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Recognizing, Understanding, and Treating Seizures in Children

Clinicians and support staff at Pediatric Home Service are fortunate to periodically have the opportunity to learn from experts in various specialties of health care. By expanding their knowledge base in these educational discussions, staff can deliver the most comprehensive care to our patient population, while also creating a more collaborative setting with our healthcare partners.

We were honored to welcome Elizabeth Gilles, MD from Child Neurology Solutions, as she came to discuss seizures in children and how to recognize, manage and treat them.

Back to Basics: What is a Seizure?

Epilepsy diagnoses throughout AmericaIn its most basic definition, a seizure is anything that irritates the brain in a way that causes the cells to fire differently in synchronized patterns.

“When I talk to kids about seizures, I tell them ‘your brain had a party, and you weren’t invited,’” says Gilles. “It can be upsetting for a child to talk about seizures, because they often don’t know what’s going on in their body when it occurs.”

Epilepsy is synonymous with a seizure disorder and is a diagnosis given to someone after they’ve had two or more unprovoked seizures.

“It has no prognostic implication whatsoever,” says Gilles.

With approximately one percent of the population having epilepsy (about 12 million people in the United States), epilepsy is more common than Parkinson’s, muscular dystrophy, cerebral palsy, and multiple sclerosis combined.

Types of Seizures

While there are many types of seizures, they can all typically be categorized as either partial or generalized. Partial seizures occur when activity is limited to a part of one hemisphere on the brain at the site where the seizure begins, and are simpler. When someone has a partial seizure, they may be alert while seizing, or will have a change in awareness of their surroundings.

the six types of seizures individuals haveGeneralized seizures occur when there is widespread seizure activity in both hemispheres of the brain, and can be categorized into six types. They can all look quite different, depending on what parts of the brain are affected by the activity.

Seizures can manifest themselves as changes in motor activity, sensory hallucinations (affecting smell, sight, sound, touch, or taste), autonomic symptoms (sweating, incontinence, or a drop in blood pressure), or psychic symptoms (intense emotions, change in language or perceptual distortions). has a helpful tool to document a child’s seizure when they’re having an episode – this can be beneficial in describing their spell to a doctor during an appointment, or recording if/how a child’s spells change over time.

First Aid During Seizures

First aid steps during a seizureThere are a few basic steps to remember that can help ensure a seizure affects the child as minimally as possible.

“I always tell parents who have children with epilepsy to get CPR training,” says Gilles. “This helps them feel more in control of the situation and empowered to assist their child as needed.”

When to Call 9-1-1

Although not every seizure requires emergency medical services, there are signs that professional intervention may be necessary.

  • Concern of life‐threatening emergency
  • First seizure lasting more than 5 minutes or child not waking up after a seizure
  • Known epilepsy with seizure not responding to emergency meds (i.e. rectal valium)
  • Rapidly worsening mental status
  • Rapidly worsening weakness
  • Postictal unilateral paresis, first time seizure
  • Head injury proximate to seizure

Treating a Seizure with Emergency Medications

Some seizures may require emergency medications to intervene during an episode. Status epilepticus is a disorder involving prolonged epileptic seizures. It was previously considered an episode that lasts between 20-30 minutes, but today is generally any episodes that last 5 minutes or more.

seizure medications may be able to be administered through a child's g-tube“The vast majority of seizures last less than a minute,” says Gilles. “If you get into the 2-4 minute range you’re starting to become an outlier, and episodes lasting more than 5 minutes typically don’t stop without assistance.”

Medications such as Diazepam, Lorazepam, and Midazolam (amongst others) are frequently used to stop seizures in emergency situations, and can be administered through intranasal, buccal (cheek), g-tube or rectal routes.

“When administering a medication into the cheek, be aware of how much space the child’s cheek can hold,” said Gilles. “Many people just squirt the medication in, but it’s more than the mouth can hold, so it won’t stay in. I’ve found administering it drop by drop is most effective.”

Providers will typically wait until a second unprovoked seizure occurs in infants and children before they recommend treating with regular medication. Epileptic patients may also use diet, magnet therapy, or other surgical methods to treat seizures.

Individualized Care to Meet Your Child’s Needs

It’s important to remember that each child’s seizure activity is unique to them – and the best thing a parent can do is document (whether through videos, photos, or notes) their child’s behaviors when they have an episode and bring it to their appropriate doctor. From there, you will be able to work together to determine what is best for helping your child.  

While seizures can be a scary thing to see your child experience, Dr. Gilles noted that most seizures themselves not produce injury to the brain. By knowing a child’s triggers, management techniques, and treatment options, parents can be an advocate and caregiver for their child’s needs.

Originally published: December 4, 2017