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What Do Severe Childhood Seizures Look Like?

Medically reviewed by Amit M. Shelat, D.O.
Updated on January 11, 2024

  • A child living with severe epilepsy may experience one or more types of seizures, some of which are more difficult to identify than others.
  • Knowing the signs of different types can help you support your child when seizures occur and help you describe their symptoms to their doctor.
  • Identifying the types of seizures a child experiences is a critical step toward accurately diagnosing what type of epilepsy they have — or determining if they have a different condition.

Nearly half a million children in the U.S. have epilepsy — a neurological disorder that involves recurrent seizures caused by abnormal electrical activity in the brain. Children living with severe epilepsy can experience many types of seizures, some of which are easier to spot and identify than others.

Knowing what different seizures look like is a critical step toward figuring out which type — or types — your child is experiencing. Providing details about your child’s seizure can help their doctor determine if they do have a severe form of epilepsy — or another condition. From there, you can work with the neurologist to find the best ways to manage and treat your child’s seizures.

What Does a Severe Seizure Look Like?

There are many types of seizures your child could be experiencing. Some types aren’t hard to recognize, but others can be tricky to identify. The following are the types of seizures a child with severe epilepsy may experience and what they look like.

Focal Seizures

Also called partial seizures, focal seizures start in one part or side of the brain. If your child has a focal seizure, they may stare off into space and ignore their surroundings. Your child may also be alert but start jerking uncontrollably on one side of their body.

Generalized Seizures

A seizure that affects the entire brain is called a generalized seizure. Your child may experience loss of consciousness and jerk uncontrollably during these types of seizures. There are different kinds of generalized seizures.

Tonic-Clonic Seizures

Tonic-clonic seizures, which used to be called “grand mal,” are a serious type of generalized seizure. During a tonic-clonic seizure, your child will likely alternate between stiffening their limbs and twitching uncontrollably.

Atonic Seizures

A child loses muscle strength during an atonic seizure. Your child’s head may drop forward and their eyelids may droop. If they are standing, they may fall to the ground.

Absence Seizures

Previously called “petit mal” seizures, absence seizures are generally brief (typically less than 15 seconds). Your child may appear to be staring into space. Their eyelids may flutter rapidly, and they may stop or slow down the activity they are performing. Individually, these seizures may not seem severe, but their frequency makes them concerning: Some children have 50 to 100 a day.

Myoclonic Seizures

During a myoclonic seizure, a muscle or group of muscles have brief bursts of jerking motions. Your child will probably be alert and mentally unimpaired during this kind of seizure. If they speak, they may describe it as feeling like being shocked by electricity.

Febrile Seizures

During a febrile seizure, your child may pass out and shake uncontrollably, typically for just a few seconds to several minutes. These types of seizures are linked to fevers and high body temperature. They are usually harmless, causing no long-term issues. While these seizures aren’t typically viewed as severe, we are describing them here because they are a common type of seizure, and it can be helpful for caregivers to know the difference between febrile seizures and other types. Most children who experience a febrile seizure do not go on to develop epilepsy.

Infantile Spasms

This kind of seizure is often hard to detect, but it may indicate a serious condition. During an infantile spasm, your child will likely spread their arms, lean forward, and pull their knees close to their body for a second or two. These motions generally occur back to back and then stop. They usually happen just after the child wakes from sleep.

Status Epilepticus

Although status epilepticus is not a seizure type, it’s important for caregivers to know that a seizure lasting longer than five minutes is called status epilepticus. Having more than one seizure in five minutes also qualifies as status epilepticus. This condition is life-threatening and requires immediate medical attention.

What To Do When Your Child Experiences a Seizure

If your child is experiencing a seizure, do not try to stop their movements, and never put anything in their mouth. Instead, place them carefully on the floor and roll them on their side. Check their behavior, and write down the time of the seizure, the symptoms (e.g., shaking, stiffening, staring into space), and how long it lasted. This information is important for your doctor.

If the seizure lasts more than five minutes, get emergency medical assistance immediately.

Visiting Your Child’s Doctor

If you suspect your child is having seizures, it’s important to take them to the doctor. You’ll be asked several questions that will establish your child’s medical history to help find a diagnosis.

Your child’s doctor will first ask you and your child’s other caregivers to describe everything that happened before, during, and after the seizure. Share every detail you can remember. Important details include the following:

  • When was the seizure, and how long did it last?
  • Is this your child’s first seizure? If not, how many have they had? Were the seizures similar, and how frequent were they?
  • Does your child have any other medical conditions, and are they taking any medications?
  • Does your child have a family history of seizures?
  • Where did the seizure occur? What was happening before it?
  • What was your child doing at the time?
  • Was your child aware or partially aware during the episode? Did they show speech or cognitive impairments before or after?
  • Was your child injured at all during the seizure?
  • Did your child lose bladder control during the seizure?
  • Did the seizure happen shortly after they stood up?

If your child can speak, the doctor will ask them how they felt before, during, and after the seizure.

