How to Deal With Seizures in Children

Seven Methods:How to Deal with Seizures at HomeUsing Medication to Treat SeizuresAdjusting Your Child’s DietUsing Nerve Stimulation Treatment and Biofeedback TreatmentUsing Other Surgical TreatmentsRecognizing the Symptoms of a SeizureUnderstanding the Causes of a Seizure

Seizures, also known as fits or convulsions or epilepsy, are characterized by jerky movements of the body, during which the child loses consciousness and is unaware of his/her surroundings. In fact, it might look like your child has received an electric shock.

Part 1
How to Deal with Seizures at Home

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    Do not try to stop your child’s convulsions. They cannot be manually prevented or slowed down, so the most important thing you can do is prevent the child from getting any additional injuries during the seizure.
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    Have your child lie down or help them lie down. If they start to convulse, get them to lie on their side to keep their throat clear and allow any allow secretions like saliva or vomit to drain.
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    Remove their glasses, if necessary. This will prevent any hazards caused by broken glass around their face.
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    Move your child away from potential hazards, such as a stove, furniture, stairs, or traffic. Try to keep them in an open, empty area.
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    Do not put anything in their mouth to prevent them from biting their tongue. This can lead to an injury to your child or to yourself.
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    Allow your child to sleep after a seizure if they are tired. Make sure you remain with them until they wake up.
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    Check their breathing as they sleep. If they are not breathing after the seizures have stopped, begin mouth-to-mouth rescue breathing (CPR).
    • Don’t try to administer CPR while your child is in a convulsive seizure, as this may lead to an injury to your child or yourself.
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    Avoid giving your child any food, water, or oral medication right after they have a seizure. They will likely be in a state of confusion and will either refuse the medication or be unable to take it.

