If a child has a seizure, it does not mean they have epilepsy. The number of seizures and the time frame when those seizures happen are important to diagnose epilepsy, a brain disease where normal nerve activity becomes abnormal.

Epilepsy is two unprovoked seizures separated by 24 hours. Unprovoked means there was not another underlying cause, like sodium levels that could mean a nutrition problem. Seizures can happen when a child is awake or sleeping.

Types and causes of seizures

There are several types of seizures, and a person with epilepsy can have multiple types. Dr. Collin Swafford, a pediatric neurologist at Arkansas Children’s Northwest in Springdale and assistant professor of Neurology at the University of Arkansas for Medical Sciences in Little Rock, explained the two most common types:

  • Tonic-clonic seizures; a child’s body can be stiff and experience jerking of their limbs. But the jerking is rhythmic, not sporadic. Some experience eye-rolling, foaming at the mouth, vomiting, losing consciousness and biting their tongue. A child having this type of seizure won’t be able to follow directions or even answer their name. It can last seconds or a couple of minutes, with most seizures stopping at two minutes. Parents of children with epilepsy that experience longer seizures frequently are given rescue medication to stop the seizures quicker. 
  • Absence seizures; a child can suddenly have a staring spell. If a person reaches out and touches them, they do not respond. These seizures can last seconds to less than a minute on average. These are difficult to detect. Teachers and therapists who regularly see a child are often the first to recognize these seizures and tell the parents. These occur more in elementary-school-aged children. Most children will outgrow these seizures.

Seizures not diagnosed as epilepsy can happen for a variety of reasons. The most common cause for a seizure in children 6 months to 6 years old is a febrile seizure caused by a fever. Because a child's nervous system is still maturing, the rapid onset of a high fever can cause a seizure that includes convulsions or shaking. It's common for formula-fed babies to have a seizure if the formula is mixed wrong and the salt content is off. A seizure can also be commonly mistaken for a fainting spell.

Rarely, epilepsy can be caused by an issue with the way the body uses energy or a metabolic problem. For some of these kids, a low-carb/high-fat diet (ketogenic diet) can be used as a treatment for seizures and seizure medications.

A person who does not have epilepsy can have one seizure, never have another or multiple seizures weeks, months or years apart.

Getting an epilepsy diagnosis

In 2021, the ACNW Neurology Clinic had 867 patients across 1,339 in person and telehealth visits with a diagnosis of seizure or epilepsy.

Swafford, who started working at ACNW in March 2022, compared epilepsy and seizures to an electrical malfunction. In the way a TV or computer screen flickers, the brain can also "flicker." Sometimes, the brain keeps going, but when it stops, that's when a child experiences a seizure.

There are many types of epilepsy, but the most common for children fall into four common categories:

  • Genetic; The way a child's DNA is structured can cause seizures. There may be no clear answer from the DNA. In that case, doctors categorize it as idiopathic or not relating to any underlying condition, and it's unknown what exactly is causing it.  
  • Structural problem; The brain structure itself is abnormal. It can mean wrinkles and grooves of the brain shape could be twisted, too wide or small or the brain itself is too large or small.
  • Trauma; The brain has experienced trauma that caused an injury, such as a brain bleed from an accident, like a car crash, fall or drowning incident, or abuse.
  • Infectious; The brain is damaged from severe infection.  

The frequency of seizures varies on the type of epilepsy, Swafford said, adding some children could have anywhere from two a year or 30 in one day.

A child as young as a newborn can be diagnosed with epilepsy. A baby in utero can also have a seizure, which sounds similar to rhythmic hiccupping. However, it is hard to detect. If a child is born with developmental issues, needs NICU-level care or starts having seizures, doctors can sometimes look back and reasonably say the child may have been experiencing seizures in the womb.

After a child has experienced what is likely a seizure and a parent or guardian makes a clinic appointment, Swafford pointed out the steps to being diagnosed with suspected epilepsy:

  • Medical history and physical exam to make sure it checks off the boxes to be a possible seizure.
  • A brainwave test, also called an electroencephalogram or EEG. Sensors are placed on the child's head with microphones that read brainwaves. It is not painful and can be short or last a couple of hours. Because it's a snapshot in time, it can look normal, but it can also detect a pattern of extra or decreased electrical activity.
  • Sometimes, a doctor orders an MRI that may require sedation for an hour. Swafford said it's not always needed.
  • Blood tests to check for signs of infection, genetic conditions, blood sugar levels, etc. A doctor may order a different set of labs if a sick child comes to the Emergency Department rather than a clinic visit.

There are three neurologists at ACNW who treat a variety of neurological conditions. Swafford said they are focused on community-centered care, helping to see patients quickly and working with area pediatricians.

"We're all communicating with one another because it does have that small-town feel. Whereas other places are taking care of the entire state, so they may be a little bit more disconnected," Swafford said. "There are great hospitals in this area that see mostly adults. We see these kids all the time, and we're very comfortable caring for them. We're also well-connected with the Arkansas Children's Hospital crew in Little Rock. So if there's a resource we don't have or a need, we always collaborate with Little Rock."

How is epilepsy treated?

Medications typically treat epilepsy. If a child has tried several medications and it is not controlling the seizures, Swafford said he recommends they visit the Comprehensive Epilepsy Program in Little Rock. They then see an epileptologist, a child neurologist with extra training in complicated epilepsy, and a neurosurgeon. For severe cases, some surgery options include a vagus nerve stimulator, an implantable device like a pacemaker for the heart that wraps around the vagus nerve to slow down brain activity related to seizures; or removing a piece of the brain causing the seizures.

Caregivers may opt for no testing or treatment if a child has one or infrequent seizures. Some children outgrow epilepsy, while others have lifelong treatments, depending on the type of epilepsy, Swafford said. Every family is different when deciding to take a child experiencing a seizure to the Emergency Department. Families with a child diagnosed with epilepsy who has experienced several seizures may not take their child to the ED as opposed to a family experiencing it for the first time. Swafford said families that live far away from a hospital might opt to have rescue medications on hand.

Swafford said some ways to help naturally reduce seizures include:

  • Getting enough sleep
  • Staying healthy; some children with epilepsy have to adjust their medications while sick
  • Nutrition; three meals a day with snacking, so children do not go hungry

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What To Do If My Child is Having a Seizure

Dr. Collin Swafford, a pediatric neurologist at Arkansas Children’s Northwest in Springdale and assistant professor of Neurology at UAMS, shared several tips on what to do if your child is having a tonic-clonic seizure:

  • Stay calm
  • Put the child on a flat surface and turn them on their side. If they are experiencing a seizure in bed, keep them in bed, but make sure they cannot fall. If they are in a chair, move them gently to the floor.
  • Turn them on their side. Some children vomit when experiencing a seizure, and it's crucial they do not breathe in vomit.  
  • Do not stick anything in a child's mouth, even if they are biting their tongue. They will not swallow their tongue. If they are choking on food, pat them on the back but do not reach in to retrieve the food.
  • Do not restrain their arms and legs. Being held down can cause injury. Make sure they can't hurt themselves.
  • Rescue medication can be given at the three-to-five-minute mark after the seizure starts. It can take a few minutes to take effect.  

For children with absence seizures, typically short staring spells, there is no need to move them, but they need to be watched. Children with seizures should be supervised appropriately at playgrounds, around water and have someone with them while crossing the street.