Hesperian Health Guides
Chapter 29: Seizures: Epilepsy
What are seizures? Seizures are sudden, usually brief, periods of changes in consciousness caused by shifts in electrical activity in the brain. A person having a seizure may lose consciousness and fall or collapse with convulsions (jerking movements). Or they may have few or no physical signs and just be âabsent.â Or something in between. When they wake up, they may feel tired and confused.
The new onset of seizures happens more in infancy and early childhood. Seizures that repeat over a long period of time may be caused by epilepsy, a condition of the brain.
Not all seizures are epilepsy. For example, children who have once had a seizure with a high fever often will have seizures again when they have a feverâespecially if other persons in the family have had seizures with fever. Fever seizures can be caused by ear or throat infections, as well as by bacterial dysentery (diarrhea with blood and fever) and they can be treated and cured with antibiotic medicines (see pp. 357-358, Where There Is No Doctor). Fever (or febrile) seizures are the most common form of childhood seizures, and lowering fever with paracetamol (acetaminophen) may stop them from repeating. Children who have fever seizures usually grow out of them.
Other seizures, including absence seizures that are less noticeable, may be epilepsy. Absence seizures are frequent breaks in a childâs consciousness that last only a short time â 10 to 15 seconds.
The chart for "Types of Seizures" describes the main types of seizures, when they begin, and their treatments.
CAUSES OF SEIZURES AND EPILEPSY
Seizures come from injuries to, or an abnormal condition of, the brain. Common causes of seizures among children include:
- Illness or injury to the brain. Injuries may occur before birth, during birth, or at any time after. The same causes of brain injury that result in cerebral palsy can cause epilepsy. In fact, cerebral palsy and epilepsy often occur together. Meningitis is a common cause of this combination. In small children common causes of seizures are high fever or severe dehydration (loss of liquids). In very ill persons, the cause may be meningitis, malaria of the brain, or poisoning (see Where There Is No Doctor, p. 178). Epilepsy that steadily gets worse, especially if other signs of brain injury begin to appear, may be a sign of a brain tumor (or of hydrocephalus in a baby). Seizures caused by a tumor usually affect the part of the body that receives signals from the part of the brain where the tumor is located. Sometimes, seizures may be caused by pork tapeworms that form cysts in the brain (see Where There Is No Doctor, p. 143). Head injuries from accidents or violence are a common cause of epilepsy.
- Hereditary. Sometimes a child with epilepsy has a parent who also has epilepsy. However, this does not mean the parent has infected the child. Epilepsy is not a disease that can be passed among people.
- Unknown causes. For about half of all people with epilepsy, the cause is not known.
MORE ABOUT SEIZURES AND EPILEPSY
Mental Ability. For many people, epilepsy does not affect mental ability. But because epilepsy is a condition of the brain, it may affect how the brain functions. Frequent uncontrolled seizures may injure the brain and cause delays in brain development. Having seizures at an early age, poor seizure control, and injuries to parts of the brain that control mood can affect brain function.
Types of seizures. Some children may have have generalized seizures (tonic-clonic or grand mal) that affect their entire brain and body. They may make strong, uncontrollable movements and lose consciousness. Others may have focal (partial) seizures that affect only one part of the brain. They may have brief spells with unusual movements of some part of the body. They can show unusual behaviors such as lip-sucking, pulling at clothes or changes in breathing, and a loss of awareness of their surroundings. Or they can have brief absences in which the child suddenly stops and staresâperhaps with blinking or fast movement of the eyelids. Different types of seizures require different medicines.
Timing of seizures. Seizures may happen often, or happen weeks or months apart. Some children may have seizures that become more frequent and severe over time. Seizures may happen when a child has an infection or cold, or when they are not getting enough sleep. Absence seizures may come in groupsâoften in the early morning or late afternoon.
Seizures usually do not last long. Focal seizures usually last less than a minute. Generalized seizures seldom last more than 2 to 3 minutes. Rarely, however, a child may have an epileptic seizure that lasts more than five minutes. This is a medical emergencyâget help.
Some kinds of seizures may appear at any age. Others begin in early childhood and usually disappear or change as the child grows older. But many people have epilepsy all their life.
Warning signs or aura. For some kinds of seizure, the child (and sometimes parents and caregivers) may be able to sense when it is about to begin. Some children experience a warning in which they see flashes of light or colors. Or they may suddenly cry out, feel fear, or sense imagined sights, sounds, smells, or tastes. In other kinds of seizures there is no warning. The childâs body may suddenly jerk or move violently. When seizures are frequent, violent, and uncontrolled, children may need to wear some kind of safety helmet or other head protection.
It may not be possible for newborns or young children to say how they feel before, during, or after a seizure. Parents and caregivers can help by observing and recording what they see and when. Write or draw what you see or keep count of the seizures by dropping a pebble into a jar every time a seizure occurs. If you can film a child having a seizure with a phone or camera, show this to a health worker so they can see the type, length, and intensity of the seizure. But remember: the childâs safety comes first. Before filming, protect the childâs head and remove anything that could cause injury.
DO NOT PUT ANYTHING IN THE CHILDâS MOUTH! No food, drink, or medicine, nor any object to prevent biting the tongue. This can block a childâs airway and cause them to choke