Hesperian Health Guides
Chapter 29: Seizures: Epilepsy
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What are they? Seizures (also called fits or convulsions) are sudden, usually brief, periods of unconsciousness or changes in mental state, often with strange jerking movements.
One out of every 10 or 20 children has at least 1 seizure by age 15. But only 1 in 50 of these children goes on to have chronic seizures (repeated fits over a long period of time)—a condition known as epilepsy.
CAUSES OF CHRONIC SEIZURES (EPILEPSY)
Seizures come from damage to, or an abnormal condition of, the brain. Common causes include:
- Injury to the brain. This causes at least ⅓ of epilepsies. Injuries may be before birth, during birth, or at any time after. The same causes of brain damage 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 damage begin to appear, may be a sign of a brain tumor (or of hydrocephalus in a baby). Seizures caused by a tumor usually affect one side of the body more than the other. Sometimes, seizures may be caused by pork tapeworms that form cysts in the brain (see Where There Is No Doctor, p. 143).
- Hereditary. There is a family history of seizures in about ⅓ of persons with seizures.
- Unknown causes. In about ⅓ of epilepsies, no family history or history of brain damage can be found.
Fever seizures. Children who have once had a seizure with a high fever often will have seizures again when they have a fever—especially if other persons in the family have had seizures with fever. Be sure to check for infections of the ears and throat, as well as bacterial dysentery (diarrhea with blood and fever), and treat the cause.
Seizures that come only with fever usually stop occurring by the time the child is 7 years old. Sometimes they may develop into ‘non-fever-related epilepsy’, especially if the child has signs of brain damage (see “Cerebral Palsy,”).
WARNING! Seizures in a very ill child may be a sign of meningitis—for which immediate medical treatment is necessary to save his life. Learn how to check for signs of meningitis (see Where There Is No Doctor, p. 185).
|The spasms of tetanus can be mistaken for seizures. The jaw shuts tightly (lockjaw) and the body suddenly bends back. Learn to spot early signs of tetanus (see Where There Is No Doctor, p. 182).|
MORE ABOUT SEIZURES (EPILEPSY)
Mental ability. Some children with epilepsy are intelligent. Others are mentally slow. Occasionally, seizures that are very frequent and severe can injure the brain and cause or increase mental slowness. Treatment to control seizures is important.
Types of seizures. Seizures may appear very differently in different children. Some may have severe, ‘big’ or ‘major’ seizures with strong, uncontrollable movements and loss of consciousness. Others may have smaller or ‘minor’ seizures. These can be ‘brief spells’ with strange movements of some part of the body. They can be sudden unusual behavior such as lip-sucking or pulling at clothes. Or they can be brief ‘absences’ in which the child suddenly stops and stares—perhaps with blinking or fast movement of the eyelids.
Some children will have both minor and ‘big’ seizures or they may first have minor ones and later develop big ones.
Warning signs or ‘aura’. Depending on the kind of seizures, the child (and parents) may be able to sense when a seizure is about to begin. Some children experience a ‘warning’ in which they may see flashes of light or colors. Or they may suddenly cry out. In one kind of seizure, the ‘warning’ may be fear or imagined sights, sounds, smells, or tastes. In some kinds of seizures there is no ‘warning’. The child’s body may suddenly jerk or be thrown violently. These children may need to continuously wear some kind of safety hat or other head protection.
Timing of seizures. Seizures may happen weeks or months apart, or very often. Minor seizures or ‘absences’ may come in groups—often in the early morning and late afternoon.
Seizures are usually short. Minor seizures may last only a few seconds. Big seizures seldom last more than 10 or 15 minutes. Rarely, however, a child may enter into a long ‘epileptic state’ which may last hours. This is a medical emergency.
Some kinds of seizures may appear at any age. Others begin in early childhood and usually disappear or change to other patterns as the child grows older.
Many persons have epilepsy all their life. However, some children stop having seizures after a few months or years.
Usually there is no need to know the exact kind of seizures a child has. However, some kinds of seizures require different medicines. The chart for "Types of Epileptic Seizures" describes the main types of seizures, when they begin, and their treatment.
WHEN ARE SPECIAL MEDICAL STUDIES NEEDED?
In some poor countries, doctors sometimes prescribe medication for seizures without properly checking for signs of causes that may need attention. However, more and more doctors regularly order expensive testing such as an ‘EEG’ (electroencephalogram). Even if these services are ‘free’, they are often only available in a distant city, which causes the family much time and expense. Such tests may not help much in deciding treatment—unless a brain tumor is suspected. And even if it is a tumor, the possibilities for successful surgery treatment may be very small, and the costs much too high.
Usually EEGs and other costly testing are not helpful.