptoms, including complex visual or auditory hallucinations.

The physical, emotional, or sensory impact of a partial seizure depends on the location of the brain damage. If the damage is in the temporal lobe, it can alter a child’s thoughts and perceptions. If located in the primary motor cortex of the cerebral cortex, it can cause unintended body movements.

Partial seizures are broken down into two categories:

• Simple partial seizures start in the temporal lobe, altering a child’s level of awareness. Typically, during a simple partial seizure, a child will remain conscious and will be able to communicate in a rudimentary way during the seizure. A person will not remember the seizure, but will report unusual sensations and feelings of happiness or sadness. To view a simple partial seizure, visit Baby with a simple partial seizure.
• Complex partial seizures include visual miscues that may impair a child’s knowledge of space and how it relates to his or her body. Objects may seem closre or farther apart than they are. physical symptoms may include compulsive chewing and repetitive movements in the limbs. Consciousness during this type of seizure can be impaired or lost. To view a simple partial seizure, visit Complex partial seizure.

Children may also have mixed seizures, which means they have both generalized and partial events. Also, a person may experience many different types of generalized seizures; the type of seizure and the effects on a child’s body are heavily dependent on the signals sent by the brain and the nature of the Cerebral Palsy.

Children with Cerebral Palsy have some brain injury that typically occurs during the birthing process or in utero. The damage sometimes creates a situation where abnormal brain impulses occur; the existence of these impulses can affect a child with Cerebral Palsy in any number of ways, seizures being only one of them.

A child who has severe brain injuries or severe damage in specific locations of the brain is at a higher risk for seizures. Also, if a child had a stroke as a result of his or her condition, the likelihood that he or she will have seizures increases. Children with Cerebral Palsy are also more likely to develop epilepsy – another causal factor of seizures.

It is common for children with Cerebral Palsy to have seizures in infancy, but it is sometimes difficult for new parents to detect because babies often make unexpected movements. With the help of a physician, a parent can learn to recognize these telltale signs in his or her child.

What are the signs that a seizure is taking place?

The first signs that a person is having a seizure may not be apparent. With a proper diagnosis and education, parents become more adept at knowing when a seizure is about to occur. Subtle symptoms could include repetitive eye-blinking, lip-smacking or prolonged staring or concentration. More obvious signs occur as the seizure progresses – convulsive movements, stiffening of the body, or spasmodic movement of body and limbs and/or unconsciousness.

Other signs that a seizure is about to occur:

• An aura, an unusual taste or a feeling or sound experienced by a child
• Change in perception of surroundings
• Hyperventilation
• Sudden changes in demeanor or personality
• Visual changes such as flashes of light

During the seizure, look for these symptoms:

• Biting
• Confusion
• Difficulty speaking
• Drooling
• Eye activity, such as staring and blinking
• Inability to sit or stand
• Increased heart rate, pulse
• Loss of bladder or bowel control
• Loss of consciousness
• Shaking or twitching
• Spasticity of the body
• Stiffening of the body
• Tremors
• Verbal cues like screaming or making noises

After a seizure, a parent should prepare for lingering symptoms, including:

• Depression or shame
• Difficulty speaking or communicating
• Exhaustion
• Headache or migraine
• Muscle weakness
• Pain
• Physical injuries such as bruises or cuts
• Stomach discomfort or nausea
• Thirst

Observing a child’s seizures can provide important clues in diagnosing the type or types of seizures, and prescribing treatment. Parents can help by giving the following information to their medical provider.

• How long do the seizures last?
• Is the entire body involved?
• If not, what parts of the body are affected? (i.e., arms, legs, one side of body)
• What symptoms is the child experiencing before, during and after the seizures?

What risks are associated with seizures?

There has been little research into the risks involved with seizures connected to children with Cerebral Palsy. It’s important to get a proper diagnosis to determine the risk for that particular type of seizure. Related concerns include injury during the seizure, such as falling down or hitting the head. There are also social and emotional ramifications.

The DO’S of managing a child’s seizures:

• Create a plan to check the child at regular intervals, especially while they are sleeping. A baby monitor will help as well.
• Provide a balanced and healthy diet. Studies indicate that diseases such as high blood pressure can trigger seizures.
• Eliminate the child’s stress triggers – loud noises, barking dogs, fighting siblings.
• Stay calm. Unfortunately, once a seizure has started, it cannot and should not be stopped.
• Know what to expect. Being aware allows you to alter the environment so the child isn’t physically harmed during the seizure, for example, falling and/or hitting his head on a hard surface.
• Place the child in a sitting position or upright position.
• Place the child on a protective surface.
• If the child is an infant, lie him or her down.
• If a child vomits, move him or her onto her side.
• Keep unsafe objects are out of reach.
• Support the child’s head with a soft object.
• Make sure the child is breathing.
• Loosen tight-fitting clothing.
• Comfort the child when a seizure has ended.

The DON’TS of managing a child’s seizures:

• Don’t put objects such as a tongue depressor in a child’s mouth
• Don’t restrain the child from physical movement
• Don’t allow the child to handle objects
• Don’t give the child food or liquids
• Don’t dress the child in restrictive clothing

Get immediate medical attention if one or more of the following occur:

• If the child has never had a seizure previously
• If the child ‘s skin changes color
• If the child ceases breathing
• If the child’s airway is obstructed
• If the seizure lasts for more than 10-15 minutes
• If the child has seizures in rapid succession
• If the child has sustained an injury

Children generally have no memory of having a seizure. However, they often feel tired, confused and in need of rest.

What new therapies and treatments are available?

There are presently no specific treatments or therapies for people who have seizures, although there are some medical interventions that have been shown to curb the frequency and severity. These remedies include medications, dietary controls, therapies and, as a last resort, surgery. Protocol depends on a child’s specific needs as well as his or her overall health.

The most common treatment available is anticonvulsant drugs. These medications include mood stabilizers, especially helpful to people that experience emotional difficulties as a result of seizures.

Other drugs have also proven effective in reducing the number of seizures a person endures. Not surprising, each medication has side effects that could include physical symptoms or behavioral changes. All children on medication must be closely monitored by a pediatrician or a neurologist to make sure that treatments are appropriate or beneficial.

One dietary treatment that is recommended by some physicians is called a Ketogenic diet, which is high in fat and low in protein and carbohydrates. It is believed that the diet modifies a person’s metabolism by increasing ketone bodies, which can help limit seizures. However, the diet also has a tendency to increase a person’s cholesterol levels.

When seizures cannot be controlled by medications or a diet, doctors may suggest surgery. Surgeons can implant a nerve stimulation device that electronically stimulates the vagus nerve to control seizures. The vagus nerve controls electrical activity between the brain and the body’s internal organs, which can reduce seizure frequency.

In the most extreme cases, surgeons can remove the right frontal lobe of the brain, which is responsible for attention span and executive function. After this surgery, children may experience a slower rate of learning. It is an intervention that is generally considered only when other less-invasive treatments and therapies have proven to be unsuccessful.