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Condition/Treatment

Seizures


Overview
What is a seizure?
What are the different types of seizures?
What causes a seizure?
What are the symptoms of a seizure?
How are seizures diagnosed?

Treatment
Treatment options
Medications
Vagus nerve stimulation (VNS)

Ketogenic Diet
ketogenic>What is a ketogenic diet?
What does the diet consist of?
How long is the diet used?


What is a seizure?
The brain is the center that controls and regulates all voluntary and involuntary responses in the body. It consists of nerve cells that normally communicate with each other through electrical activity.

A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function.

What are the different types of seizures?
There are several different types of seizures in children, including the following:
  • Partial seizures
    Partial seizures take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. In about one-third of children with partial seizures, the child may experience an aura before the seizure occurs. An aura is a strange feeling, either consisting of visual changes, hearing abnormalities or changes in the sense of smell. Two types of partial seizures include:
    • Simple partial seizures
      The seizures typically last less than one minute. The child may show different symptoms depending upon which area of the brain is involved. If the abnormal electrical brain function is in the occipital lobe (the back part of the brain that is involved with vision), the child's sight may be altered. The child's muscles are typically more commonly affected. The seizure activity is limited to an isolated muscle group, such as fingers or to larger muscles in the arms and legs. Consciousness is not lost in this type of seizure. The child may also experience sweating, nausea or become pale.
    • Complex partial seizures
      This type of seizure commonly occurs in the temporal lobe of the brain, the area of the brain that controls emotion and memory function. This seizure usually lasts between one to two minutes. Consciousness is usually lost during these seizures and a variety of behaviors can occur in the child. These behaviors may range from gagging, lip smacking, running, screaming, crying, and/or laughing. When the child regains consciousness, the child may complain of being tired or sleepy after the seizure. This is called the postictal period.
  • Generalized seizures
    Generalized seizures involve both sides of the brain. There is loss of consciousness and a postictal state after the seizure occurs. Types of generalized seizures include:
    • Absence seizures (formerly known as petit mal seizures)
      These seizures are characterized by an altered state of consciousness and staring episodes. Typically the child's posture is maintained during the seizure. The mouth or face may move or the eyes may blink. The seizure usually lasts no longer than 30 seconds. When the seizure is over, the child may not recall what just occurred and may go on with his/her activities, acting as though nothing happened. These seizures may occur several times a day. This type of seizure is sometimes mistaken for a learning problem or behavioral problem. Absence seizures are uncommon before the age of 5 and occur more often in girls.
    • Atonic
      With atonic seizures, there is a sudden loss of muscle tone and the child may fall from a standing position or suddenly drop his/her head. During the seizure, the child is limp and unresponsive.
    • Generalized tonic-clonic seizures (GTC or formerly known as grand mal seizures)
      This seizure is characterized by five distinct phases that occur in the child. The body, arms and legs will flex (contract), extend (straighten out), tremor (shake), a clonic period (contraction and relaxation of the muscles), followed by the postictal period. During the postictal period, the child may be sleepy, have problems with vision or speech, and may have a bad headache, fatigue or body aches.
    • Myoclonic seizures
      This type of seizure refers to quick movements or sudden jerking of a group of muscles. These seizures tend to occur in clusters, meaning that they may occur several times a day, or for several days in a row.
    • Infantile spasms
      This rare type of seizure disorder occurs in infants from before six months of age. There is a high occurrence rate of this seizure when the child is awakening, or when they are trying to go to sleep. The infant usually has brief periods of movement of the neck, trunk or legs that lasts 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.
    • Febrile seizures
      This type of seizure is associated with fever. These seizures are more commonly seen in children between 6 months and 6 years of age and there may be a family history of this type of seizure. Febrile seizures that last less than 15 minutes are called simple, and typically do not have long-term neurological effects. Seizures lasting more than 15 minutes are called complex and there may be long-term neurological changes in the child.
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What causes a seizure?
A child may experience one or many seizures. While the exact cause of the seizure may not be known, the more common seizures are caused by the following:
  • Newborns and infants:
    • Birth trauma
    • Congenital (present at birth) problems
    • Fever Metabolic or chemical imbalances in the body
  • Children, adolescents and young adults:
    • Alcohol or drugs
    • Trauma to the head
    • Infection
    • Unknown reasons
  • Other possible causes of seizures may include:
    • Brain tumor
    • Neurological problems
    • Drug withdrawal
    • Medications
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What are the symptoms of a seizure?
The child may have varying degrees of symptoms depending upon the type of seizure. The following are general symptoms of a seizure or warning signs that your child may be experiencing seizures. Symptoms or warning signs may include:
  • Staring
  • Jerking movements of the arms and legs
  • Stiffening of the body
  • Loss of consciousness
  • Breathing problems or breathing stops
  • Loss of bowel or bladder control
  • Falling suddenly for no apparent reason
  • Not responding to noise or words for brief periods
  • Appearing confused or in a haze
  • Sleepiness and irritable upon waking in the morning
  • Nodding the head
  • Periods of rapid eye blinking and staring
During the seizure, the child's lips may become bluish and breathing may not be normal. The movements are often followed by a period of sleep or disorientation.

