Jessica Kingsley Publishers

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Children with Seizures

A Guide for Parents, Teachers, and Other Professionals

Martin L. Kutscher MD
Foreword by Gregory L. Holmes MD

Part of the JKP Essentials series

Paperback: £13.99 / $19.95

2006, crown, 152pp
ISBN: 978-1-84310-823-8, BIC 2: VF MJN MJW

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Chapter 1

Overview of Seizures

What is a seizure?

In four words, a seizure is a “temporary brain short circuit.” The brain cells get caught up in a reverberating cycle, and cause the body to enact the events that we interpret as a “seizure.”

Here's a bit more detail. The brain consists of billions of neurons, communicating with each other via electrical impulses. When one brain cell is sufficiently stimulated, it sends an electrical current down its long, wire-like axon. When this message reaches the end of the axon, the neuron releases a chemical neurotransmitter that floats across a synapse and lands on a receptor of the next cell—in turn, causing it to fire. Meanwhile, other neurons are putting a damper on all of this activity, trying to keep everything from getting out of control.

On occasion, these dampening activities are insufficient, and the brain cells essentially get themselves into a reverberating short circuit. The brain cells fire—causing the muscles that they control to contract. This leads to the movements we witness during a typical seizure. Fortunately, the brakes usually regain control. Each time such an event occurs, the person is said to have experienced a seizure.

Sometimes, the part of the brain that is involved in the seizure controls something other than muscle activity. In such cases, the person having the seizure may experience an unusual sensation, have an altered level of alertness, or do whatever is controlled by that part of the brain. Sometimes, the seizure focus spreads from one part of the brain to others, causing the manifestation of the seizure to change as the seizure evolves.

A seizure may have up to three parts: possibly an introductory “aura,” the actual “ictal” seizure event, and possibly a “post-ictal” state. If present, the aura is the patient's initial experience while the seizure is just beginning. During an aura, the uninvolved part of the brain is “watching” the other part of the brain have the seizure. Once the short circuit has spread as much as it will, the rest of the actual brain short circuit is called the “ictal” event or “seizure.” After the actual seizure itself, there may or may not be a period of transiently altered brain function called the “post-ictal” period. During the post-ictal period, the parts of the brain that were involved in the seizure may have already spent all of their energy, and might temporarily be unable to perform. The post-ictal period usually consists of sleepiness and/or temporary muscle weakness, and needs to be distinguished from the actual seizure itself.

So, that is all that a seizure is. An electrical short circuit in the brain. Nothing more. Nothing less. Nothing to be embarrassed about.

What is “epilepsy?”

Saying that a person has “epilepsy” just means that he or she has more than one seizure. That's it. By itself, epilepsy has nothing to do with being developmentally or psychologically abnormal.

The term can be used for people who have a chemical predisposition towards recurrent seizures (“idiopathic epilepsy”), or for people whose seizures are symptoms of some more identifiable cause such as head trauma or meningitis (“symptomatic epilepsy”).

Unfortunately, the word “epilepsy” still carries a stigma for some people—even though epilepsy is just a medical issue like asthma or diabetes. Some people may find it easier to use the term “seizure disorder.”

How does the term “seizure” relate to the term “epilepsy?”

Note that the term “seizure” refers to the specific neurological event, such as a staring spell or a jerking spell. In contrast, we will refer to “epilepsy” as a syndrome. The term “epilepsy syndrome” refers to a full syndrome consisting of the: type(s) of seizures seen in that syndrome, EEG findings, typical age of patient, typical response to different anticonvulsants, typical prognosis, etc. For example, “absence seizure” refers to the specific event of staring for several seconds. However, “childhood absence epilepsy” (previously called “petit mal epilepsy”) refers to a syndrome of young, neurologically normal children whose EEG shows 3-per-second spike-wave discharges and who are likely to outgrow their seizures. Determination of the correct type of epilepsy syndrome helps guide the work-up, choice of anticonvulsants, and expected outcome for the child.

The rest of this chapter will be about the different types of seizures. The epilepsy syndromes are discussed in Part 2.