Seizures after an Acquired Brain Injury

Disclaimer: This information sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What Are Seizures?

Seizures occur when the normal electrical signals within the brain misfire. This usually affect the child's awareness of their surroundings or their actions for a short period of time. The electrical signals usually return to normal within a few seconds or a few minutes and the seizure will then stop. Seizures usually occur without warning and without the child being aware of what is happening.

It is quite common for children who have a brain injury to have a seizure soon after the injury. Sometimes medication ("anticonvulsants") is required to help prevent further seizures. The medication is often given directly into the veins to allow it to act quickly. After they are more aware and they are swallowing safely the child will take tablets or syrup. Where seizures continue to occur anticonvulsant drugs will need to be given for a longer period of time

Types of Seizures

There are several different types of seizures. Generalised seizures occur when the whole brain is misfiring, and partial seizures when one part of the brain is affected. Some of the most common types of seizures are:

1. Generalised seizures: Convulsive seizures (tonic-clonic or grand mal seizures): children may give a sudden cry, lose consciousness, fall, wet or soil themselves, and shake all over.
2. Absence seizures (petit mal seizures): children stare blankly without losing consciousness, blink quickly, may make chewing actions, or show twitching of their facial muscles.
3. Partial Seizures:
1. Simple partial seizures: The child may experience abnormal sensations or movements of a part of the body while they remain awake; one part of the body, arm, leg, or face may jerk.
2. Complex partial seizure: These begin with a 1- to 2-minute period during which the person loses their awareness of their surroundings. It is similar to an absence seizure, but it is followed by random actions such as picking at clothing. These seizures are often followed by a period of drowsiness.

Diagnosis of Epilepsy

It is important to carefully observe the child's behaviour at the time of the suspected seizure. This should include:

• What the child was doing at the time eg watching TV, just dropping off to sleep etc.
• What happened during the episode
• How long the episode lasted
• What the child was like afterwards

Some specific tests will help determine the cause of the seizures. The number and types of tests used to diagnose epilepsy are different for each patient. An electroencephalogram (EEG) is a test that measures electrical activity in the brain, and is frequently used to help to diagnose epilepsy. Some other common tests include CAT and MRI scans. It may be necessary for some children to be sedated so that these scans can be done accurately.

Treatments for Epilepsy

Once it is decided that a child requires treatment for their seizures a particular drug is used. This will depend on the type of seizures (generalised or partial). If possible a single drug is given, such as carbamazepine, valproate, gabapentin, phenytoin, topiramate, and lamotrigine. Most children respond well to medication. Anticonvulsant medications are usually very effective. Sometimes they may have side effects such as drowsiness and weight gain. Some also need to be checked with blood tests.

New Interventions

Surgery for epilepsy in children is considered only in those who are not helped by medication and whose seizures severely affects their quality of life and development. Surgery is done only in carefully selected patients, usually those with a known focus (part of the brain) that is responsible for causing the seizures.

Talking to Your Child about Epilepsy

Some ways you may help your child more fully understand their condition are to:

• listen to your child's feelings of frustration, anger, fear, or guilt (reassure them that it is not their fault)
• explain, in terms your child can understand, what happens during an epileptic seizure, how treatment will help and what they should do when a seizure occurs
• assure your child, if they ask, that it is extremely rare for someone to die during a seizure
• you may wish to introduce your child to other children with epilepsy
• emphasize your child's abilities and talents
• openly talk about epilepsy and your child's treatments so that family and friends are comfortable with the condition

During a Seizure

• The major task when your child has a seizure is to keep the airway open so that the brain can get normal amounts of oxygen.
• If your child is having trouble breathing their lips will be a blue colour. This may mean that their airway is blocked.
• Place your child face down or on their side to allow the mouth contents to drain and the tongue to come forward.
• Remember Children do NOT swallow their tongue. If your child does vomits then quickly clear their mouth if it is possible. It is NOT necessary to force anything into their mouth. You may injure yourself unnecessarily if you force your fingers between their clenched teeth.
• When your child is breathing without difficulty, place them on the ground or floor in a safe area. Move all objects away from him, and place cushions around his head if possible.
• Loosen tight clothing.
• Do not restrain their movements.
• Call your child's doctor.
• If breathing is troubled, or the seizure lasts longer than a few minutes, you should call an ambulance. DIAL 000

Following the seizure, your child may fall into a deep sleep. This is normal. Do not try to wake them. Do not attempt to give any food or drink until they are awake and alert.

Following a seizure - particularly if it is a first or unexplained seizure - call your doctor or emergency medical service for instructions. Your child will usually need to be evaluated by a doctor as soon as possible

Rehabilitation Department The Children's Hospital at Westmead Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead, 2145 Tel: (02) 9845 2132 - Fax: (02) 9845 0685 http://www.chw.edu.au/rehabilitation/