Seizures and Seizure Management in Early Childhood

Editor’s note: This text-based course is an edited transcript of the webinar, Seizures and Seizure Management in Early Childhood, presented by Nancy Nathenson, RRT.
Learning OutcomesAfter this course, participants will be able to:
Define seizures and epilepsy.Identify the correct and incorrect steps for helping a child having a seizure.Recognize when it would be necessary to call emergency personnel (911) in the event of a seizure.Introduction and DefinitionsI speak with a little bit of experience because my husband has a seizure disorder. Although I don't care for a child with a seizure disorder, I may interject some of the experiences that I've had with him. I am also seizure recognition and first aid certified by the Epilepsy Foundation of America. We'll talk more about the Epilepsy Foundation and all that they can do for you. Because a majority of our audience is in the United States, I will refer to 911 as the number to get help when needed. 911 services in the United States were started about 50 years ago, and cover the United States, North America, and other US territories. However, for our international audience, please ensure you're aware of the emergency number in your area to call for help. For example, in the European Union and India, the number is 112, and in Australia, 000. Please be mindful of that.
Let's define seizures and epilepsy. A seizure is a sudden uncontrolled electrical disturbance in the brain. It can cause changes in a person's behavior, movement, feelings, and levels of consciousness. It can impact all of those things or it can impact just one of those things. Every individual is different. According to the Mayo Clinic, epilepsy is having two or more seizures at least 24 hours apart that are not brought on by an identifiable cause. The reason for the seizure is unknown and they happen close together. A seizure occurs when there is a change in electrical signals in the brain. There's a short circuit in the way messages are sent to the body. Seizures can occur with other medical conditions as well, and not everyone that has a seizure has epilepsy.
Let's talk about the impact of seizures and epilepsy in the United States. One in 10 people will have a seizure in their lifetime. There are currently approximately 330 million people in the United States. About a million of them still have seizures even though they are on medication to prevent them. Luckily, my husband's seizures are controlled with medication. Nearly 3 million Americans of all ages live with epilepsy. Remember, epilepsy is a medical condition that happens when there are frequent seizures close together. One in 26 people will be diagnosed with epilepsy during their lifetime, and 25% of cases develop before the age of five. This is the demographic most of you work with. Males are more likely than females, and African Americans are more likely than Caucasians to have epilepsy. While this course is focused on what happens to a child during a seizure, the information is also applicable to others of any age. The terms individual, person, and child may be used interchangeably.
Seizures in ChildrenLet's talk about seizures specifically in children. About 3% of all children have seizures when they're less than 15 years of age. 50% of these are febrile seizures, meaning they occur when there is a fever. They are the most common type and can happen with an ear infection, chicken pox, or even the common cold. The risk factors for seizures in children include genetics, having something to do with the family medical history, and developmentally delayed children. One in four children that have febrile seizures will have another one within one year.
Children with seizures often have other disorders that accompany the seizures. One of those things is fainting. Fainting is when blood pressure drops and there is less pressure or circulation to the brain. The most common reason fainting occurs is dehydration. If this happens to a child, the doctor may say the child needs to drink more water because the more volume of water you drink, the more blood you've got circulating. It is also important to eat on time and to eat salty foods because salty foods help you to retain water and keep that volume in your bloodstream.
Another common disorder seen with seizures is breath-holding. Breath-holding spells can happen in children from six months to six years of age, but mostly they happen in children that are six months to 18 months old. Breath-holding usually occurs after the child has been very angry or if they are frustrated, startled, or when in pain. A child may even pass out for a minute or two when they do their breath-holding. Cyanotic breath-holding, which means the face of the child turns blue from lack of oxygen, usually occurs after a child cries really hard, often from anger or frustration. Pallid breath-holding is when the face turns white from being startled or in pain. It is important to note that children do not have breathing spells on purpose. They don't have control over this.
Night terrors can affect toddlers and preschoolers during their deepest stage of sleep. They can last for a very short time and the child can recover and go right back to sleep and be fine, or they can last up to about 45 minutes. Children have migraines just like adults, but they generally don't last as long as migraines in adults do. Migraines can be genetic and you can have just a history of migraines in the family or certain foods and beverages can cause migraines. Sugar and some carbohydrates really affect the brain. Migraines can also happen from stress, anxiety, infection, or even minor head trauma. You might see a child with seizures who also has psychic disturbances, severe anxiety, or strong fear.
Risks Related to SeizuresThere are risks related to seizures. Physical injury can occur when someone's having a seizure and are not able to control their body. One time my husband was driving a car and he had a seizure. Another time I was with him and he had a breakthrough seizure. I had to help him guide the car off the highway and put on the brake. That was a very scary situation. Sometimes people having seizures have difficulty breathing. Other seizure emergencies and even early death can occur, such as accidents or drowning. If a child has breathing or heart problems and they have a seizure, that could cause early death. There is a risk of suicide in people with epilepsy, sometimes because of the type of medication that they're taking and the high level of this medication in their bloodstream. Some medications, such as pregabalin or Lyrica, can cause suicidal thoughts, hallucinations, and depression. Sudden unexpected death (SUDEP) may occur, although it's rare. One in 1000 individuals with epilepsy that have uncontrolled epilepsy can die from SUDEP. That happens most often when they have uncontrolled seizures, when they have seizures at night, or when they have violent tonic-clonic seizures. We will talk more about tonic-clonic in a minute, but that's just when your body is stiff and shaking terribly.
Did you know that most seizures are not medical emergencies? That's a relief. A person may not be even aware that they are having a seizure. Seizures are not contagious. A person cannot swallow their tongue during a seizure. It's been a misconception over the years that you put something in the mouth to keep the individual from swallowing their tongue, but that cannot happen. Epilepsy, as I mentioned, is a medical disease. Sometimes a person can die from a seizure.
Seizure signs and symptoms of seizures vary from person to person. It's all individual and is not the same in every person. However, in most cases, they are usually consistent, look the same, and are predictable for each individual. You get used to a person and the type of seizure that they have and when they might occur. Anything the brain can do normally the brain can do during a seizure. During a seizure, you may move, see, feel, hear, smell, or do other things even if you don't want to while you're having a seizure. Also, the heart will keep beating and the lungs will keep breathing in nearly every case.
Characteristics of a SeizureIn general, seizures can result in changes in body or facial movement. It can also cause changes in sensations, such as the sensations a person might feel inside their body or just on the outside of their body, such as their skin. Behavior can change when there's a seizure. Someone may be fine and then they might be very violent or be misbehaving. A person's speech also can be affected. The person may not be able to speak during a seizure, or you may not be able to understand their speech during a seizure. Awareness also can be affected so they can be totally aware of their surroundings or not aware. The area of the brain involved determines what the seizure looks like, and we'll talk more about that now.
Types of SeizuresThe type of seizure depends on where it starts in the brain. Focal seizures occur in a specific spot in the brain. If it's occurring in the speech center of the brain then it will affect the individual's speech. When generalized seizures occur the disruption...