Pediatric Neurology

Pediatric Epilepsy Symptoms & Seizure Types

A seizure is a burst of uncontrolled electrical activity in the brain, causing symptoms based on the part of the brain that is affected. This can lead changes in level of alertness, vision, speech, sensation or motor function. 

Are Seizures Always a Sign of Epilepsy?

Seizures are the main sign of epilepsy, but they don’t always mean your child has epilepsy. Provoked seizures associated with a high fever in a young child or with an abnormal sodium level are not indicative of epilepsy. When seizures are unprovoked and associated with a high risk of recurrence or certain features on electroencephalogram (EEG), then the diagnosis of epilepsy may be made.

Symptoms of a Seizure

Seizures can have a variety of symptoms depending on the type. Not all children have visible seizure signs. Childhood seizure signs that are easy to recognize include:

  • Sudden pause in behavior with staring when a child was previously active
  • Rhythmic twitching of the arms or legs
  • Rapid jerk of the arms or legs that may cause the child to fall or throw an object in their hand
  • Lasting stiffening of the body with loss of awareness

Epilepsy & Seizure Types

Seizures are defined by how and where they start in the brain. Seizure symptoms can be different depending on the type of seizure

There are two broad categories with associated types:

  • Focal seizures – Start in one part of the brain and may spread
    • Focal aware, the child is aware during a seizure, even if the child cannot talk or respond
    • Focal impaired awareness, the child has confusion and may be unable to respond during the seizure
    • Focal to bilateral tonic-clonic, the child may start with a focal aware or impaired aware seizure with change to a bilateral tonic-clonic seizure. Sometimes the initial focal seizure may not be visible to observers
  • Generalized seizures – Affect both sides of the brain at the same time
    • Absence seizure, a common cause of brief staring episodes
    • Myoclonic, a sudden jerk or twitch of body often observed in arms
    • Tonic, stiffening of the body with tensing of muscles
    • Atonic seizure, causes sudden loss of muscle strength, leading to change in position or a fall
    • Tonic-clonic seizure, characterized by loss of consciousness, tense muscles and jerking movements
    • Myoclonic and tonic seizures

Signs of Epilepsy

If you think your child may be having seizures, be sure your child is safe first, and then take a video of the event for your doctor to review during diagnostic evaluation. Each seizure will typically be like prior ones or have similar features.

When to See a Doctor

Consult a neurologist or epileptologist if you’ve seen a pediatric primary care provider and your child needs specialized care for:

  • Repeated unprovoked seizures (not caused by fever or low blood sugar) that occur more than 24 hours apart
  • Diagnosis of a single seizure with a high risk of having another one, which includes a child with an abnormal electroencephalogram (EEG) test or an epilepsy syndrome diagnosis
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