KidsMD Health Topics

Seizures

  • Seizures happen when brain cells over-fire, temporarily disrupting the brain’s normal electrical signals. They’re quite common, especially among children, and they have a wide range of causes. Certain seizures are easy to recognize (jerking, twitching, stiffness), while others don’t have any outward signs. If your child has seizures, it doesn’t necessarily mean that her brain is being harmed, but some seizures can cause damage to a child’s brain.

    No matter what your child’s specific situation may be, we at Boston Children's Hospital know that seizures can be frightening, and you’re probably looking for information that will help you understand what’s going on and find the care your child needs. We invite you explore this site to learn more about seizures, how doctors diagnose them and the treatments they use to help children live seizure-free and to protect them from complications.

    • Many people think of seizures as involving convulsions in a child’s whole body or a temporary loss of consciousness. But with some types of seizures, a child and the people around her may not notice anything out of the ordinary.

    • Seizures are very common: Researchers believe that about 5 percent of people in the United States experience at least one seizure.

    • Seizures are more common in children than in adults, and infants and young children are affected especially often.

    • Epilepsy is a condition in which a person is more susceptible to having unprovoked seizures. A child may have epilepsy if she has had two or more unprovoked seizures.

    • Sometimes, seizures are triggered by a disease or injury, but for most children, there is no detectable cause.

    • What appears to be a seizure is often another condition, such as fainting or a stroke.

    Treatments for seizures have expanded greatly in recent years. Today, doctors use many different medications to control seizures. For some children with epilepsy, they also use a specialized diet called the ketogenic diet or, in serious cases, a variety of brain surgeries.

    In some cases, seizures are associated with neurological conditions and problems with learning and behavior. Neurologists and other specialists work to identify these sorts of problems and intervene to help your child both physically and emotionally.

    The Boston Children’s Hospital approach

    In 1944, Boston Children’s neurologist William Lennox, MD, developed the Boston Children’s Seizure Unit, the first comprehensive pediatric epilepsy unit in the world. Since then, we have stayed at the forefront of pediatric epilepsy research and care.

    We care for children who have epilepsy or who have experienced seizures through our Epilepsy Program, Fetal-Neonatal Neurology Program and programs dedicated to caring for children with disorders that can cause seizures. If your child’s seizures are caused by an underlying condition, specialists experienced in treating that condition work closely with our seizure specialists to provide the best possible care for your child.

    Our seizure specialists are part of the Boston Children’s Brain Center, which is made up of more than 100 doctors, including some of the world’s top pediatric neurologists, neurosurgeons, psychiatrists, psychologists and developmental behavioral pediatricians. Because our team is so comprehensive, we’re able to thoroughly evaluate suspected seizure disorders and consider all possibilities for treatment.

    We also have active research programs developing new treatment methods for children—from infants to teens—who have experienced seizures.

    Our epilepsy specialists provide outpatient services in Boston as well as at our satellite locations around the Boston area.

    Understanding seizures

    Visit tabs within these pages for overviews of seizure types and symptoms and for guidelines on what to do when a seizure happens.

    Seizures: Reviewed by Blaise Bourgeois, MD
    © Children’s Hospital Boston; posted in 2010

  • At Boston Children's Hospital, we believe that the more you know about your child's condition, the more in control and less anxious you'll feel. Below is some background on seizures that will help you understand this complex condition.

    One of the most important ways that brain cells communicate is by transmitting electrical signals to each other. So the electrical firing of cells in the brain is a major part of how our bodies work and how we think and feel. A seizure happens when cells in the brain over-fire, temporarily disrupting the brain’s normal electrical signals.

    Seizures can take a wide variety of forms, depending on things like what part of the brain has the abnormal electrical activity. Some seizures are easy to recognize, such as if your child’s body shakes and she temporarily loses consciousness. Other seizures are so mild that you might not even recognize them as seizures: They might involve only a visual hallucination, for example, or a moment of very strong emotions. In some cases, seizures have no outward signs at all.

    Seizures are fairly common: About 5 percent of people in the United States experience at least one at some point in their lives. Our brains change dramatically from birth to adulthood, and seizure activity changes as we grow up, too.

    • Children are more likely to experience seizures than adults.

    • Newborns and young children have seizures most frequently. Their seizures are often caused by problems around the time of birth, including injuries during birth or infections.

    • The types of seizures that children experience are different from those in adults. Visit Types to learn more about the types of seizures that children experience.

