Question

1. What are the different characteristics between a febrile seizure, and generalized seizure and an absence seizure?

2. Name the three different causes of seizures, in children. Give an example of each.

3. Name two common anticonvulsive medications and their side effects.

Answer 1

Seizures are the sudden and uncontrolled electrical activity in the brain which is caused by the hyperexcitability of the neurons in the brain.

Characteristics of different types of seizures

1. Febrile seizure

• It occurs due to high grade fever in children, a low grade fever also could develop febrile seizures but the most common cause is a high grade fever.
• It lasts for few seconds to 15 minutes.
• This type of seizure is seen in children below the age group of 5 years.
• This usually subsides when the child's fever subside.
• There will be normal development of the children without any neurological symptoms.
• There is no need to take long term anticonvulsant drugs in this type of seizure.
• The child can be treated with phenobarbital therapy till the age of 5 if he or she develops seizures till this age.
• Another drug is valproate which is also be used to treat febrile seizures.

​​​​​​2. Generalized seizures

• This is a type of seizures which has got neurological symptoms such as loss of consciousness and strong muscle contractions.
• There will be no fever for the child. The seizure may occur due to byper excitation of the neurons in the brain.
• This type of seizure lasts for 10 to 20 seconds.
• Generalized means it affects the whole area of the brain and the strong jerking movements of the body occur. So there is a risk of getting physical injury to the child.
• This is rare in children upto 13 years and most common in the age group of 14 - 18 years.
• As the symptoms include loss of consciousness the child will not remember the seizure activity once he gains consciousness.
• This can be treated with anticonvulsants like carbamazepine and need to be continued until the doctor tells to stop the medication.

3. Absence seizure

• ​​​​​​This is a type of generalized seizures which involves a starring look for few second to about 15 seconds.
• This is also known as 'petit mal' seizures which is most common in children than in adults.
• In this type the child may be starring at anything for few seconds and then quickly revert back to normal level of alertness.
• Thus there will be no physical injury to the child.
• The treatment for this type of seizure is with anti - seizure medications like Ethosuximide, valproic acid and lamotrigine ( used rarely).

The three different causes of seizures in children are,

1. Family history

• If the child's parents, grandparents or any of the siblings have seizures then there is a chance of getting seizures in the child.
• For eg. If the child's father or mother had a history of seizures in their childhood then it could be a cause of getting seizure to their child.

2. Brain infections

• If the child has got any brain infection such as meningitis or encephalitis there is a chance of abnormal excitation of brain neurons.
• For eg. A baby admitted with a diagnosis of meningitis has to be regularly monitored for the development of seizures and will be administering anticonvulsants to the baby.

​​​​​​ 3. Birth injury

• Birth injury usually occur durinv the time of any complicated delivery which requires a forceps or vacuum to take the baby out of the uterus.
• For eg. If the baby has got any brain tissue damage during the instrumental delivery there is a chance for developing seizures.

The mainly used two anticonvulsant medications are carbamazepine and valproate.

Side effects of carbamazepine

• Common side effects are nausea, vomiting, problems with walking and coordination, drowsiness and dizziness.
• Serious side effects include skin reactions, hives (skin rash), swelling of tongue and lips, blisters over the face etc.

Side effects of valproate

• Common side effects are nausea, vomiting, diarrhea, stomach ache, headache etc.
• Serious side effects include loss of consciousness, fainting, black tarry stools, slow and irregular heart rate.

Note: seizures is a disorder of brain which affects most commonly in childhood. It can be cured with good prognosis if treated well.

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