Children's Hospital of Orange County

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Epilepsy and Seizures in Children

Seizures and epilepsy affect children at different ages and in different ways. For some, it will be a temporary problem, easily controlled with medication and outgrown within years. For others, it may be an ongoing challenge that affects many areas of life.

Very few children with one seizure will develop severe epilepsy; less than half will have a second seizure. Children who do have a second seizure (especially if no medication was started) are more likely to have a third seizure. When your child has two or more seizures, he or she is considered to have epilepsy.

With planning and preparation to help limit risks, most children with epilepsy can lead an active lifestyle.

What causes epilepsy?

There are many possible causes of epilepsy including tumors, strokes and brain damage from illness or injury. It can also be caused if the brain did not develop normally. This is called cortical dysplasia. Many times there seems to be no likely cause for epilepsy – in this case, the cause may be genetic, meaning it runs in the family. Sometimes the cause is not known.

What causes seizures?

The brain is the center that controls all responses in the body. The brain is made of nerve cells that talk with each other through electrical activity. A seizure occurs when there is abnormal activity in the brain and causes a sudden change in awareness, movement or behavior. Provoked seizures are caused by something that affects the brain for only a short time. Some examples are:

  • Fever
  • Low blood sugar
  • Brain infection or injury
  • Taking a poison or other toxin
  • Brain tumor

What types of seizures are there?

Seizures are put into two basic groups: partial and generalized. Partial seizures are limited to one part of the brain but can spread to other parts of the brain and cause generalized seizures. Generalized seizures involve both sides of the brain.

Types of Partial Seizures

Simple partial seizures: During this type of seizure, your child is awake and alert and does not lose consciousness. Your child may experience an aura, or strange feeling, consisting of changes in smell, vision or hearing. Not all children experience an aura. The seizures typically last less than one minute. Your child may experience different things depending upon which area of the brain is involved 

Complex partial seizures: This is the most common type of partial seizure. The seizure starts in one small part of the brain and then spreads to involve more parts of the brain. Your child may be awake but not alert. This means that your child cannot answer questions or may not make sense when talking. The seizures typically last one to two minutes and are characterized by repetitive activities such as lip smacking, running, screaming, crying, laughing, swallowing or talking without making sense. After regaining consciousness, your child may complain of being tired or sleepy.

Types of Generalized Seizures

Absence seizures (formerly called petit mal seizures): These seizures are characterized by a brief 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 10 seconds. When the seizure is over, the child may not recall what just occurred and may go on with his or 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, behavioral problem, or attention deficit disorder. Absence seizures typically start between ages 4 to 10 years. 

Atonic seizures (formerly called drop attacks): With atonic seizures, there is a sudden and brief loss of muscle tone and the child may fall from a standing position or suddenly drop his or her head. During the seizure, the child is limp and unresponsive. 

Generalized tonic-clonic seizures (formerly called grand mal seizures): The classic form of this kind of seizure, which may not occur in every case, is characterized by five distinct phases. The body, arms and legs will flex, extend and shake, followed by the child feeling sleepy, having problems with vision or speech, or having a headache, fatigue or body aches. Not all of these phases may be seen with every one of these seizures. Sometimes, partial complex seizures evolve to generalized tonic clonic seizures. 

Myoclonic seizures: This type of seizure refers to quick movements or sudden jerking of a group of muscles. These seizures can occur in isolation or in clusters, meaning that they may occur several times a day, or for several days in a row. 

Infantile spasms: This type of epilepsy typically occurs in infants between the ages of 4-8 months of age.  Infantile spasms often occur when the child is awakening from sleep, or when they are trying to go to sleep. The infant usually has brief movement of the neck, trunk or legs that lasts for a few seconds, occurring in clusters. Infants may have hundreds of these seizures a day. Infantile spasms are a very serious form of epilepsy and can have long-term complications. Early treatment is critical. Learn more about infantile spasms. 

