Hesperian Health Guides

Types of Epileptic Seizures

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HealthWiki > Disabled Village Children > Chapter 29: Seizures: Epilepsy > Types of Epileptic Seizures


Note: This information is for rehabilitation workers and parents because many doctors and health workers do not treat seizures correctly. With care, perhaps you can do better. However, correct diagnosis and treatment can be very difficult. If possible, get advice from a well-informed medical worker. Ask her help in using this chart. It is adapted from Current Pediatric Diagnosis and Treatment by Kempe, Silver, and O’Brien (Lange Medical Publishing), in which more complete information is provided.


TYPE AGE SEIZURES BEGIN APPEARANCE TREATMENT
Newborn seizures
birth to 2 weeks Often not typical of later seizures. May show sudden limpness or stiffness; brief periods of not breathing and turning blue; strange cry; or eyes roll back; blinking or eye-jerking; sucking or chewing movements; jerks or strange movement of part or all of body.

WARNING!: Make sure spasms are not from tetanus or meningitis.

With cerebral palsy in the newborn, the baby is usually limp. Stiffness and/or uncontrolled movements usually appear months later, but the baby does not lose consciousness.
Phenobarbital or phenytoin. Add diazepam if not controlled.

(Seizures due to brain damage at birth are often very hard to control.)
newborn baby
Baby spasms (West’s syndrome)
3-18 months (sometimes up to 4 years)

A child have spasms with hands spread out
Child having spasms with hands crossed over chest Sudden opening of arms and legs and then bending them — or repeat patterns of a strange movement. Spasms often repeated in groups when waking or falling to sleep, or when very tired, sick, or upset. Corticosteroids may be tried—but are dangerous. Try to get help from an experienced doctor or health worker. Valproate or diazepam may help.
Most children with these spasms are mentally slow.
Fever seizures (seizures that occur only when child has a fever) 6 months to 4 years Usually ‘big’ seizures (see next page) that happen only when child has a fever from another cause (sore throat, ear infection, badcold). May last up to 15 minutes or longer. Often a history of fever seizures in the family.

WARNING!: Look for signs of meningitis.
A child who has had fever seizures on several occasions should be treated with phenobarbital continuously until age 4 or until one year after the last seizure. Seizures usually do not continue in later childhood.
A thermometer indicating fever
Jolt or ‘lightening bolt’ seizures (Lennox- Gastaut syndrome)
any age but usually 4-7 years Sudden violent spasms of some muscles, without warning, may throw child to one side, forward, or backward. Usually no loss of consciousness, or only brief.

Many children also have ‘big’ or generalized seizures.

May be a history of ‘baby spasms’ (see above) in earlier childhood.
Try phenobarbital, with valproate. If If no improvement, consider trying corticosteroids as in baby spasms, or other medicines with medical advice.

Protect child’s head with headgear and chin padding.
A shild having a jolt seizure while walking
Child wearing headgear and chin pad
Blank spells or ‘absences’ (petit mal). (This type of seizure alone is rare.) 3-15 years

A child with a blank expression
Child suddenly stops what she is doing and briefly has a strange, empty or ‘blank’ look. She usually does not fall, but does not seem to see or hear during the seizure. These ‘absences’ usually happen in groups. She may make unconscious movements, or her eyes may move rapidly or blink. These seizures can be brought on by breathing rapidly and deeply. (Use this as a test.) Often confused with ‘psychomotor’ seizures, which are much more common. Valproate or ethosuximide. Since many children also have ‘big’ seizures, add phenobarbital if necessary (or try it first if you think the seizures might be ‘psychomotor’ —see below).
‘Marching’ seizures (Focal seizures) any age Movement begins in one part of the body. May spread in a certain pattern (Jacksonian march) and become generalized.

A child lying on floor with seizures in hand then spread to feet

Note: If seizures that occur in one part of the body get worse and worse, or other signs of brain damage begin to appear, the cause might be a brain tumor.


Phenobarbital or phenytoin (or both). If poor results, try carbamazepine or primidone.
Mind-and-body seizures (psychomotor seizures)
any age Starts with ‘warning’ signs: sense of fear, stomach trouble, odd smell or taste, ‘hears’ or ‘sees’ imaginary things. Seizure may consist of an empty stare, strange movements of face, tongue or mouth, strange sounds, or odd movements such as picking at clothes. Unlike ‘blank spells’, these seizures usually do not occur in groups but alone and they last longer. Most children with psychomotor seizures later develop ‘big’ seizures. Try phenobarbital first —then phenytoin, or both together, then carbamazepine, or both together, then carbamazepine, or all 3 together. Valproate may also be useful. Or primidone instead of phenobarbital. Psychological counseling sometimes also helps.
A girl pulling at the neck of her dress while being irritated
ARHHH
Generalized or ‘big’ seizures (grand mal) any age Loss of consciousness—often after a vague warning feeling or cry. Uncontrolled twisting or violent movements. Eyes roll back. May have tongue biting, or loss of urine and bowel control. Followed by confusion and sleep. Often mixed with other types of seizures. Often family history of seizures. Try phenobarbital first. Then phenytoin. Then carbamazepine —or combinations. Or combine primidone with one or more of the others.
A boy lying on the floor with uncontrolled twisting movements
Temper tantrum fits (not really epilepsy) under 7 years Some children in ‘fits of anger’ stop breathing and turn blue. Lack of air may cause loss of consciousness briefly and even convulsions (body spasms, eyes rolling back). These brief fits, in which the child turns blue before losing consciousness, are not dangerous. No medical treatment is needed. Use methods to help the child improve behavior (see Chapter 40).
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This page was updated:21 Nov 2019