Every year, 120,000 to 150,000 people under the age of 20 suffer a single seizure. In the same year, only one percent will go on to be diagnosed with epilepsy.
Seizures
A seizure suddenly occurs when a group of brain cells become activated and do not receive the signal to deactivate. Since there is a tendency for the same group of cells to lose control each time, there is also the tendency for an individual’s seizures to look exactly the same, or stereotyped, each time. A seizure may or may not involve loss of consciousness.
How the seizure looks depends upon where in the brain these overly activated cells are located, since each part of the brain serves a different function. For example, if the cells responsible for your being able to bend your thumb become overly activated, the seizure will present as uncontrolled bending of the thumb. As more cells become activated, the seizure may stay on that hand, spread to the entire side of the body, or to the other side.
Some people have seizures where they have the same smell or see something over and over, since the activated cells may only be in the part of the brain controlling vision or smell.
Not all seizures cause shaking. Some can cause severe tightening of muscles, known as stiffening spells; complete loss of strength, sometimes called “drop attacks;” or simply blank staring episodes. Some people have an aura, or warning, before they have a seizure, such as an unusual smell, sight, sound, or feeling. And since the entire brain is not yet involved during the warning, the individual does not lose awareness, and is able to alert others of an impending seizure.
Epilepsy
A seizure disorder becomes epilepsy when there is more than one unprovoked seizure. Anything irritating to the brain can provoke a seizure, such as high fever, low blood sugar, and nutritional abnormalities. As long as these can be proven to be present at the time of the seizure, no matter how many seizures that person has, he will not be diagnosed with epilepsy.
A common seizure disorder in pediatrics is a febrile seizure. The child’s fever causes changes that are irritating to the brain, and then produces seizures. The brain itself is usually normal, so the appropriate action is to diagnose and treat the cause of the fever.
Typical seizure medications do not prevent febrile seizures. A febrile seizure is rarely the presentation for later epilepsy. If a febrile seizure occurs, the pediatrician or emergency personnel need to decide whether the child needs to be evaluated further by a neurologist.
Exams for seizures depend on the circumstances surrounding the seizure, and the child’s physical exam. Most will require blood tests to look for infection or nutritional deficiencies. Sometimes, there is need for further focused brain testing, such as imaging by a CT Scan or MRI to inspect the brain structure, or an electroencephalogram to assess brainwave rhythms.
The need for further testing, as well as the decision to medicate a child, will be determined through careful assessment by the child’s neurologist and pediatrician. If medication is started, it is typically continued for at least two years.
Unlike adults, the type of seizure a child or adolescent experiences may change, since the brain is still changing in these age groups. This does not necessarily mean that the seizures are getting worse; rather, it calls on the neurologist to adjust medications. For an individual with epilepsy, close neurologic follow-up is necessary and often includes periodic blood tests and repeated EEGs.
Epilepsy actually affects about .5 percent of (or five out of every 1,000) people. At any given time, there are a couple of hundred thousand people living with epilepsy in the United States.
Epilepsy is a lifelong diagnosis, but this does not mean that the seizures will continue to occur, as there are a good number of seizures that children outgrow by adolescence.