The symptoms of a seizure may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

How are seizures diagnosed?
The full extent of the seizure may not be completely understood immediately after onset of symptoms, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a seizure is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the child and family and asks when the seizures occurred. Seizures may be due to neurological problems and require further medical follow up.

Diagnostic tests may include:
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Treatment

Your child’s physician determines specific treatment for a seizure based on:
  • Your child's age, overall health and medical history
  • Extent of the condition
  • Type of seizure
  • Your child's tolerance for specific medications, procedures or therapies
  • Expectations for the course of the condition
  • Your opinion or preference
The goal of seizure management is to control, stop or decrease the frequency of the seizures without interfering with the child's normal growth and development. The major goals of seizure management include:
  • Proper identification of the type of seizure
  • Using medication specific to the type of seizure
  • Using the least amount of medication to achieve adequate control
  • Maintaining good medicating levels
Treatment may include:
  • Medications
    There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, age of the child, side effects, cost of the medication, and the adherence with the use of the medication.

    Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles, or syrup) but some can be given rectally (into the child's rectum). If the child is in the hospital with seizures, medication by injection or intravenous (IV) may be used.

    It is important to give your child his/her medication on time and as prescribed by your child's physician. Different people use up the medication in their body differently, so adjustments (schedule and dosage) may need to be made for good control of seizures.

    All medications can have side effects, although some children may not experience side effects. Discuss your child's medication side effects with his/her physician.

    While your child is taking medications, different tests may be done to monitor the effectiveness of the medication. These tests may include the following:
    • Blood work-frequent blood work is usually required to check the level of the medication in the body. Based on this level, the physician may increase or decrease the dose of the medication. Blood work may also be done to monitor the affects of medications on organs.
    • Urine tests-these tests are performed to see how the child's body is responding to the medication.
    • Electroencephalogram (EEG)
    • Ketogenic diet-certain children who are having problems with medications, or whose seizures are not being well controlled, may be placed on a special diet called the ketogenic diet. (Read below for more information on the Ketogenic Diet.)

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  • Vagus nerve stimulation (VNS)
    Some children, whose seizures are not being well-controlled with seizure medications, may benefit from a procedure called vagus nerve stimulation (VNS). VNS is used for children over the age of 12 who have partial seizures that are not controlled by other methods.

    VNS attempts to control seizures by sending small pulses of energy to the brain from the vagus nerve, which is a large nerve in the neck. This is done by surgically placing a small battery into the chest wall. Small wires are then attached to the battery and placed under the skin and around the vagus nerve. The battery is then programmed to send energy impulses every few minutes to the brain. When the child feels a seizure coming on, he/she may activate the impulses by holding a small magnet over the battery. In many people, this will help to stop the seizure.