Part 2
Using Medication to Treat Seizures

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    Be aware that seizure treatment for children is different than for adults. Often, the doctor does not start with the medicines right away, once your child has their first episode of seizure as it might just be a single, isolated episode.
    • Most anti-convulsion medicines have side effects that lead to liver damage[1] and damage to teeth, so most doctors avoid starting long term medications until a clear case of epilepsy has been diagnosed.
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    Allow your child’s doctor to administer Lorazepam to stop their seizures. This drug helps by inhibiting the GABA (Gamma aminobutyric acid) neurons that fire from your child’s brain continuously during a seizure. But, it should be used only as a drug to stop a seizure and not as a way to treat your child’s seizures in the long term.
    • The dosage for children is 0.1mg/kg, with the maximum dose being 4 mg/kg. It is usually given at 2 mg/minute intravenously i.e through your child’s veins and is administered every five minutes until the seizure stops.
    • If the vein is difficult to find, other routes like sublingual (placing the tablet below the tongue) or per rectal (inserting tablet through the anal opening) may also be used. In these cases, the dose is 2mg/ml in saline that is injected into the anus to curb the seizures.[2]
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    Let your child’s doctor administer Midazolam to ease your child’s seizures. Your child’s doctor can give your child this drug in several ways, including:[3]
    • Through an I.V. This the best, more preferred way to administer the drug, as it will reach your child’s bloodstream very fast. The dose is 0.1mg/kg.
    • Orally. Your child’s doctor may give your child Midazolam as a pill if their seizure is too rapid for an I.V. The dose is 0.5mg/kg, which is administered every five minutes up to two times a day.
    • Through their nose. If your child is not agreeing to the I.V. or to swallowing a pill, the doctor may give administer Midazolam as a spray that your child can puff through their nose. Each puff is 0.1mg/kg, so two puffs in each nostril will sedate your child. If you are treating your child’s seizures at home, you will likely be advised to use this option as it has the least side effects. But take your child to the hospital immediately if they experience increased seizures.
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    Be aware of the side effects of Lorazepam and Midazolam. The most common side effects of these drugs include sedation, hypotension, and respiratory depression.
    • Since these drugs abolish the GABA (Gamma aminobutyric acid) pathway that helps to stimulate your child’s receptors and muscles, exceeding the prescribed dosages of these drugs can lead to these side effects. These drugs should only be given in a hospital by medical professionals and closely monitored.[4]
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    Let your child’s doctor administer Phenobarbital as a last resort. If any of the other drugs fail to control your child’s seizures, this drug is used.
    • The dose is 20 mg/kg and can only be increased up to 1000 mg.
    • It is administered at 1 mg/kg/min and is mixed in saline. It will be given over a period of 20 minutes. It is also the first choice of medicine for babies suffering from seizures who under 30 days of age. [5]
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    Ask your child's doctor to prescribe Sodium Valproate. This is the most commonly used drug to treat generalized seizures.
    • The dose is usually 5 ml per day for a period of 1 to 2 years and can be given as a 100 mg tablet to children 10 years and older. They should consume only one tablet every day at the same time for 1 to 2 years.
    • This drug balances the electrical activity in your brain by allowing the right amount of sodium and potassium changes. But it shouldn’t be given to children with kidney or heart problems.
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    Have a qualified pediatrician or neurologist analyze your child and prescribe anti-epileptics. These drugs are used in the treatment and prevention of seizures. They start at a low dose and gradually increase until the seizures are brought under control. These medications work by inhibiting the over-excitation of the neurons in your child’s brain that lead to seizures.
    • Diazepam reduces the electrical over-activity of your child’s brain and relaxes the muscles that contract to produce seizures. Generally, children are given a lower dose of Diazepam, even if their body weight is equivalent to an adult. The adult dosage is 3-10 mg divided into several doses.
    • Carbamazepine is given in doses based on age. In children younger than 6 years old, an initial dose of 10-20 mg per kg body weight is given. For children between 6-12 years old, the initial dose is 100mg twice a day and in children older than 12 years old, the initial dose is 200 mg twice a day.
    • Ethosuximide is used in the treatment of petit mal (absent) seizures. In children between 3-6 years old, the initial dose is 250 mg/day and in children older than 6 years old, the initial dose is 500 mg/day.
    • You may also get a prescription for Lamotrigine. In children 12 years and older, the initial dose is 25 mg once a day.
    • Phenytoin is used in the treatment of complex partial seizures, grand mal (generalized) seizures and seizures during or after surgery. The initial dose is 5mg per kg per day.
    • Gabapentin is used in to treat partial seizures. The dose is 10-15 mg per kg per day in children between 3-12 years of age.
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    Make sure your doctor conducts regular blood checks and liver function tests if your child is taking anti-epileptics. Your child’s doctor should follow the drug levels in your child’s body and also monitor any side effects due to the medication.
    • Keep in mind it will take time for your child to adjust to the medication.
    • While it is more preferred for your doctor to prescribe just one drug for your child’s seizures, your doctor may prescribe another drug to control the seizures if needed.
    • If your child is taking medication on a regular basis, the drugs should be tapered over a period of time until your child’s doctor is convinced your child is starting to recover.
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    Give your child melatonin tablets to increase the amount of melatonin in their brain. Melatonin is a hormone secreted by a small gland deep inside your child’s brain called the pineal gland. It controls our sleep-wake cycle, so it’s possible that by increasing the amount of melatonin in your child’s brain, they can reduce the risk of seizures brought on by fatigue, as it induces sleep.
    • In children, a dose of 3mg melatonin before bedtime along with the anti-epileptics can have therapeutic effects.[6]

Part 3
Adjusting Your Child’s Diet

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    Ask your child’s neurologist about a ketogenic diet. This is a special diet that has been found to be effective at treating seizures and can be used as an alternative therapy for children who do not respond to conventional drugs.[7]
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    Understand how a ketogenic diet works. This diet consists of low carbohydrates, moderate proteins and is high in fat content, as a typical ketogenic diet provides 3 to 4 grams of fat for every 1 gram of carbohydrate and protein. With this diet, your child’s body is forced to burn fats instead of carbohydrates.
    • Under normal circumstances, the carbohydrates consumed in food are transformed into glucose, which is then used mainly for the brain function. But since there are very little carbohydrates in a ketogenic diet, the liver comes into play and transforms fats into fatty acids and ketone bodies. This ketone then reaches your child’s brain and replaces glucose as the source of energy.
    • Increased levels of ketones in the blood lead to ketosis which in turn decreases the frequency of epileptic seizures.[8] In fact, this diet reduces seizures by about 50% in children below 10 years old.[9]
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    Consult with your neurologist and a nutritionist before putting your child on this diet. Working together with these medical professionals will ensure you find the best way to apply this diet for your child.

