Types of Seizures in Children
There are many different types of seizures in children. They fall into a few categories:
- Focal, meaning the seizure activity begins in one part of the brain and may spread from there.
- Generalized, meaning the seizure affects all parts of the brain at once.
- Infantile spasms, a type of seizure that begins during the first year of life.
- Status epilepticus, which involve convulsions of more than five minutes.
- Febrile seizures, which occur within 24 hours of a fever for children between six months and five years of age.
Focal Seizures
Focal seizures are a common type of seizure in children. Symptoms include:
- A feeling of falling or spinning
- A feeling of "pins and needles"
- A sense that familiar things are suddenly unfamiliar, or vice versa
- A sudden feeling of anger or fear
- "Automatisms" (involuntary gestures), such as removing or fiddling with clothing, grunting, lip-smacking and clumsy movements
- Buzzing noises
- Garbled speech or problems with memory
- Repeating words or phrases, laughing or crying
- Rhythmic twitching of a limb or part of a limb (twitching may spread to other parts of the body)
- The appearance of daydreaming, including blank stares
- Smelling or tasting things that aren't there
- Vivid hallucinations
- Wandering
Children can experience two types of focal seizures:
- "Focal aware seizures" (previously called “simple partial seizures”)—The child remains fully alert and awake. They remember having the seizure. But they may not be able to interact with others while the seizure is happening.
- "Focal impaired awareness seizures" (previously called “complex partial seizures”)—The child is unaware of their surroundings. They may not remember the seizure.
Generalized Seizures
There are two categories of generalized seizures. They include non-motor such as absence (pronounced "ab-SONCE") seizures and motor seizures.
Non-motor, Absence Seizures
Sometimes called “petit mal seizures,” absence seizures are one of the most common seizures in children. A child having this type of seizure may look like they are daydreaming or zoning out. The seizures last 15 seconds or less. They may occur many times a day. They may begin at age four through adolescence. Some children outgrow them.
Motor Seizures
The four types of generalized motor seizures include:
- Atonic seizures
- Myoclonic seizures
- Tonic seizures
- Tonic-clonic seizures
Atonic seizures
Atonic seizures involve a sudden loss of muscle tone. Sometimes called a "drop attack," these can cause symptoms such as:
- Brief loss of consciousness
- Falling to the ground
- Head dropping down
Myoclonic seizures
Myoclonic seizures involve sudden, shock-like muscle contractions affecting one or more limbs. These seizures may happen once or in clusters, with more than one occurring in a short period of time.
Tonic seizures
These seizures involve stiffening of the body and/or arms and legs. They may occur when the person is awake or asleep. If they happen while standing or sitting, the person may fall to the ground.
Tonic-Clonic seizures
When a person has a tonic-clonic seizure (sometimes called a “grand mal seizure”), they lose consciousness, their muscles stiffen, and their arms and legs jerk uncontrollably. A tonic-clonic seizure usually begins on both sides of the brain. It can also start on one side and spread to the whole brain. There are two phases:
- Tonic phase: The person's muscles stiffen. They may fall to the floor. Breathing is affected. The person may turn a bit blue in the face and cry out. The person may bite their tongue or cheek, causing bleeding from the mouth.
- Clonic phase: This follows the tonic phase. It involves convulsions—the person's arms and usually legs begin to jerk. Sometimes the person loses control of their bladder or bowel.
These seizures usually last a few minutes. A tonic-clonic seizure of five minutes or more is a medical emergency.
Infantile Spasms (West Syndrome)
Sometimes called "epileptic spasms," these seizures are diagnosed in a baby's first year of life. They may start with a quick spasm involving a downward head jerk. Over time, these may develop into clusters of spasms in which the child’s arms or legs arms rise and/or straighten suddenly.
Seizures most often occur when the child is waking up or falling asleep. At first, these symptoms may be subtle. Over time, they become more noticeable.
Infantile spasms are a medical emergency. They do not pose an immediate danger, but children with infantile spasms are at high risk for developmental delays. The child may lose skills, such as crawling and walking, if left untreated. They need immediate treatment for the seizures to minimize their risk for long-term problems.
Cincinnati Children's offers a specialized neurometabolic program to help infants or children experiencing infantile spasms. It is available through our Infant Seizure Program.
Status Epilepticus
Status epilepticus is a medical emergency. It involves convulsive seizures lasting more than five minutes. If the seizures last longer than 30 minutes, serious problems could occur, including permanent brain damage. Children diagnosed with status epilepticus need to have "rescue medication" nearby at all times. An adult can give this medication to stop the convulsions quickly.
Febrile Seizures (seizures in toddlers)
These seizures occur in children ages six months to five years old. They happen within 24 hours before or after the child has a fever. These motor seizures involve convulsions. Children typically outgrow these seizures.
Febrile seizures can be simple or complex. To be considered complex, febrile seizures must last longer than 15 minutes or occur more than once in 24 hours or affect one part of the body. The shaking may affect one or both sides of the body. A small percentage of children who have complex febrile seizures develop epilepsy.