    Many different diseases and injuries can cause children’s seizures. These include:

    • head injuries
    • birth trauma
    • congenital conditions (conditions that your child is born with) such as brain development problems
    • poisoning
    • fever or infection
    • brain tumors
    • maternal illness during pregnancy
    • heredity
    • degenerative brain disorders
    • stroke
    • metabolic problems and chemical imbalances in the body
    • alcohol or drugs
    • medications

    Often, however, the exact cause of seizures cannot be determined.

    A child who has had multiple seizures may be considered to have epilepsy, a condition in which a person is more susceptible to having seizures.

    Just as the types of seizures vary greatly, so do the effects that they may have on your child. Some are apparently harmless, whereas some can cause serious complications:

    • Seizures sometimes produce side effects that remain even when your child isn’t actually having a seizure, such as dramatic changes in behavior and personality.
       
    • Some seizures can also be associated with long-term neurological conditions and problems with learning and behavior.
       
    • In addition, some children may fall or get injured during a seizure, and the episode can leave your child exhausted. Seizures may also cause your child to feel embarrassed or isolated from her friends.

    Neurologists and other specialists work to identify these sorts of problems and intervene to help your child both physically and emotionally.

    Types

    Children experience many different types of seizures. They include:

    • Focal seizures (also called partial seizures) happen when abnormal electrical activity occurs in one or more spots in the brain, all of which are on one side (“hemisphere”) of the brain. With focal seizures, your child may experience an aura—a strange feeling that involves changes in hearing, vision or sense of smell—before the seizure. Two types of focal seizures are:
      • Simple focal seizures involve different symptoms depending on which area of the brain has the abnormal activity. They usually affect the muscles, which can cause your child to have a variety of abnormal movements.
        • The seizure activity is limited to one muscle group, such as the fingers or the larger muscles in the arms and legs.

        • Your child does not lose consciousness with this type of seizure.

        • Your child may also experience sweating or nausea or become pale.

        • If the abnormal activity is in the occipital lobe (the back part of the brain that is involved in vision), your child may experience changes in vision.

        • These seizures usually last less than a minute.

      • Complex focal seizures may occur in any lobe of the brain.
        • Your child can experience a variety of behaviors, such as gagging, lip smacking, running, screaming, crying or laughing.

        • Children usually lose consciousness during these seizures.

        • After the seizure, your child may feel tired. This is called the postictal period.

        • These seizures usually last one to two minutes.

    • Generalized seizures involve both sides of the brain. Children lose consciousness during these seizures and have a postictal period after the seizure. The types of generalized seizures include:
      • Absence seizures (also called petit mal seizures) involve episodes of staring and an altered state of consciousness.
        • Your child’s posture usually is not affected. Her mouth or face may move or her eyes may blink.

        • These seizures usually don’t last longer than 30 seconds.

        • After an absence seizure, your child may not recall the seizure and may go on with her activities as if nothing happened.

        • These seizures may happen several times a day.

        • They almost always start between ages 4 and 12.

        • Absence seizures are sometimes mistaken for a learning or behavioral problem. 

      • Atonic seizures (which may cause drop attacks) involve a sudden loss of muscle tone. Your child may fall from a standing position or suddenly drop her head. During the seizure, your child is limp and unresponsive.

      • Tonic seizures involve a sudden stiffening of parts of the body or of the entire body. Brief tonic seizures may also cause drop attacks.

      • Generalized tonic-clonic seizures (also called GTC or grand mal seizures) are characterized by five distinct phases:

        • flexing in your child’s body, arms and legs

        • a straightening out of her body

        • tremors (shakes)

        • contracting and relaxing of the muscles (the clonic period)

        • a period in which your child may be tired and sleepy, have problems with vision or speech or have a bad headache or body aches (the postictal period)

      • Myoclonic seizures involve sudden jerking in a group of muscles. These seizures tend to occur in clusters, meaning that they may happen several times a day or for several days in a row.

        • Infantile spasms are a rare type of seizure disorder that occurs in infants from 3 months to 12 months old.

          • Infantile spasms usually involve brief periods of movement in the neck, trunk or legs. They often happen when a child is waking up or trying to go to sleep. They usually last for a few seconds.

          • Infants may have hundreds of these seizures a day. This can be a serious problem and can have long-term complications.

          • Spasms may also occur later throughout life, and they can also cause drop attacks.