Part 4
Using Nerve Stimulation Treatment and Biofeedback Treatment

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    Ask your child’s doctor about vagus nerve stimulation treatment (VNS). This treatment is gaining momentum in the treatment of drug resistant seizures.[10] It helps to shorten or abort seizures altogether. In fact, many people who undergo VNS experience a significant (more than 50%) reduction in the frequency of their seizures, as well as a decrease in seizure severity.
    • It is not known exactly how VNS works. But the vagus nerve is an important pathway to the brain, so one possible way this treatment works is that by stimulating the vagus nerve, electrical energy is discharged upward into a wide area of the brain, disrupting the abnormal brain activity responsible for seizures.[11]
    • Another theory suggests that stimulating the vagus nerve causes the release of special brain chemicals that decrease seizures.[12]
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    Understand how vagus nerve stimulation treatment works. Your child will be put under general anesthesia for the procedure. A stimulator device about the size of a silver dollar is surgically placed under your child’s skin, in the upper part of their chest. A connecting wire is run under their skin from the stimulator to an electrode that is attached to the vagus nerve, which is accessible through a small incision in their neck.[13]
    • Once the stimulator is implanted, it is programmed to generate pulses of electricity at regular intervals, depending on your child's tolerance. For example, the device may be programmed to stimulate the nerve for 30 seconds every five minutes.
    • The settings on the device are adjustable, so the electrical current is gradually increased as your child's tolerance increases. Re-programming the stimulator can be done at the doctor's office.
    • Your child will also be given a hand-held magnet, which when brought near the stimulator, can generate an immediate current of electricity to stop a seizure in progress or reduce the severity of the seizure.
    • Keep in mind VNS is an add-on therapy, so it should be used in addition to another type of treatment, like seizure medication. If your child is using VNS, their doctor may reduce the dosage of their medication.
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    Be aware of the risks and side effects of VNS.These include injury to your child’s vagus nerve or nearby blood vessels, including the carotid artery and jugular vein.[14]
    • With any surgical procedure, there are also risks such as infection, bleeding and an allergic reaction to the anesthesia.
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    Get a referral for a biofeedback specialist for your child. Biofeedback is a treatment technique where your child is trained to improve their health with the help of information and signals from their own bodies.[15]
    • Biofeedback is used in treating various disease conditions by specialists to relax patients, to reduce their pain, and reclaim normal functioning.
    • In a case of epilepsy, the form of biofeedback used is called neurofeedback. It is used to teach patients to control their brain activity consciously and thereby prevent seizures.

Part 5
Using Other Surgical Treatments

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    Ask your child’s doctor about lesionectomy surgery, but keep in mind this is major surgery. In this surgery, isolated brain lesions that are injured or a defect like a tumor or an abnormal blood vessel causing seizures only are removed. Though this is a drastic option, recovery is quick and mostly complete.
    • The results of a lesionectomy are great once the exact lesion has been identified.
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    Talk to your child’s doctor about surgery on your child’s Corpus callosum. These are a band of nerve fibres that connect the two halves of the brain’s cerebrum.
    • In this operation, a part or entire callosum is cut, disabling the communication between both hemispheres of the brain. This prevents the seizures from spreading from one side of the brain to the other side.
    • The usefulness of this surgery is limited and it is only rarely performed in children with ‘drop attacks’.
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    Discuss multiple subpial transection (MST) surgery with your child’s doctor. In this procedure, the surgeon makes a series of shallow cuts on your child’s brain tissue to interrupt any seizure impulses but does not harm their normal brain activity.
    • This is used in epileptic cases where the area of focus cannot be removed safely.
    • Due to the plasticity of your child’s brain, the brain quickly makes up for the minor deficits that might occur. So, the earlier the surgery is done, the better the results.
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    Talk to your child’s doctor about lobe resection, but be aware of how invasive the procedure is. In this surgery, the point where the impulse discharge of seizure occurs is removed by removing that lobe of the brain. E.g. frontal lobe removal, etc. This is an extremely drastic measure undertaken only when survival becomes more important than meaningful survival.
    • Resection of an entire lobe of the brain has many downsides as it means loss of all the functions that the lobe performed.
    • The recovery is rapid due to plasticity of a child’s brain to recuperate fast, but some permanent deficits like language and memory, depending on the lobe removed, will occur.
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    Ask your child’s doctor about functional hemispherectomy surgery but be aware it is a drastic option. In this surgery, one hemisphere is disconnected from the rest of the brain, but only some part of the brain tissue is removed.
    • This is a last stand surgery and is rarely ever performed.

