Seizures in Children: Causes, Symptoms, and Diagnostic Measures

Epilepsy is a neurological disorder characterized by episodic dysfunction of the central nervous system caused by sudden and transient excessive discharge of nerve cells in the brain. It affects individuals regardless of age or gender, with varying incidence rates across different populations. 

Among all age groups, epilepsy in children is the most common form of the disease, accounting for a significant percentage of cases. This article aims to provide an overview of seizures in children, including their causes, symptoms, and diagnostic measures.

Epilepsy Overview

Epilepsy manifests as repetitive and sudden attacks, causing disturbances in neurological functions. These attacks are characterized by specific patterns and are identifiable through electroencephalogram (EEG) recordings that show paroxysmal waves. Epilepsy can occur at any age, but its prevalence varies among different age groups. 

In children, the incidence of epilepsy is highest, with approximately 50.5% of cases appearing before the age of 10 and 75% occurring before the age of 20. Furthermore, epilepsy tends to increase again after the age of 60.

Causes of Epilepsy in Children

Seizures in children can be attributed to various factors:

Inheritance: Epilepsy can be inherited through autosomal dominant or autosomal recessive patterns. Recent studies have identified specific genetic alterations, such as alterations in chromosome 20, associated with benign familial neonatal epilepsy.

Factors occurring before birth: Maternal trauma during pregnancy, maternal drug poisoning (including severe lead poisoning), and fetal skull stenosis can contribute to epilepsy in children.

Factors occurring during delivery: Severe postpartum hypoglycemia accompanied by respiratory failure, premature birth (before 37 weeks) with low birth weight (less than 2,500g), and birth asphyxia are potential causes. Cerebral kernicterus, a condition characterized by neonatal jaundice accompanied by neurological signs, can also lead to epilepsy.

Factors occurring after birth: Nerve infections (encephalitis, bacterial/viral meningitis), brain injury at birth (cerebral-meningeal bleeding, traumatic brain injury), severe respiratory failure of various causes, and progressive metabolic diseases can trigger seizures in children.

Unknown cause: In some cases, the exact cause of epilepsy remains unclear.

Signs of Epilepsy in Children

The clinical presentation of seizures in children is often sudden and transient, with a wide range of symptoms. These symptoms may include dyskinesias (spasticity, convulsions, loss of voluntary movement, atony, and excessive salivation), sensory disturbances (pins and needles, blurred vision, tinnitus, dizziness, electric current-like sensations), and mental disorders (anxiety, fear, memory disorders, hallucinations, mental retardation, behavioral disorders).

Specific types of seizures in children include:

Generalized Seizures

Absence seizures: Characterized by episodes of confusion or loss of consciousness within a short period. They can involve immobility, blurred vision, interruption of ongoing activities, slight twitching of eyelid or mouth muscles, postural atony, hypertonia, and vasomotor disturbances.

Myoclonic jerks: Short, lightning-like, symmetrical muscle jerking movements that can cause the child to fall without losing consciousness.

Convulsions: Sudden twitches on both sides of the body, often associated with high fever.

Hypertonic episodes: Muscle spasms without tremors, lasting from a few seconds to a minute, with or without disturbances of consciousness and vegetative symptoms.
Atony episodes: Episodes of loss or hypotonicity, which can manifest as
folding or dropping of the head, or the child falling to the ground with completely flaccid muscles.

Spastic-convulsion (major seizure): Characterized by the loss of consciousness, muscle spasms, possible tongue biting, and subsequent bilateral muscle twitching. It may also involve autonomic disturbances such as tachycardia, increased blood pressure, dilated pupils, blushing, and may lead to temporary cessation of breathing. 

The post-clinical phase includes symptoms like reduced muscle strength, cloudy consciousness, bed-wetting, increased sputum production, headache, and body pain.

Partial Seizures

Simple motor seizures: Convulsions affecting specific body parts without loss of consciousness. This can involve finger or toe convulsions, facial asymmetry, or eye, head, body, and hand movements.

Simple sensory and sensory partial seizures: Sensory disturbances on the opposite side of the body, such as the sensation of ants crawling, pins and needles, or electric shock-like pain. Children may also experience hallucinations, visual impairments, ringing in the ears, unpleasant odors, dizziness, or taste disturbances.

Simple partial seizures with vegetative symptoms: Manifestations may include increased salivation, swallowing, chewing, nausea, palpitations, changes in skin color, bed-wetting, and shortness of breath.

Simple partial seizures with psychotic symptoms: Children may experience speech impairment, slurred speech, feelings of familiarity or unfamiliarity, hallucinations, discomfort, fear, anxiety, or abnormal thirst and hunger sensations.

Complex partial seizures: Characterized by the loss of consciousness from the beginning, accompanied by automatic mouth movements, hand movements, or other purposeless actions. The child may be unresponsive or exhibit behaviors such as rubbing, scratching, or organizing objects. In some cases, the child may utter sounds, cry, or say words or sentences.

Diagnostic Measures

Accurate diagnosis of childhood epilepsy involves a range of tests and assessments, including:

Blood tests: Complete blood count, liver function tests, blood sugar levels, electrolyte levels, and blood calcium levels are examined to identify any underlying metabolic or systemic causes.

Electroencephalogram (EEG): This test records the brain's electrical activity and helps identify specific seizure patterns and abnormalities associated with epilepsy.

Brain magnetic resonance imaging (MRI): An MRI scan provides detailed images of the brain, allowing for the identification of structural abnormalities or lesions that may be responsible for seizures.

The diagnostic criteria for epilepsy in children include the presence of directional, brief, and repeated episodes; disturbances in nerve functions related to movement or sensation; loss of consciousness during seizures (except for simple partial seizures); rapid recovery after seizures; and EEG findings showing paroxysmal waves associated with seizures.

Conclusion

Seizures in children can have various causes, including genetic factors, prenatal and perinatal complications, and postnatal conditions. The signs and symptoms of epilepsy in children are diverse and can range from motor and sensory disturbances to mental disorders. 

Accurate diagnosis often involves blood tests, EEG recordings, and brain imaging. Early detection and appropriate management are crucial for optimizing the quality of life for children with epilepsy and reducing the impact of seizures on their development and well-being.