    • Status epilepticus is a situation in which seizures develop into one non-stop seizure. This condition is a medical emergency; if this happens to your child, she needs to be hospitalized.

    • Febrile seizures involve contractions in your child’s muscles—either mild (such as stiffening of your child’s limbs) or severe (convulsions). They are triggered by fever.

      • These seizures are fairly common: About 2 to 5 percent of children in the United States experience a febrile seizure. These seizures usually happen in children between 6 months and 5 years of age. Children who have febrile seizures often have a family history of this type of seizure.

      • Febrile seizures that last less than 15 minutes are called “simple.”

      • Seizures that last more than 15 minutes are called “complex.”

    Symptoms

    A child may have a wide variety of symptoms depending of her type of seizures. Some signs that your child may be experiencing seizures include:

    • staring
    • jerking movements in the arms and legs
    • stiffening of the body
    • loss of consciousness
    • breathing problems
    • loss of bowel or bladder control
    • falling suddenly for no apparent reason
    • not responding to noise or words for short periods of time
    • appearing confused or in a haze
    • extreme sleepiness and irritability when waking up in the morning
    • head nodding
    • periods of rapid eye blinking and staring

    The symptoms of a seizure may resemble other problems or medical conditions. See the Testing tab to learn about how doctors evaluate suspected cases of seizures.

    In an emergency

    • If your child is having a seizure, it can be very frightening. The most important thing to do is to protect her from hurting herself. Here are some guidelines:
      • If your child is sitting or standing, gently ease her to the floor.
         
      • Keep your child’s head from falling backward. You can place a soft object under her head.
         
      • Turn your child on her side. Don’t let her turn over on her back. This will prevent your child from choking in case she vomits.
         
      • Move tables, chairs or other hard objects away so that your child won’t bump into them. (If you can’t move them, gently slide your child away from them.)
         
      • Loosen tight clothing.
         
      • Do not try to open your child’s mouth or place anything between her teeth. This could injure her gums or break her teeth.
         
      • Do not try to stop your child’s movement or try to “shake her out of it.”
         
      • Stay with your child until the seizure stops.

    Contact your child’s doctor right away or call 911 for emergency help if:

    • your child has trouble breathing or if her skin becomes blue
    • the seizure lasts more than five minutes
    • your child remains unresponsive for 30 minutes after the seizure

    You will need to tell your child’s doctor what the seizure was like. Look for such things as:

    • What time is it when the seizure starts? When does it stop? (Time the seizure with a watch, if possible.)
    • Where did the seizures start? (hands, arms, legs, eyes)
    • Did the seizure stay in that part of your child’s body or did it move to other areas?
    • What type of movement did you see? (jerking, twitching, stiffness)
    • Is there anything that you think might have triggered your child’s seizure?
    • Did your child experience anything unusual before the seizure started?
    • Has there been a change in how often your child’s seizures happen or in the type of seizure activity?

    After the seizure:

    • If your child has soiled her pants or vomited, help your child get cleaned up.

    • Let your child rest. She may be very tired and sleep for a few hours.

    • Your child may complain of a headache or soreness. Talk to your child’s doctor about what you can do for her if she’s feeling pain.

    • If your child feels cold, keep her warm with a blanket or coat. Some seizures can be caused by fever, so it’s a good idea to check your child’s temperature (rectally). Contact your child’s doctor any time she has an unexplained fever.

    • Write down your observations about your child’s seizure.

    If this was your child’s first seizure, call her doctor.

    • Your child’s doctor may evaluate your child or have you go to an emergency room.

    • Ask your doctor how you can protect your child in case she has another seizure, and what you should do if she does have one. The guidelines on the What you can do at home tab of our Epilepsy page can also help.

    FAQ

    Q: What is a seizure?

    A: Seizures happen when cells in the brain over-fire, disrupting the brain’s normal electrical signals. Seizures can take many different forms: Some are easy to recognize, such as if your child’s body shakes and she becomes temporarily less aware, whereas some seizures are invisible.

    Q: How common are seizures?

    A: They’re very common. About 5 percent of people experience at least one seizure at some point in their lives, generally during childhood.

    Q: What is epilepsy?

    A: Epilepsy is a condition that makes people more susceptible to having seizures. A child may have epilepsy if she has had two or more unprovoked seizures. There are many possible causes, such as head injuries, brain development disorders, infections or heredity. Usually, however, there is no detectable cause for a child’s epilepsy.