Part 6
Recognizing the Symptoms of a Seizure

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    Check if your child stares or blinks with no awareness of their surroundings for a few seconds to a few minutes. Your child may be suffering from a simple absence seizure or petit mal seizure.
    • These short episodes will start and stop suddenly. Your child will likely return to normal as soon as the seizure stops. There will be no falling down, tongue biting or frothing at the mouth that you may find during a more severe convulsion.
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    Pay attention if your child continually chews, smacks their lips or claps, and then lapses into a confused state. They may be suffering from a complex partial seizure.
    • Partial seizures generally affect just a small group of muscles that spasm and move convulsively.
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    Notice if your child experiences rhythmic jerking and muscle spasms for 2-5 minutes. These convulsions are sometimes accompanied with difficulty breathing and rolling of their eyes. They may also froth at the mouth and bite their tongue. These are symptoms of generalized and febrile seizures.
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    Be aware your child will be sleepy and confused after a convulsive seizure. They may also not remember they had a seizure. This stage of drowsiness is known as the aural phase.
    • Your child should return to normal within 15 minutes but may suffer from fatigue for about a day after the seizure.
    • They may also suffer from constipation. Occasionally, jerking during a seizure leads to injuries that range from a bite on their tongue to a broken bone.
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    If your child is younger than 2 years old, notice if they have seizures that last more than 30 minutes. They are likely experiencing a very serious type of seizure called status epilepticus, which is a symptom of epilepsy. In this condition, your child may also have repeated seizures over quick intervals without returning to a stage of normalcy in between each seizure.[16]

Part 7
Understanding the Causes of a Seizure

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    Check if there is a history of seizures in your family. Certain types of epilepsy seem to run in families. As well, your child could inherit a low seizure threshold. Individuals with a lower seizure threshold are more likely to have seizures.[17]
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    Have your child checked for an upper respiratory infections or infections that cause high fever. These conditions can lead to the development of a febrile seizure, which is the most common type of seizure found in children.[18]
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    Get your child tested for zinc deficiencies. This can be a probable cause of febrile seizures in children.[19]
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    Check if your child is suffering from meningitis, metabolic disorders or a head injury. Other conditions like cerebral palsy,[20] bleeding in the brain, ingesting certain poisons, and taking certain medicines[21] can lead to the firing of excessive electrical impulses in the brain, leading to a convulsion or seizure.
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    Understand why seizures occur. Seizures are caused by abnormal electrical discharge from the brain. Our brain needs electronic impulses to function so we have hormones in our brain that stimulate and inhibit electrical impulses. A decrease in these impulses leads to seizures.
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    Recognize the two different types of seizures. Your child may experience either of these types.
    • A partial seizure involves excessive impulses being fired from only a part of the brain, so only a part of the body is affected.
    • A generalized seizure involves a much larger portion of the brain and often affect the entire body as one unit.

Sources and Citations

  1. Björnsson ES. Epidemiology and risk factors for idiosyncratic drug-induced liver injury. Semin Liver Dis. 2014 May;34(2):115-22.
  2. Wilder BJ. Efficacy of phenytoin in treatment of status epilepticus. Adv Neurol 1983;34:441
  3. [McIntyre J, Robertson S, Norris E, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: A randomised controlled trial. Lancet 2005;366:205-10.] [Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M. Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: Prospective randomised study. BMJ 2000;321:83-6.]
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Categories: Neurological Disorders