David is a bright and active eight-year-old boy who loved playing in the compound and discovering new things around him. One day, while playing with his toys under the shade of a tree in front of his house, he suddenly fell to the ground and started shaking uncontrollably.

His mom was terrified and quickly called out for help. The neighbours came together, and one of them offered his bike. David’s father quickly got on the bike, and with the help of his mother and a neighbour, they carefully placed David on the bike. With David held between his parents, they rushed to the clinic, hoping he would get better soon.

At the clinic, the doctors ran a series of tests before diagnosing David with a seizure disorder, often referred to as epilepsy.  This meant that he would be at risk for future seizures. For David and his family, this diagnosis was life-changing. 

If you have a child like David, this article will help you learn about seizure disorders in children and how to manage similar cases.  It provides an overview of seizure disorders in paediatrics, including the definition of seizures, common causes, diagnosis, and treatment options. Additionally, it provides coping strategies for parents and caregivers to manage seizures in children and ensure their safety.

What is a seizure?

A seizure is a disorder in which brain cells malfunction and transmit electrical impulses involuntarily, resulting in symptoms that impact other areas of the brain and body. In this case, seizures often cause loss of consciousness and abnormal movements, usually immediately. 

It can result in unexpected, abrupt changes in a child's movements, sensations, cognition, and behaviour. Neurons in the child's brain may freeze excessively during a seizure, resulting in odd feelings, emotions, or behaviours. The seizure may be minor or severe, lasting between a few seconds and several minutes.

Paediatric seizure disorder occurs in approximately 4 to 10 out of every 1,000 children.

Causes of seizure disorders in children

Several possible causes of seizure disorder in children may include the following:

• Genetic factors - some forms of epilepsy may be inherited.
• Brain injury or damage - can occur during birth from infections, head injuries, or strokes.
• Brain malformations - when the brain does not develop properly before birth.
• Infections - such as meningitis, encephalitis, or abscesses in the brain.
• Metabolic disorders - including low blood sugar, electrolyte imbalances, or kidney or liver failure.
• Brain tumours - both benign and malignant tumours can cause seizures.
• Febrile seizures - which occur during high fever in young children.
• Unknown causes - in some cases, no specific cause of the seizure disorder can be identified.

Types of seizure disorders

A seizure can come in different forms, depending on the cause and the part of the brain affected. The common types include:

• Generalised seizures 

They affect the entire brain and can render a child unconscious. They can be atonic or tonic-clonic seizures if they affect the child’s muscles and movement or absence seizures if the child just stares into space or blanks out for a few seconds. Absence seizures were once called petit mal seizures.

• Focal or partial seizures

These seizures might originate in one specific location and result in a limited range of symptoms. If the child does not lose consciousness, the seizure could be simplepartial seizures. Complex partial seizures result in altered consciousness.

Symptoms of a seizure in children 

The symptoms of a seizure vary depending on the type. Common symptoms include:

• Abnormal movements: The seizure may include jerking or twitching the arms, legs, or face.
• Loss of consciousness: The child may appear to stare blankly, become unresponsive or confused, or even fall to the ground.
• Convulsions: The severity of convulsion can range from mild to severe and can include shaking stiffness, and loss of muscle control.
• Change in mood or behaviour: Children may experience sudden changes in mood or behaviour, and may become irritable, aggressive, or anxious.
• Changes in sensations: Children may complain of hearing unusual sounds or seeing flashing lights.
• Loss of bladder or bowel control: A child with a seizure may find it difficult to hold her pee or poop.

Diagnosis of seizures in children

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Seizures in children combine medical history, physical exam, neurological assessment, and diagnostic testing. 

• Medical history: The doctor will ask about the child's symptoms and medical history from the parents or other primary caregivers
• Neurological assessment. This involves a comprehensive neurological examination comprising tests for nerve and sensory functions, gait and balance, etc. 

Management options for seizure disorders

The primary goal of treatment of a seizure disorder is to stop the seizure and, if it can’t be stopped, to control or reduce the frequency and severity of the seizure. These goals may be achieved through: 

• Anti-seizure drugs: Anti-seizure drugs are the mainstay of treatment for children with seizure disorders. The drugs reduce the abnormal electrical activity in the brain. 
• Nutritional therapy: There have been reports of some epileptic children experiencing fewer seizures while following a high-fat, low-carb ketogenic diet.
• Cognitive-behavioural therapy (CBT) is a form of treatment that can be used with other therapies to help children with seizure disorders manage their disease's emotional and psychological aspects.
• Vagus nerve stimulation (VNS) is a noninvasive medical procedure that involves implanting a device beneath the skin of the chest and connecting it to the vagus nerve in the neck. VNS stimulates the brain with electrical impulses, which lessen the frequency and intensity of seizures.
• Surgery: For kids with seizure disorders, surgery may occasionally be advised to remove the portion of the brain producing the seizures without causing greater harm to the healthy brain tissue.

Coping strategies for parents and caregivers of children  having a seizure disorder

Having a child with a seizure disorder can be challenging and stressful for a parent or caregiver.  To help you cope, try:

• Working closely with a paediatric neurologist to create a personalised treatment plan for children with seizure disorders. Identifying and addressing any sign of seizure disorder early can improve treatment outcomes and reduce the risk of complications.
• Ask for help: Connect with other parents and caregivers whose children have similar challenges. Join a support group, attend seminars or conferences, or consult a therapist or counsellor who focuses on helping families dealing with seizure disorders.
• Make self-care a priority: Make time for leisurely pursuits like reading, jogging, and socialising with friends. These activities can help you unwind. When you need a break, take one, and if you require assistance, ask friends or family for assistance.
• Create an action plan for seizures: Consult with your child's doctor to create an action plan that specifies what to do during a seizure. If you have a strategy, you may feel more prepared and confident in controlling your child's seizures.
• Create a safe space for your child. This may entail clearing your child's room of sharp or harmful things, setting up safety equipment like bed rails or epilepsy helmets, and instructing other family members and caregivers on handling seizures.