    Q: Are seizures harmful?

    A: They can be. Even small seizures can impact children’s brains. Some children may experience dramatic changes in their behavior and personality. Children can also get injured while they’re having a seizure, and seizures can make them feel very embarrassed. The goal of treatment is to minimize any potential impacts on your child from seizures and to help your child live seizure-free.

    Q: What do I do if my child has a seizure?

    A: There are many different types of seizures; it’s best to talk to your child’s doctor about the right way to respond if she has a seizure. Your doctor may also ask you to keep a record of when the seizure occurs and what your child’s specific symptoms are. For some guidelines about what to do when a child has a seizure, see In an emergency.

    Q: Is there anything I can do at home to prevent my child’s seizures?

    A: Your child may be able to help control her seizures through measures such as getting enough sleep and avoiding stress and flashing lights. Talk to your child’s neurologist about what may be helpful in your child’s case. The guidelines on the What you can do at home tab of our Epilepsy page may also be helpful.

    Q: Will my child’s seizures affect her behavior or school performance?

    A: They could. Seizures are sometimes associated with learning or behavior difficulties or other neurological or psychiatric issues. Talk with your child’s medical team about any difficulties she may be having.

    Q: My child has to come to the hospital for an appointment, testing or a procedure. Should I talk to her about it ahead of time?

    A: Yes. It’s important to talk with children—even young children—if you know a test or procedure is about to happen. Make sure your child gets the information that’s appropriate for her age and level of understanding.

    To read more about talking to your child and getting ready to come to the hospital, go to The hospital experience on the Boston Children’s Hospital's For Patients and Families website

    If you’re coming for an electroencephalogram (EEG), you and your child may also find it helpful to view this walkthrough of an EEG study together.

  • From your child’s first evaluation at Boston Children’s Hospital, we consider you an integral part of the care team. We rely on your observations of your child’s symptoms and work with you to understand her situation and find the right treatment plan.

    If your child is experiencing unexplained seizures, we try to answer these questions:

    • Is your child experiencing seizures, or some other problem that looks like seizures?
    • What type of seizures are they? How many of them are happening, and how serious are they?
    • What is causing your child’s seizures? Do they represent epilepsy?
    • What part of the brain is causing the seizures?
    • How can we manage your child’s seizures and help her live seizure-free?

    You and your child will meet with a neurologist, who will review your child’s medical history and family history and perform a specialized physical exam.

    We may ask you questions such as:

    • At what time of day do your child’s seizures occur?
    • How long do they last?
    • What parts of your child’s body are affected?
    • What is her mental awareness like immediately before and after a seizure?

    To learn about your child’s seizures and to plan treatment, we may perform a number of specialized tests including:

    • blood tests (such as blood sugar, complete blood count, electrolytes and liver and kidney function tests)

    • electroencephalography (EEG), a test that records electrical activity in your child’s brain using tiny wires attached to her head. The instruments are so sensitive that they pick up even small seizures that don’t lead to physical symptoms.

    • brain imaging tests including CT, MRI and PET scans to look for any scar tissue, tumors or brain malformations that may be causing your child’s seizures

    • spinal tap (lumbar puncture) to see if there is an infection or other problems

    These tools help us to accurately diagnose your child’s condition. Many other conditions—such as stroke, fainting, problems with heartbeat or breath-holding spells—can often look like seizures.

    Many of these tests are performed on an outpatient basis, meaning that your child doesn’t have to stay overnight. Specialists in our neurophysiology laboratories perform about 5,000 electroencephalograms (EEGs) each year, making us exceptionally experienced. Our technologists specialize in working with children: Your child will be tested by someone who is dedicated to providing excellent, compassionate care. You can stay with your child throughout testing.

    In addition to studying your child’s seizures, we watch for other problems that may be related to them, such as learning or behavior difficulties or depression. Neuropsychologists on our team use specialized testing to monitor your child’s cognitive abilities, learning, behavior, emotional well-being and social function, in order to develop strategies to help your child function at her highest possible level.


  • At Boston Children's Hospital, we care for children who have epilepsy or who have experienced seizures through the Epilepsy Program, Fetal-Neonatal Neurology Program and many other programs that are dedicated to caring for children with disorders that may cause seizures.

    If your child is experiencing seizures that are triggered by another disease or injury, specialists experienced in treating that condition work closely with our epilepsy and seizure specialists to provide the best possible care for your child. We work together and with your family to help your child live a seizure-free life, and to minimize any complications from seizures.

