Our pediatric neurologists offer specialized care for children experiencing seizures

Seizures are more common in children than many families realize, especially during the first year of life. Population-based studies show that 4% to 10% of children will have at least one seizure by age 16, and about 3% will develop epilepsy. According to the National Institutes of Health, seizures account for about 1% of all emergency department visits in the U.S. each year.

“A child arriving in the emergency department after a seizure or seizure-like event can be scary for the child and their family,” says Ednea Simon, M.D., a pediatric neurologist and epilepsy expert at Providence Swedish. “Because many conditions can cause similar symptoms, clinicians gather as much information as possible to make the right diagnosis and recommend the most appropriate care.”

 With careful evaluation, families can better understand what happened, whether another seizure is likely and what steps may help keep their child safe. Dr. Simon took some time recently to share more about pediatric seizures, how they’re evaluated and how physicians support families in making the right treatment decisions for their kids.

What can cause a seizure?

When a child is seen in the emergency department after a seizure, one of the first questions clinicians ask is whether something specific triggered it. A seizure caused by another health issue is called an acute symptomatic seizure. Possible causes include changes in blood sugar or electrolytes, exposure to toxins, lack of oxygen, infection or inflammation, head injury, acute structural changes in the brain or problems with blood flow.

“In many cases, once the underlying cause is identified, another seizure is unlikely and additional testing may not be needed. For children ages 6 months to 5 years, clinicians also look closely at whether the seizure happened with a fever,” says Dr. Simon. “Identifying the cause helps the care team recommend the right treatment and give families clear guidance about what to expect next.”

How doctors diagnose epileptic seizures

An epileptic seizure happens when there is a sudden burst of abnormal electrical activity in the brain.

Seizures can affect both sides of the brain and may cause a child to lose consciousness and have stiffening  and rhythmic jerking movements of the arms and legs. These are called generalized tonic-clonic seizures, or grand mal seizures.

Other seizures can begin in one area of the brain and are called focal seizures. Depending on where they start, focal seizures may cause unusual movements, changes in sensation, auras, changes in awareness or responsiveness, speech problems, or changes in thinking or behavior.

Dr. Simon says. “After a seizure, a child may be tired or confused for several minutes to hours.  Some children may also have temporary weakness in part of the body, known as Todd’s paralysis. It is important to make sure that the child is gradually improving . If concerns, parents should call 911 immediately for evaluation and immediate assistance.”

Seeing a child having a seizure can be frightening and overwhelming for parents. It is natural to have questions about the cause, possible reoccurance t, whether it will happen again or amy necessary treatments or testing. Studies of first unprovoked seizures show that the chance of another seizure is highest in the first six months, when about 53% to 70% of recurrences happen. Overall, about 90% of recurrences are within two years of the first seizure.

“Having one seizure does not always mean a child has epilepsy,” Dr. Simon notes. “Epilepsy means a person has an ongoing tendency to have seizures. It can also be associated with challenges that affect learning, development, mental health and social well-being.”

In general, epilepsy is diagnosed when a child has had at least two epileptic seizures more than 24 hours apart, or one epileptic seizure along with risk factors that make future seizures more likely. A detailed neurologic evaluation can help determine those risks. This may include a careful description of what happened during the seizure, the child’s medical history, a neurologic exam, an electroencephalogram (EEG), and, when needed, brain imaging. Risk factors may include an abnormal EEG, changes seen on a neurologic exam, developmental concerns, abnormal brain imaging or focal EEG findings. Genetic testing is also becoming an important tool in understanding the cause of seizures in some children.

What happens after an epilepsy diagnosis?

After a child is diagnosed with epilepsy, the next step is to understand what type of epilepsy they have.

“Some childhood epilepsy syndromes have a good outlook and often improve or resolve over time, such as childhood absence epilepsy or SeLECTS, which stands for Self-limited Epilepsy with Centrotemporal Spikes and was formerly known as benign Rolandic epilepsy,” Dr. Simon affirms. “Other childhood epilepsy syndromes are more serious and can be harder to control. These include developmental epileptic encephalopathies such as infantile spasms, Dravet syndrome and Lennox-Gastaut syndrome, which are associated with developmental regression.”

An EEG measures the brain’s electrical activity and can help doctors diagnose epilepsy, identify the type of seizure or recognize features of a specific epilepsy syndrome. It may also be used to record seizure-like events and determine whether they are caused by abnormal brain activity. A brain MRI may be recommended if a child has an abnormal neurologic exam or if an EEG shows focal changes. Together, these tests help the care team make a diagnosis, estimate what to expect over time and recommend the best treatment plan.

If a child has one unprovoked seizure and no significant risk factors, antiseizure medication is not always recommended. A detailed history is important to make sure there have not been similar events in the past, which could change the diagnosis and treatment plan. Studies suggest that 30% to 50% of children who have the first unprovoked seizure will have another one. After a second unprovoked seizure, the risk of recurrence rises to 70% to 80%, which supports a diagnosis of epilepsy and usually indicates the need for antiseizure medication.

Fever-related seizures

Febrile seizures are the most common type of seizure in childhood. They affect about 2% to 5% of children, usually between ages 6 months and 5 years. When a child has a seizure with a fever, clinicians still need to consider other possible causes, especially infection involving the brain or nervous system. Research shows that febrile seizures are more likely to happen again in children 18 months or younger and in children with a family history of febrile seizures. In some cases, febrile seizures can be an early sign of Dravet syndrome, a genetic form of epilepsy most often linked to changes in the SCN1A gene. Dravet syndrome can cause frequent seizures triggered by fever or overheating, prolonged seizures and developmental regression.

Seizure-like events that are not epilepsy

Some events can look like seizures but are not caused by abnormal electrical activity in the brain.

“These are called paroxysmal nonepileptic events, or PNEE. In children, examples can include fainting, certain movement disorders, tics, sleep-related movements, breath-holding spells, night terrors, migraine-related symptoms and psychogenic nonepileptic events. Because these episodes can be difficult to tell apart from epileptic seizures, your doctor may recommend a video-EEG monitoring, which records both brain activity and video. Sometimes we need to keep the video-EEG for several days to be able to capture the event for diagnosis.  Antiseizure medications do not treat PNEE, so an early and accurate diagnosis is important for helping families understand what is happening and what care is needed,” Dr. Simon says.

“A child arriving in the emergency department after a seizure or seizure-like event can be scary for the child and their family. Because many conditions can cause similar symptoms, clinicians gather as much information as possible to make the right diagnosis and recommend the most appropriate care,” says Dr. Simon. “With a careful evaluation, families can better understand what happened, whether another seizure is likely and what steps may help keep their child safe.”

Learn more and find a physician or advanced practice clinician (APC)

When you have questions or concerns about your child’s wellness, Swedish Pediatrics is here to help. Call today to schedule a visit. 

You can also contact Swedish Primary Care to schedule an appointment with a primary care physician. If you or your child has an illness, you can connect virtually with your care team who can review your symptoms and give instructions and follow-up care as needed. With Swedish ExpressCare Virtual, you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections and more. You can use our provider directory to find a specialist or primary care physician near you. 

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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