Febrile seizures: This type of seizure is associated with fever and is not epilepsy, although a fever may trigger a seizure in a child who has epilepsy. These seizures are more commonly seen in children between 12 months and 5 years of age and there may be a family history. 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 or focal seizures are called complex febrile seizures.  There may be long-term neurological consequences in children with complex febrile seizures. They are also at higher risk to develop epilepsy.

How is epilepsy diagnosed?

Sometimes doctors do not know why a seizure happens. There are tests that can be done to help provide more information. Diagnostic tests may include:

EEG (electroencephalogram): This test records the brain’s continuous electrical activity by using electrodes (wires placed on your child’s head). Your doctor will order a specific EEG that will tell you more about you or your child’s seizures or condition. Learn more about having an EEG.

Long-term video EEG monitoring: Long-term video EEG recording may be used if a diagnosis is difficult or if epilepsy surgery is being considered. Learn more about long-term video EEG monitoring.

MRI: The MRI is a machine that uses large magnets and a special computer to take very clear pictures of your child’s brain. It can sometimes help identify the cause of the child’s epilepsy. Learn more about having an MRI.

Blood tests: These tests check for infections or other metabolic problems.

Lumbar puncture (spinal tap): A special needle is placed into the lower back into the spinal canal. A small amount of cerebral spinal fluid (CSF) is removed with the needle and sent for testing to look for infection or other disorders called inborn errors of metabolism. CSF is the fluid that bathes your child’s brain and spinal cord.

How is epilepsy treated?

The goal of epilepsy management is to completely control the seizures, thus allowing your child to grow and develop normally. Our main goals are to identify the type of seizure, find the right medicine for it, and use the smallest amount of medicine possible to completely control the seizures.

The medications used for epilepsy are called anti‐epileptic drugs, or AEDs. AEDs are used to help the brain fight off seizure activity. Your child will start taking one AED at a time. The amount of medicine will be increased slowly until the seizures are controlled. Most of the time only one AED is needed and few side effects occur. If the amount of medicine is too high, it can cause side effects. If one AED is not enough to control the seizures, the doctor can add another AED. The first AED may be continued or may be slowly decreased and then stopped. If medications do not control a child’s seizures, epilepsy surgery should be considered.

A comprehensive evaluation will help determine if surgery is appropriate for a patient – and the best surgical option for them. Learn more about epilepsy surgery. Some children with seizures may find the vagus nerve stimulator (VNS) helpful. Our epilepsy team was among the first to perform this less invasive surgical option that places a device in a patient’s chest – much like a pacemaker – that sends pulses to the brain to minimize seizures. Learn more about vagus nerve stimulation.

Certain children whose seizures are not being well-controlled, may be placed on a special diet called the ketogenic diet. This type of diet is low in carbohydrates and high in protein and fat. Learn more about the ketogenic diet.

What to Do When Your Child Has a Seizure

Because seizures can happen without warning, it’s best to have a plan in place so you’ll know what to do when an episode occurs.

  • Stay calm.
  • Do not try to stop the movements.
  • Clear the area around your child of any hard, sharp or hot objects. If walking around, gently lead your child away from hard, sharp or hot objects, doors or stairways.
  • If your child is lying down, pillows or blankets may be used to pad items that cannot be removed. An item that is flat and soft should be put beneath the head.
  • Do not try to put anything between your child’s teeth or in your child’s mouth (so they do not aspirate their secretions into their lungs).
  • For a tonic‐clonic seizure, gently roll your child onto one side until he/she is fully awake.
  • Stay with your child until the seizure is over and your child can answer questions such as “Who am I?” or “Where are you?”
  • Allow your child to rest if he or she is sleepy. Check on your child frequently.

Your child’s doctor may recommend a rectal form of medication called Diastat Acudial. This can be used at home to stop a seizure that lasts longer than five minutes or three seizures in one hour. If you do not have this prescription, ask your doctor if this would be helpful for your child.

