Frequently Asked Questions

1. What is epilepsy?
Epilepsy is a disorder that arises because the brain's electrical impulses are not working properly. The normal electrical messages that the brain sends back and forth to tell the body how to behave and react "misfire" in such a way that a "storm" of electrical activity occurs on the surface of the brain. This activity may be confined to one area of the brain or it may spread to other brain areas.

2. What is a seizure?
The storm of electrical activity that occurs on the surface of the brain as a result of abnormal electrical messages and the resultant chain reaction of other activity throughout the brain is called a seizure.

3. Are all seizures alike?
There are many different kinds of seizures and some people have more than one type. The most common seizure types are:

• Generalized tonic-clonic seizures (sometimes referred to as "grand mal") affect the entire body. The child may cry out or gasp, the body stiffens and the muscles begin alternating periods of spasm and relaxation. Typically the child falls and becomes unconscious. The child may lose bladder or bowel control and breathing becomes shallow. When the child regains consciousness they may be confused or drowsy, have a headache, difficulty speaking or weakness of an arm or leg.
• Absence seizures (sometimes referred to as "petit mal") consist of a sudden, brief loss of awareness that may occur multiple times a day. This type of seizure is frequently missed because it is so brief and subtle. During the seizure there may be tearing, eye blinking, or mild facial twitching. After the seizure the child will continue doing whatever he or she was doing prior to the attack.
• Complex partial seizures may cause a child to appear to be in a trancelike state. The child may have a glassy stare and is usually unaware or unresponsive to questioning. They may perform unusual actions such as picking at clothing, facial grimacing, contorting on one side, lip smacking or chewing motion. A complex partial seizure usually lasts a few minutes but the post seizure confusion can last substantially longer. In rare cases, a complex partial seizure progresses to a generalized convulsive seizure.
• Simple partial seizures are similar to complex partial seizures, but there is no discognitive state, the child remains aware throughout the episode.

Less common types of seizures include:

• Atonic seizures which consist of a sudden loss of muscle tone that causes a child to fall down.
• Myoclonic seizures which are sudden brief muscle jerks that may involve the whole body or parts of the body.
• Infantile spasms which are characterized by brief, sudden flexion of the head, trunk and limbs and occur during infancy.

4. What causes seizures?
About 80% of seizures have no known cause. Many factors can provoke seizures in a child who is subject to them. However, certain situations have been proven to lower a child's "seizure threshold," the point at which the brain will go into seizure. Improper use of prescribed medication, not taking it at the proper time or in the correct dose, or changing it without medical advice is the most common factor that increases a child's seizure occurrence. Illness, especially those associated with fever, emotional stress, lack of sleep and fatigue, and menstrual periods are also contributing factors.

5. At what age is epilepsy most likely to first occur?

• 17% first experience epileptic episodes in the first 2 years of life.
• 13% are in preschool.
• 34% are in elementary school.
• 13% are in high school.
• 16% are young adults.
• 5% first experience epileptic episodes during middle age
• 2% first experience epileptic episodes during old age.

6. How are seizures treated?
Anticonvulsants or anti-epileptic drugs are the principal treatment for seizure. The goal is to totally prevent seizure from occurring with the least possible side effects. In many cases a combination of medication is more effective than one medication alone.

7. Will my child remain on anticonvulsants indefinitely?
As a general rule, if your child has reached a goal of two to four years of complete seizure control, the doctor may begin to slowly reduce the medication. Approximately 75% of children who achieve this seizure free period on medication, will not have another seizure once they are weaned from the medication. These successful remissions are influenced by several factors, which include the type of seizure and the promptness of the initial control.

8. What should I do if my child is experiencing a seizure?
Although they may be frightening to witness, most seizures are not medical emergencies and can be allowed to run their course. There is no way to shorten a typical convulsive seizure, however there are several things that can be done to reduce its impact on your
child:

• Move sharp, hot or hard objects out of the way.
• Loosen all tight clothing, especially around the neck.
• Turn your child on his or her side and wipe away saliva from their mouth.
• Time every seizure by the clock and note the duration.

It is normal for your child's skin to turn pale or bluish during a generalized seizure.

While your child is experiencing a seizure you must NOT:

• Restrain your child's movements in any way.
• Insert any object into your child's mouth it is impossible for them to "swallow" their tongues as was once feared.
• Try to force the mouth open if it is tightly closed.
• Try to give medication or any other substance by mouth during the seizure.

9. How will I know if my child's episode is not a typical convulsive seizure?
There is one situation in which a seizure lasts longer than 30 minutes, or two seizures occur in a row without the child regaining consciousness in between. This is a rare condition known as status epilepticus and it is a true medical emergency and can be life- threatening.

As a general rule, it is recommended that you call 911 if your child's seizure does not stop in less than five minutes.

By the time the rescue squad reaches your home and your child is on the way to the hospital, close to 10 or 15 minutes may have passed. If the seizure has ceased by the time the rescue squad arrives, there is no need to transport your child. However, if he or she is still convulsing you will be glad that you didn't wait any longer to get expert care!