    Treatment may include:

    • We use a variety of anti-seizure medications. We choose medications for your child based on the type of seizures she's having and her age. We also try to minimize side effects from medication.
       
    • For certain children whose seizures are not well-controlled by medications, we may prescribe a specialized diet called the ketogenic diet. This diet usually has to be started in the hospital, and your child's medical team will provide close follow-up to help your family implement the diet at home and to make sure your child is tolerating it well.
       
    • In certain very severe cases, we may recommend surgery, which generally involves removing the brain tissue where your child's seizures start or preventing their spread. Our team at Children's uses a variety of specialized tests to carefully plan any surgery we are considering and to ensure that it is the best option for your child.
       
    • A relatively new type of treatment for seizures that are hard to control is vagal nerve stimulation (VNS), in which a small pacemaker is implanted under the skin below the collarbone to deliver small pulses of electricity to the vagal nerve, one of the major nerves running along the neck to the brain.

    You can read more about all of these treatments on our Epilepsy page.

    An important part of caring for your child is treating not only the seizures themselves, but any complications they may cause. For example, neuropsychologists use specialized testing to monitor your child's cognitive abilities, learning, behavior, emotional well-being and social function, in order to develop strategies that will help your child function at her highest possible level.

    Experimental treatment

    If existing therapies don't control your child's seizures, or if we believe that experimental methods would improve her treatment, we may recommend a clinical trial. Our team will take care to explain these options to your family. Participation in any clinical trial is completely voluntary.

    You can read more about our research and the new treatments we are developing for children with seizures on the Research and Innovation tab.

    Visit the Clinical Trials and Research to learn about clinical trials throughout Boston Children's.

    Coping and support

    Seizures can be incredibly disruptive and frightening—not only for your child, but for your whole family. From your first visit at Boston Children's, you'll work with a team of professionals who are committed to supporting you.

    There are a variety of resources at Boston Children's to help you and your family through this difficult time:

    Patient education: From office visits to inpatient testing or surgery, our nurses will be on hand to walk you through your child's treatment and help answer any questions you may have. They will also reach out to you by phone, continuing the care and support you receive while you're at Boston Children's.

    Parent to parent: Want to talk with someone whose child has been treated for a similar seizure disorder? We can often put you in touch with other families who have been down a similar road and can share their experience.

    Faith-based support: Your child's seizures and their impact on her may be hard on your whole family. You may also find yourself needing to make difficult decisions about your child's treatment. If you and your family are in need of spiritual support, we can connect you with the Boston Children's chaplaincy. Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during your treatment experience.

    Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses related to coping with illness and dealing with financial difficulties. Many of our programs that care for children with seizure disorders have social workers on their teams, so they've helped many other families whose children have similar conditions.

    To find out more about support services available to families at Boston Children's, you may want to explore the  Family Resources tab of the Boston Children's For Patients and Families website, which also offers information on getting to Children's, accommodations and navigating the hospital experience.


  • Physicians and researchers at Boston Children’s Hospital are constantly looking for safer, more effective treatments to help children live seizure-free.

    Our clinicians and basic researchers work together, so discoveries from the laboratory quickly become new treatments. We typically have several clinical trials going on at any time. Our doctors are:

    • searching for and testing new anti-seizure drugs
    • developing better methods for diagnosing and treating seizures
    • looking for ways to prevent other conditions from triggering seizures
    • evaluating new imaging techniques that help surgeons avoid damaging functional brain tissue

    Developing treatments that work for our youngest patients

    In our Fetal-Neonatal Neurology Program, Janet Soul, MD, director of Clinical Neonatal Neurology, is working to put these breakthroughs to work for our patients. Dr. Soul is leading the first randomized clinical trial of a new seizure medicine for newborns in decades. Learn more.

    Finding the best ways to diagnose seizures

    Babies rushed to the emergency room with seizures and fever often get a spinal tap to rule out bacterial meningitis. But spinal taps are invasive and can be very uncomfortable for children. So Amir Kimia, MD, and colleagues in the Boston Children’s Division of Emergency Medicine are working to determine when spinal taps are really needed. In a recent study, they found that spinal taps probably shouldn’t be done routinely, although they should be done for children who have certain symptoms.

    Learn more

    To read more about our research and new treatment strategies for children who are experiencing seizures, please visit our Epilepsy page.

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