Go to the emergency department or call 911 if:

  • The seizure lasts longer than 5 minutes and there is no Diastat available.
  • The seizure is followed by more seizures and your child does not wake up in between seizures.
  • Your child has trouble breathing, seems hurt or is in pain.
  • Your child’s color appears bluish or gray during or after the seizure.
  • Your child has diabetes or may be pregnant.
  • The seizure occurred in the water.

Please bring your child’s medication bottle and have the name of your child’s neurologist and clinic phone available for the emergency providers.

Call your child’s neurologist or doctor if:

  • Your child’s seizures have increased in frequency.
  • Your child has experienced a new type of seizure.
  • Your child has side effects from the AEDs.
  • Your child developed a rash after starting new AEDs.

Use the following list of questions to help record the seizure and share this information with your child’s neurologist.

1.    How did your child act before and after the seizure?
2.    Were there any warning signs that the seizure was starting?
3.    What happened during the seizure?
4.    Was one side or part of the body more affected?
5.    Did it start on one side of the body and affect the other side?
6.    Did the head or eyes turn to one side during the seizure?
7.    How long did the seizure last?
8.    How long did it take your child to return to normal?
9.    Was one side of the body weaker after the seizure?
10.  Did your child pee or poop during the seizure?

Illness in your child may cause a breakthrough seizure. A breakthrough seizure is a seizure that occurs in a child whose seizures had previously been well‐controlled. If your child is sick, please share this information with your neurologist because it may influence his or her decision to adjust your child’s AEDs.

Frequently Asked Questions about Epilepsy

    Can my child participate in sports if they have epilepsy?

    When your child’s epilepsy or seizures are under good control, regular physical activity is good for your child. However, your child should avoid sports that involve climbing to a high location or contact sports that may result in head injury, until your doctor has approved of these activities. Your child may swim once the doctor determines the seizures are under control, but he or she needs to always have adult supervision. Your child should never engage in any type of water sports without adult supervision and that includes wading in a small pool. The adult should be able to swim and have the strength to carry your child if the need arises. If there is a lifeguard on duty, inform the lifeguard that your child has epilepsy.

    Can my child play video games if they have epilepsy?

    For most children with epilepsy, playing a video game is not a problem. However, some children have seizures that are triggered by light. These are called photosensitive seizures. These seizures may be triggered by flashing lights such as when playing a video game, watching television or simply driving past trees on a sunny day.

    Can my child ride a bicycle, skateboard or roller blades if they have epilepsy?

    Yes. Once your child’s epilepsy or seizures are under control, your child can ride a bike or scooter, or go rollerblading, roller skating and skateboarding. Your child should always wear a helmet prevent serious head injury.

    What if my child has a seizure at school?

    We know that children with epilepsy might feel anxious about going to school. Our neuropsychologists will work one-on-one with your child, communicate with their school and develop special programs to transition them back to the classroom after a diagnosis. You may also want to meet with your child’s teacher, school nurse and coach to explain your child’s condition and the steps to take if your child has a seizure while under their watch. This education may need to occur at the beginning of every school year as your child is given new teachers.

    My child has not had a seizure in a long time. Can we stop taking medication?

    Never stop taking AED medication without talking to your doctor. More than half of children with epilepsy who have no seizures for two years can be tapered off their antiepileptic medication. If the AED is stopped and seizures start again, then medication is usually restarted. This relapse may indicate the need for long-term antiepileptic drug treatment.

    Can my child’s epilepsy go into remission?

    For some children, epilepsy is not permanent and with age it disappears. These children usually have at least one of the following:

    • Normal intelligence
    • Normal neurological exam
    • Few seizures when diagnosed
    • Age of first seizure is below 12 years of age

    My child had a fever that caused a seizure. Does she have epilepsy?

    Most likely, your child has had a febrile seizure. Febrile seizures are associated with fever and are not epilepsy, although a fever may trigger a seizure in a child who has epilepsy. These seizures are more commonly seen in children between 12 months and 5 years of age and there may be a family history of this type of seizure. The first febrile seizure most commonly occurs between 15 months to 2 years of age. 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 or focal seizures are called complex febrile seizures and they may result in long-term neurological consequences.