Question
What are the different types of seizures people have?
Answer
The 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 and electrical activity are all over the brain. It's not centralized so they could have speech and motor disruptions, as well as behavioral disruptions. Seizures can occur whether or not awareness is affected and may or may not involve other symptoms such as movement.
General Symptoms/Warning Signs of a Seizure
Here are some general symptoms of seizures to look for if you're watching children. They may be staring or look like they're daydreaming. They might not respond to words or noises for brief periods, or if you're chatting with them and they're not responding, rapid eye blinking with staring can occur. They may appear confused or in a daze. They might nod their head rhythmically when they're not aware or conscious. Their body could just stiffen all of a sudden or they could fall suddenly for no apparent reason. Loss of consciousness and loss of bowel or bladder control can also indicate that there is a seizure going on.
Infantile Spasms
Infantile spasms are quite common in children less than 18 months old. They may be associated with mental retardation in a child, but not always. During an infantile spasm, there are sudden, repeated uncontrolled movements by the child. They will have a flexed stature, so their body will be flexed and they may bob their head or scrunch up their little body. When this type of thing occurs, it often occurs on awakening. If you're caring for a child and they're awakening from their nap, be observant of that. If you see the signs, take a video of it and then offer that information to the parent, or if you're a parent of a child yourself take it to the physician and obtain a diagnosis if it's infantile spasms. Then they can prioritize the treatment that the child might need. Infantile Spasm Awareness Month happens every December because this is something that's common.
Febrile Seizures
Febrile seizures occur in children between six months and six years of age. It is the most common type of seizure in children. They're more likely caused by viral infections, which can't be treated by an antibiotic, and less common bacterial infections, which can be treated by an antibiotic. For example, the flu virus and the virus that causes roseola commonly have high fevers which appear to be frequently associated with febrile seizures. Roseola is when a child gets a rash all over them and they run a particularly high fever. Other things that may cause high fevers are brain infections, outside temperature, and infectious agents being breathed in. There are many different things that can trigger febrile seizures. Most children with febrile seizures rarely develop long-term health problems. There is possibly a genetic cause of febrile seizures. Febrile seizures have no negative effects on behavior, scholastic performance, or cognition. Most febrile seizures are very short and they self-terminate, or, stop on their own. Most don't require any type of long-term treatment with anti-epileptic drugs.
Seizure with No Change in Awareness
Seizures that occur with no change in awareness are focal aware seizures. The individual is fully awake and aware during the seizure. They generally last about one to three minutes. There can be any change in behavior with this type of seizure, such as motor, sensory, or psychic. A motor change in behavior might be a rhythmic twitching of the body or jerking of the face and the arms and legs. A sensory change could include tingling, sounds, smelling something specific, or visual changes. Psychic changes are changes in thinking, feeling, or perceptions, so they could become terribly fearful or anxious or have that feeling of deja vu as if this just happened before. These seizures with no change in awareness are often just called focal seizures.
Seizure with Confusion or Not Aware
Seizures with confusion or they are not aware are called focal impaired awareness seizures. The person is not aware of what is going on or is confused. They may have a blank, dazed state. They're relatively short-lived and generally last about one to three minutes. The child may have some repeated purposeless movements called automatisms, such as lip-smacking, chewing, or clapping their hands. They might have clumsy movements when they're confused and not aware during this type of seizure. They may not be able to talk. Many seizures are often followed by side effects for a while, such as tiredness, headache, or nausea. The child could become combative if they're restrained. We will talk more about how it's best not to restrain an individual with seizures.
Generalized Seizure Terms
Remember, a generalized seizure is one that affects many parts of the brain at once and can affect muscle tone or tension. Here are some terms that are important to know. Tonic means muscle tone. Stiffness may occur and the individual could just fall over like a tree trunk. Atonic means an absence of tone, which means that the body could be very loose or floppy. They may fall like rag dolls and may have the twitching and jerking of muscles in an atonic seizure. Myo means muscle and clonic means jerking, so myoclonic means brief jerks in a muscle or a group of muscles. The arm may begin to jerk and then as the seizure progresses, that jerking will move throughout the body so it'll move to the next arm or the legs, et cetera. Clonic means rhythmic jerking in part or all of the body.
Seizure with Loss of Consciousness
Seizures with loss of consciousness mean the individual has passed out. During tonic-clonic seizures the body is in a very flexed stature with tense muscles and jerking. If a child is having a tonic-clonic seizure you might hear the child cry out with a sudden hoarse-sounding cry. They'll lose consciousness and may fall because they have stiff arms and legs (tonic) and then rhythmic jerking (clonic). They may have shallow breathing and drooling may occur. They typically last between one and three minutes, and the child could have a loss of bowel or bladder control with this type of seizure as they lose consciousness.
Seizure with Staring and Not Aware
When someone has a generalized absence seizure they usually stare and are unaware of their surroundings. A pause in activity occurs with a blank stare and they have a brief lapse in awareness. They might have a chewing or blinking motion during this seizure. It may occur many times a day, but it lasts less than 20 seconds. After the seizure, the child will return to normal immediately. These are very short-lived seizures and the person is totally fine after and not aware that they happened. These seizures are often followed by a headache and confusion, even though they seem back to normal. They might be tired or sore, especially if they bit their tongue when they were doing the chewing motions. They may have some speech difficulty after.
This Ask the Expert is an edited excerpt from the course, Seizures and Seizure Management in Early Childhood, presented by Nancy Nathenson, RRT.