Testing Methods

After getting a medical history, your child’s doctor will likely perform additional tests or refer them to a pediatric neurologist or epilepsy center for in-depth testing. These tests may include:

  • Neurological exam — Your child will be asked to perform a number of tasks to test their underlying neurology. These exams test movement, coordination, eye tracking, speech, memory, and cognition.
  • Blood tests — Blood work can test for factors such as blood sugar issues that may lead to seizures.
  • Electroencephalogram (EEG) — This test can detect abnormalities in brain activity. The child is usually monitored on video while the EEG is performed.
  • Brain imaging — Technologies like computed tomography (CT) scans and magnetic resonance imaging (MRI) can show abnormalities in the brain’s structure.

Which Forms of Epilepsy Cause Severe Childhood Seizures?

A few types of epilepsy are associated with more intense seizures. These types of epilepsy pose serious risks without medical care.

Dravet Syndrome

Dravet syndrome is a rare condition that causes severe, prolonged epileptic seizures that begin in the first year of life. Dravet syndrome is usually caused by a mutation to the SCN1A gene, which regulates electrical activity in the nervous system. People with Dravet syndrome experience developmental delays, cognitive impairment, and an increased risk of sudden unexpected death in epilepsy (SUDEP).

Seizures in Dravet syndrome often occur back to back and can be caused by rises in body temperature. A person with Dravet syndrome could have several types of seizures, including:

  • Febrile
  • Myoclonic
  • Absence
  • Atonic
  • Focal

Although Dravet syndrome is resistant to treatment, it can be managed with antiepileptic drugs (AEDs), other medications like cannabidiol (Epidiolex), and a ketogenic diet.

Read more about Dravet syndrome.

Lennox-Gastaut Syndrome

Lennox-Gastaut syndrome (LGS) is a rare form of epilepsy that can cause cognitive disabilities (such as trouble learning or problem-solving) and intense seizures. LGS seizures usually start when the child is preschool age. LGS may be caused by a brain injury, developmental issues, or genetic disorders. People with LGS are considered at risk of developmental delays that worsen as their seizure intensity increases.

Children living with LGS can experience multiple forms of seizures, including these types:

  • Tonic
  • Atonic
  • Absence
  • Focal
  • Myoclonic
  • Tonic-clonic
  • Infantile

LGS is difficult to control. It is typically treated with a combination of AEDs and dietary changes. If seizures are not reduced or medication side effects are too harsh, therapies like vagus nerve stimulation (VNS) may help. VNS involves implanting a small device in the chest that sends electrical signals to the brain.

Read more about Lennox-Gastaut syndrome.

West Syndrome

West Syndrome is a type of epilepsy that primarily causes infantile seizures that begin around 6 months of age. This rare epilepsy syndrome is usually caused by a brain injury or genetic disorders. It can also be caused by LGS.

Survival rates are high for people with West syndrome, but most children with the disorder will have cognitive disabilities. Treatment typically includes the use of AEDs and, in some cases, adopting a ketogenic diet.

Work With Your Care Team

After you have a diagnosis, you can work with your child’s care team to design a treatment plan to meet their needs. Treatment may not help your child become completely seizure-free, but medical care based on your child’s needs may help reduce the intensity and frequency of their seizures.

Talk With Others Who Understand

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. On MyEpilepsyTeam, more than 112,000 members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

Are you caring for a child with epilepsy? Do you have questions about the different types of seizures? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Epilepsy Fast Facts — Centers for Disease Control and Prevention
  2. Absence Seizures — Johns Hopkins Medicine
  3. Epilepsy Syndromes in Children — Johns Hopkins Medicine
  4. What Happens During a Seizure? — Epilepsy Foundation
  5. Causes of Epilepsy in Childhood — Epilepsy Foundation
  6. Diagnosis and Management of Epilepsy — Canadian Medical Association Journal
  7. Seizures and Epilepsy in Children — Johns Hopkins Medicine
  8. Types of Seizures — Epilepsy Foundation
  9. Partial Epilepsy — StatPearls
  10. Focal Seizures — Johns Hopkins Medicine
  11. Seizure — StatPearls
  12. Generalized Tonic-Clonic Seizure — StatPearls
  13. Generalized Seizures — Johns Hopkins Medicine
  14. Atonic Seizures — Epilepsy Foundation
  15. Absence Seizure — StatPearls
  16. Juvenile Myoclonic Epilepsy — StatPearls
  17. Febrile Seizure — Mayo Clinic
  18. Febrile Seizure — StatPearls
  19. Infantile Spasms: Little Seizures, Big Consequences — Epilepsy Currents
  20. Symptoms: Epilepsy — NHS
  21. Management of Status Epilepticus in Children — Journal of Clinical Medicine
  22. Diagnostic Approach of Epilepsy in Childhood and Adolescence — Maedica
  23. Seizure Safety — Nationwide Children’s
  24. Managing Seizures — Epilepsy Foundation
  25. Epilepsy in Children: From Diagnosis to Treatment With Focus on Emergency — Journal of Clinical Medicine
  26. Precision in Pediatric Epilepsy — F1000 Research
  27. Neuroimaging in Pediatric Epilepsy — Brain Sciences
  28. Dravet Syndrome — Epilepsy Foundation
  29. Lennox-Gastaut Syndrome LGS — Epilepsy Foundation
  30. Vagus Nerve Stimulation — Mayo Clinic
  31. West Syndrome — NORD
  32. Causes of Epilepsy in Childhood — Epilepsy Foundation

Updated on January 11, 2024
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Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Lorelei Tucker, Ph.D. has a doctorate in neuroscience from Augusta University. Learn more about her here.

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