    There are some side effects that may occur with the use of VNS. These may include, but are not limited to, the following:
    • Hoarseness
    • Pain or discomfort in the throat
    • Change in voice

  • Surgery
    Another treatment option for seizures is surgery. Surgery may be considered in a child who has:
    • Seizures that are unable to be controlled with medications
    • Seizures that always start in one area of the brain
    • Seizure in a part of the brain that can be removed without disrupting important behaviors such as speech, memory or vision
    Surgery for epilepsy and seizures is a very complicated surgery performed by a specialized surgical team. The operation may remove the part of the brain where the seizures are occurring, or the surgery helps to stop the spread of the bad electrical currents through the brain.

    A child may be awake during the surgery. The brain itself does not feel pain. With the child awake and able to follow commands, the surgeons are better able to make sure that important areas of the brain are not damaged.

    Surgery is not an option for everyone with seizures. Discuss this with your child's physician for more information.

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Ketogenic Diet

What is a ketogenic diet?
What does the diet consist of?
How long is the diet used?

What is a ketogenic diet?
The ketogenic diet is sometimes offered to children who continue to have seizures while on seizure medication. When medications do not work, a ketogenic diet may be considered. No one knows exactly how the diet works, but some children do become seizure-free when put on the diet. However, the diet does not work for everyone.

What does the diet consist of?
The ketogenic diet is very high in fat (about 90 percent of the calories come from fat). Protein is given in amounts to help promote growth. A very small amount of carbohydrate is included in the diet. This very high-fat, low-carbohydrate diet causes the body to make ketones. Ketones are made by the body from protein. They are made for energy when the body does not get enough carbohydrates for energy. If your child eats too many carbohydrates, then his/her body may not make ketones. The presence of ketones is important to the success of the diet.

High-fat foods:
  • Butter
  • Heavy cream
  • Oil
  • Mayonnaise
  • Cream cheese
  • Bacon
  • Cheese
High-carbohydrate foods:
  • Fruit and fruit juice
  • Breads and cereals
  • Vegetables (corn, peas, and potatoes)
  • Beans
  • Milk
  • Soda
  • Snack foods (chips, snack cakes, crackers)
  • Sweets
Your child's physician will determine if this diet is right for your child. When the ketogenic diet is started, your child will be admitted to the hospital. It may take four to five days in the hospital to get the diet started and for you to learn how to plan the diet.

While in the hospital, your child may not be able to eat for one to two days until ketones are measured in the urine. Once ketones are present in the urine, special high-fat, low-carbohydrate shakes may be started. These are sometimes called keto shakes. After several meals of keto shakes, your child will be started on solid foods.

You may also be taught how to check your child's urine for ketones. The dietitian will help determine how much fat, protein and carbohydrate your child is allowed to have, usually divided into three meals a day. The ketogenic diet can by very challenging to prepare and requires that all foods be weighed using a food scale. The ketogenic diet is not nutritionally balanced, therefore, vitamin and mineral supplements are needed.

Some medications and other products, such as toothpaste and mouthwash, contain carbohydrates. It is important to avoid these products if your child is on the ketogenic diet. Your child may not make ketones in their urine if too many carbohydrates are included in the diet. Your child's physician and dietitian can give you a list of medications, and other products, that are free of carbohydrates.

How long is the diet used?
Children usually stay on the diet about two years. The diet is then slowly changed back to a regular diet.

Sample ketogenic meal
Sample ketogenic shake
  • 60g heavy cream
  • 21g strawberries
  • 53g eggs
  • 10g cheddar cheese
  • 10g bacon
  • 21g butter
  • 500g Ross Carbohydrate-free Formula (concentrate)
  • 270g heavy cream
  • 13g Egg Beaters®

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    Seizures - Departments & Programs - Children's National Medical Center