Getting a description of the seizures

A detailed account of the event is the first steps towards deciding whether a child has epilepsy. A good description of the event may allow the doctor to confidently make a decision on whether the event was a seizure or not, and whether the child has epilepsy.

Note :

At times, this may prevent unnecessary investigations to a child who did not actually have a seizure.

Identify the type of epilepsy

The description of the seizures give the doctor an idea of what type of epilepsy the child is having. Knowing the type of epilepsy helps the doctor decide which treatments are best for the child.

This is the most common type epilepsy in children. It usually begins in the middle and late childhood years, and persists into adolescence. Seizures in these children arise from the Rolandic region in the brain, hence the name.

Common types of epilepsy seen in children include:

• Rolandic epilepsy. Such seizures usually occur during sleep, and may begin with the child waking up to discover a strange sensation in the mouth or lips, drooling, or the occurrence of spasms or twitching around the mouth. Most children only experience these symptoms, though some do go on to develop vigorous jerking involving one or more limbs.

• Childhood absence epilepsy. Also known as ‘petit mal’ epilepsy, childhood absence epilepsy begins in the middle and late childhood years. Typical seizures take the form of a sudden brief blank stare, becoming unaware of the surroundings, and repeated blinking. The child fully recovers immediately after the seizure, resuming his/her previous activity. The seizure however can recur many times in a day.

• Generalised tonic clonic epilepsy. Also known as ‘grand mal’ epilepsy. Generalised tonic-clonic seizures usually begin at any age after the toddler years. These seizures begin with a sudden loss of awareness, and then violent stiffening of the limbs followed by vigorous jerking of the limbs.

• Complex partial seizures. These seizures occur at any age. When the seizures begin, the child is noted to become confused and disorientated. At an older age, the child may describe an odd feeling, unpleasant sensation, or visual disturbances before the seizure – this is known as the ‘aura’ or a premonition of the oncoming seizure.

• Frontal lobe epilepsy. Frontal lobe epilepsy gives rise to seizures that occur in sleep. These seizures resemble nightmares, with the child appearing to be confused or frightened, and violent thrashing movements of the limbs. These events always follow the same pattern, with difficulty arousing the child during the event. After the seizure, the child usually returns to sleep.

• Infantile spasms. This uncommon epilepsy disorder only occurs in the first year of life. The infant is seen to have sudden, violent contractions resulting in either buckling of the torso and limbs, or an extended posture of the torso and limbs. These seizures usually occur repeatedly in a cluster, usually soon after awakening. The frequent seizures often cause a slowing in the child’s development. Children with this form of epilepsy would need to be urgently seen by a child specialist.

Examine the child

Doctors will need to conduct a thorough physical examination, as well as an assessment of the child’s developmental stage and cognitive abilities. This may enable them to identify a cause for the epilepsy and gauge the effect of the disorder on the child.

Ask for an EEG (Electroencephalography)

The EEG measures the electrical activity in the brain, similar to the ECG (electrocardiogram) which measures the electrical activity arising from the heart.

The procedure is harmless, and involves placing electrodes with wires on the skin over the scalp. The pattern of electrical activity recorded may help determine whether the child does indeed have epilepsy, and if possible, suggest the type of epilepsy.

Note: Often the only test that the child requires is an EEG recording.

Perform other tests (optional)

• Blood and urine tests may at times be required in the difficult epilepsy disorders.
• Brain scans may be required in certain types of epilepsy. These involve taking snapshots of the brain using machines such as a Computed Tomography (CT) or a Magnetic Resonance Imaging (MRI) scanner.