What Does a Seizure Look Like?

It can be difficult to tell if your child is experiencing a seizure if you're not sure what to look for. Here's what you should know, and what you can do.

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"A seizure is one of the scariest things you'll ever see happen to another person," says Phillip Pearl, M.D., director of epilepsy and clinical neurophysiology at Boston Children's Hospital. "The first question most parents ask is 'Can my child die during a seizure?' It's extraordinarily unlikely." Most injuries during seizures happen not because of the seizure itself but because of what a child may be doing at the time; life jackets should be worn when swimming and helmets when riding bikes, skiing, or playing any sport with a high risk of head injury. But some seizures are more violent than others, increasing the risk of injury. If your child has epileptic seizures of any kind, you need to know the warning signs so you can keep her safe when an attack happens. Here's a rundown of the most common types of seizures and their symptoms.

Generalized Seizures

These seizures begin over both sides of the brain at once, which makes them a bit more difficult to treat. Children with generalized seizures may not be candidates for surgery, for example, because doctors can't pinpoint one place to operate. The seizures can manifest in a variety of forms.

Absence Seizures A child experiencing an absence seizure (also known as a petit mal seizure) will seem vacant and stare without moving, usually for less than 15 seconds. These seizures can happen many times a day; teachers may think the child is simply daydreaming or having trouble paying attention. The child may not remember what has happened, but she'll instantly return to being alert as soon as the seizure is over. What You Can Do: Stay calm and speak reassuringly until she is able to focus again. If this kind of seizure happens while you're out and about, guide her away from any dangers but don't restrain her.

Myoclonic Seizures If you've ever started to fall asleep and then jerked awake, you've experienced a myoclonic jerk, or muscle spasm. This type of seizure feels like being hit with a jolt of electricity, which can cause a series of these jerks. Myoclonic seizures are usually one manifestation of a mixed seizure disorder, so children who experience them will likely have other symptoms. What You Can Do: Ease your child down to the floor and put something soft under his head. Remove eyeglasses or any constricting clothing. Do not hold him down or try to stop his movements; just speak reassuringly and wait until the seizure passes.

Clonic Seizures During a clonic seizure, muscles in a child's elbows, legs, and head will spasm uncontrollably until the movements gradually subside. As the spasms stop, she will typically let out a sigh, which often signals the end of the seizure. What You Can Do: Ease your child down to the floor and put something soft under her head. Remove eyeglasses or any constricting clothing. Do not hold her down or try to stop her movements; just speak reassuringly and wait until the seizure passes.

Tonic Seizures These seizures start with a stiffening of all of the muscles; then the child will lose consciousness. His eyes will roll back in his head and his back will arch; this tightens the chest muscles, making it harder for him to breathe, so you may see his face turn a little blue and he will make gargling noises. What You Can Do: Ease your child down to the floor and put something soft under his head. Remove eyeglasses and any clothing that might restrict breathing; call 911 if breathing trouble persists. Do not hold him down or try to stop his movements; just speak reassuringly and wait until the seizure passes. Whatever you do, don't attempt to open his tightly clenched jaw -- you could injure his jaw or teeth. (It's a myth that people can swallow their own tongues during seizures.) When the seizure passes, check for injuries that may have occurred when he fell to the floor.

Tonic-Clonic Seizures Also known as a grand mal seizure, this is the best-known kind of seizure. First a child's body will stiffen; then she'll fall to the ground and lose consciousness. Her eyes will roll back in her head, she'll arch her back and have trouble breathing, and then begin to spasm. The spasms can last for several minutes; once they pass, she may remain unconscious for a few more minutes while the brain works to regain control over the misfired neurons. When she wakes up, she may feel sore, tired, and confused. The best thing you can do when a tonic-clonic seizure occurs is to stay calm and reassure her that she's okay. What You Can Do: Put something soft under her head. Remove eyeglasses and any clothing that might restrict breathing; call 911 if breathing trouble persists. Do not hold her down or try to stop her movements; just speak reassuringly and wait until the seizure passes. Don't attempt to open her tightly clenched jaw -- you could injure her jaw or teeth. (It's a myth that people can swallow their own tongues during seizures.) When the seizure passes, check for injuries that may have occurred when she fell to the floor.

Atonic Seizures In this type of seizure, a child's entire body will go limp and he may crumple to the ground. It's common to experience both atonic and myoclonic seizures. Atonic seizures may also be a symptom of Lennox-Gastaut Syndrome. What You Can Do: Put something soft under his head. Remove eyeglasses or any constricting clothing. When the seizure passes, check for injuries that may have occurred when he fell to the floor.

      Focal Seizures

      These seizures are also known as partial seizures because they begin in one specific part of the brain, but Dr. Pearl notes that this is a bit of a misnomer: "That makes it sound like the patient only has part of a seizure, but what we mean by a focal seizure is that it originated in a focal area of the brain," he explains. "The seizures themselves can be just as dramatic as generalized seizures."

      Simple Partial Seizures These seizures start in a specific section of the brain and tend to manifest with one set of symptoms, depending on which part of the brain is activated: motor (jerking movements on one side of the body), sensory (hallucinations, hearing problems, or other distorted perceptions), autonomic (changes in involuntary functions such as blood pressure, heart rhythm, or bowel function), or psychic (feelings of fear, anxiety, or déjávu). What You Can Do: Stay calm, speak reassuringly, and help your child lie down. Do not attempt to control any movements or restrain him in any way.

      Complex Partial Seizures These seizures may begin with a simple partial seizure or an aura; the child may then stare blankly into space or experience non-purposeful repetitive movements. Complex partial seizures start in one lobe of the brain but cause an alteration of awareness due to the spreading of seizure activity in that side of the brain. What You Can Do: Stay calm and speak reassuringly until she is able to focus again. Do not attempt to restrain her or stop the movements. If this kind of seizure happens while you're out and about, guide her away from any dangers but don't restrain her.

      Partial Seizures that Secondarily Generalize These seizures start in one side of the brain, then spread to the other side. As the seizure spreads, the child may experience convulsions or spasms, or go limp. What You Can Do: Ease your child down to the floor and put something soft under his head. Remove eyeglasses or any constricting clothing. Do not hold him down or try to stop his movements; just speak reassuringly and wait until the seizure passes. Don't attempt to open a tightly clenched jaw -- you could injure his jaw or teeth. (It's a myth that people can swallow their own tongues during seizures.) When the seizure passes, check for injuries that may have occurred when he fell to the floor.

        When Should I Call 911?

        Because seizures can be so dramatic, it can be difficult to know if your child is truly in danger. According to the Centers for Disease Control and Prevention, you should consider a seizure to be an emergency situation if it meets any of the following criteria:

        • It lasts longer than five minutes without signs of slowing down.
        • Your child has trouble breathing during the seizure or afterward, appears to be in pain, or has an unusual recovery in any way.
        • Your child has a seizure soon after the first one or a cluster of nonstop seizures (known as status epilectus).
        • You can't wake your child up after the seizure activity has stopped.
        • Your child is injured from a fall or other movement during the seizure.
        • Your child becomes aggressive.
        • Your child's seizure happens in water.
        • Your child has any other health conditions that may make a seizure more dangerous.

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