Epilepsy is a fairly common condition in Singapore – about 150 new cases of epilepsy are diagnosed each year. In this article, we examine childhood epilepsy symptoms, diagnosis and safety measures parents and caregivers should take at home to keep an epileptic child safe during a seizure.
Childhood epilepsy symptoms, causes
Epilepsy is a neurological condition which affects the central nervous system, causing abnormalities in the brain which can lead to seizures and unusual behaviour.
There are many underlying causes of epilepsy.
These range from the child being born with a genetic tendency to have seizures, a structural brain abnormality either from the brain not developing properly, or from previous infections or injury. In many cases, a definitive cause may not be found despite extensive investigations.
An epileptic child has a tendency to have seizures. There are many different types of seizures, and the type of seizures that each child has depends on the area of the brain that is affected.
During a seizure, the brain’s electrical signals are disrupted. Examples of the types of seizures include repetitive stiffening and jerking of the whole body (generalized seizures) or part of the body (focal seizure), staring episodes, or just an unusual sensation or feeling such as feeling scared, or having ‘butterflies in the stomach’.
The child may be aware of what is happening, but unable to stop the movements or feelings, or the child can be unconscious and have no recollection of the event.
Symptoms of epilepsy would depend on the type of seizure, which can be classified into two major groups – focal seizures or generalised seizures.
Focal seizures, also known as partial seizures, occur when the electrical activity remains only on one side of the brain. On the other hand, generalised seizures affect both sides of the brain due to seizure activity throughout the brain.
Here are some general symptoms of focal seizures and generalised seizures:
Symptoms of focal seizures
- Dizziness
- Involuntary jerking of an arm or leg
- Staring into space
- Performing repeated movements such as lip-smacking or chewing actions in the mouth even when not eating, or rubbing hands together for no reason
Symptoms of generalised seizures
- Loss of consciousness – usually lasting from 30 seconds to 5 minutes
- Stiffening of muscles in the back, arms or legs
- Sudden jerks of the neck, arms and legs
- Inability to control urination or bowel movements
- Tongue biting which can result in excessive bleeding
How is epilepsy diagnosed?
Clinical suspicion of epilepsy arises when a child has 2 or more seizures. A detailed history of what happened before, during or after the event, or a video recording of the event is extremely helpful in aiding the doctor with the diagnosis.
Tests that may help to provide more information include an electroencephalogram (a test which records the electrical activity of the brain) and possibly an MRI of the brain.
Paediatric neurologists are children’s doctors who specialise in the brain and they help to make the diagnosis, arrange tests as well as discuss further medications such as anti-epileptic medications with the child and family.
Different types of epileptic seizures in children and what triggers them
The two major groups of seizures, focal seizures and generalised seizures, can be further broken down into sub-categories such as the following:
Focal seizures
- Simple focal seizures
These seizures affect how your senses react. For example, something can smell or taste strange. In addition, muscle activity may also be affected where you will feel your fingers and limbs twitching, or a part of your body to have jerking movements. Some people may experience autonomic symptoms such as changes in heartbeat, blood pressure, or bowel or bladder function.
- Complex focal seizures
These are often preceded by simple focal seizures. They commonly occur in the area of the brain that controls memory and emotion and can usually last for 1 to 2 minutes. You may exhibit a variety of behaviours such as screaming, crying, running or repeated actions such as smacking of the lips.
Generalised seizures
- Absence seizures
You tend to stare into space and become unresponsive to others around you. At times, the eyes might roll back in the head for a few seconds, unaware to you. Such seizures can happen several times a day and are sometimes mistaken for a learning or behavioural problem.
- Atonic seizures
During a seizure, your muscles will suddenly go limp and cause your head to drop forward or your whole body to collapse. For such seizures, you are usually not fully aware during the event and are not responsive to anyone.
You might get bruises, cuts, or other injuries without knowing and would need first aid. For more serious injuries such as a broken bone or head injury, you will need to go to an emergency room. Such seizures can be dangerous, especially for people who are alone when the seizure happened.
- Myoclonic seizures
This type of seizure refers to a sudden jerk in the muscles as if you have been shocked. These seizures can occur multiple times a day for several days in a row.
- Tonic-clonic seizures
These seizures are the most common and best-known type of generalized seizure. They will cause the body to stiffen and shake while you lose consciousness.
As this type of seizure can lead to breathing problems or cause someone to bite their tongue or cheek, it is crucial for people around to call for medical help.
Common triggers are usually lack of sleep, intercurrent illnesses or missed medications.
What are the safety measures parents and caregivers should take at home to keep an epileptic child safe during a seizure?
Here are some tips when an epileptic child is experiencing a seizure:
Do’s:
- Try to stay calm
- Turn the child gently to rest on one side to prevent choking
- Move away any objects or furniture nearby that could potentially hurt the child
- Place something soft and flat under the child’s head such as a folded jacket, cushion or pillow to prevent head injuries
- Wipe away any saliva or discharge from the outside of the mouth to prevent it from running back down the throat or nasal passages which can cause the child to choke
- Time the seizure. Seek medical help immediately if the duration lasts more than 3 minutes and is not stopping
- Monitor and watch the child during and after the episode
Don’ts
- Do not force open the child’s mouth or try to put anything in it as it can break the teeth, injure the mouth or cause the child to accidentally swallow the object
- Do not restrain the child or stop any movements as it can cause injuries and make the child more confused, agitated or aggressive
What are the possible impacts of epilepsy on a child’s life?
We encourage children with epilepsy to participate in the same activities as their peers. However, we do recommend that caregivers take simple measures to make these activities safer.
Examples are closely supervising swimming, wearing helmets during cycling or scootering. Activities involving heights such as rock climbing are not advised. First aid measures are taught to the families and should be given during a seizure.
As a child grows older, they may feel different in front of their peers or they may start to question why they have to take regular medications for their condition. It is important to encourage them to talk about their feelings and address any concerns that they may have.
On the whole, many children may not be able to get a holistic learning experience in school or at home due to inadequate social skills and poor self-esteem. This can continue to affect the child’s life as they are growing up.
Hence, it is important not just for family members and health care providers, but also educators and the general public to understand epilepsy in order to provide a more conducive and inclusive learning environment for epileptic children.
This article was contributed by Dr Wendy Liew, Paediatrician (special interest in paediatric neurology), SBCC Baby & Child Clinic (A member of Healthway Medical Group)
Her areas of expertise include paediatric neurological diseases, especially neuromuscular diseases such as myasthenia gravis, spinal muscular atrophy and Duchnne muscular dystrophy.
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