What Causes Seizures?

Seizures are mysterious. They cause the body to act strangely. They’re hard to predict and they can’t be seen, except with special tests of the brain. So, what causes seizures?

As a neurologist with special training in epilepsy, CHOC Children’s epileptologist Dr. Maija-Riikka Steenari has dedicated her career to understanding seizures and epilepsy, which affects 470,000 children nationwide. In recognition of National Epilepsy Awareness Month, she provides a look into the mystery of seizures.

dr-maija-steenari-choc-childrens-epileptologist
Dr. Maija Steenari answers frequently asked questions related to what causes seizures.

What happens in the brain during a seizure?

“Brain cells, called neurons, communicate by electrical activity. If there is a dysfunction, the brain can get overexcited. The electrical activity in the brain surges, causing the neurons to get out of control. The surge of electricity can start in one spot and spread, called a focal onset seizure, or it can happen throughout the brain, called a generalized seizure.”

What does a seizure look like?

“A seizure can manifest in many different ways. When a family comes to us, we ask them what they saw when their child had a seizure. What happened first? Was one arm stiff, were both arms jerking, did the child fall down, did their head turn to one side, were they unresponsive? It’s very helpful if the family has video of a seizure happening. A seizure can make you see, feel and taste weird things. We will ask the child, do you remember having a seizure or not? All these details help us determine if the seizure started from one focus and from which area of the brain, or if it was generalized onset.”

What causes seizures?

“Focal onset seizures can be caused by multiple different things, for example a malformation in the brain or an injury to the brain. Other causes could be a genetic or metabolic disorder which affects how the brain works, or causes a buildup of toxic materials, or is preventing the brain from getting what it needs. Many seizures or epilepsies are considered idiopathic, which means they have no known cause. We are learning more about them and why they happen, and as we do more testing, we find explanations to previous mysteries, often caused by genetic mutations.”

What can tests tell you about seizures?

“We always start with an EEG. That looks at the electrical activity in the brain. We can often see epileptiform discharges on the EEG, which tells us a patient has a tendency of having seizures. I often describe these discharges as sparks of electrical activity. I like to use the lawn analogy when I am talking to families. Think of a brain that has a tendency of having seizures as dry grass. Epileptiform discharges, or sparks, can easily cause a fire (I.e. seizure) on the dry grass. We may also use an MRI to look at the structure of the brain, to look for any abnormalities like a cortical malformation, tumor, or scar tissue from an infection or brain injury such as a stroke.”

How do you treat seizures?

“If the seizure was unprovoked, and after the initial evaluation we have a high suspicion that seizure will reoccur, we recommend starting a medication to treat the seizures. Referring back to the lawn analogy, medication can be considered as watering the lawn, to make the environment more difficult for the sparks to cause more fires. About 60-70 percent of the time, the first medication works when picked correctly. If the seizures continue despite appropriate dosing, we often try a second one. With adding a second medication, the chance of being seizure free is much less likely and If they fail two medications, we need to consider other treatment options, for example epilepsy surgery, diet treatments or vagal nerve stimulator.”

When considering epilepsy surgery, how do you know what part of the brain to operate on?

“Prior to surgery, we gather a lot of information about the seizures, the cause of the child’s epilepsy and the brain structure. We capture typical seizures during an inpatient video EEG study, and we will often lower medication to encourage a seizure to happen. We use detailed imaging techniques to look at the brain structure and how the brain uses energy, to see if we can pinpoint a focal seizure onset zone. We will also do neuropsychological testing, to understand if a child has difficulties in certain brain functions. We will discuss the results with our multidisciplinary epilepsy team, and evaluate if the child could benefit from epilepsy surgery.”

Is everyone’s brain mapped the same?

“No. Most brains are generally mapped the same but it’s not always the case, and sometimes the cause of the seizure has also caused the brain to map differently. A child’s brain is very plastic, and it has adapted around the injury or abnormality. Seizures cause disruption of typical brain development and the more seizures you have and the longer you have them, at some point your brain has learned to have seizures and they are much harder to control. Disruption of normal brain networks can also cause learning difficulties and developmental delays. That’s why it’s important to treat epilepsy as early as possible in children.”

Learn more about the CHOC Epilepsy Program

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Keeping A Close Watch

annual-report-2013-close-watch
annual-report-2013-close-watch-2By age 4, Grace Rogers was riding a bicycle without training wheels. She was roller-blading and skateboarding—an active, spunky kid growing up in Buena Park with an older sister and little brother.

But her mother, Debbie Rogers, would notice that at times, Grace would appear to be off balance. And she thought it odd that ever since Grace was 2, she slept excessively—12 hours a night, plus an afternoon nap.

“She was so coordinated, but then she would trip or fall,” Debbie says. “And all that sleeping. It didn’t make any sense.”

It wasn’t until she was 6, when Grace’s kindergarten teacher noticed the same things—as well as Grace appearing inattentive for brief spells—that Debbie and her daughter began a journey at CHOC Children’s that continues to this day.

That journey has brought Grace and her mother to a new unit at CHOC Children’s at Mission Hospital that specializes in the evaluation and treatment of the disorder afflicting Grace: epilepsy.

A program like no other

Opened in late 2012, the four-bed inpatient epilepsy monitoring unit (EMU) at CHOC Mission augments the eight-bed inpatient EMU in Orange.

Developed and run by world-renowned pediatric epileptologist Mary Zupanc, M.D., director of the Comprehensive Epilepsy Program and CHOC

Children’s Specialists division chief of neurology, the epilepsy program at CHOC Children’s has been designated as Level 4 by the National Association of Epilepsy Centers, making it the only Level 4 program in the state run by a free-standing children’s hospital.

The new EMU at CHOC Mission offers quiet, private rooms for patients like Grace to undergo intensive neuro-diagnostics monitoring that includes long-term video EEG (electroencephalogram) recording to help CHOC specialists monitor patients around the clock to pinpoint exactly where and why the child is having seizures. CT scans and MRIs also are used.

According to Dr. Zupanc, the EMU at CHOC Mission is for patients with lower-acuity epilepsy whose disorders generally are under control. Patients with more intractable epilepsy are treated at CHOC’s main campus in Orange, where they also undergo surgery if medication fails to control their seizures.

The EMUs provide the highest level of medical and surgical evaluation and treatment for patients with complex epilepsy, says Dr. Zupanc.

Finding an answer

CHOC’s epilepsy program team consists of clinical and support staff, including epileptologists, neurosurgeons, neurologists, neuropsychologists, neuroradiologists, social workers, physical therapists, dietitians, nurses and nurse practitioners, child life specialists and case managers.

“Epilepsy provides multiple challenges for families,” says Dr. Zupanc. “And nobody wants to talk about epilepsy, because unfortunately there’s still a lot of stigma attached to the disorder.”

Epilepsy is a brain disorder in which a person, over time, has repeated seizures, or episodes of disturbed brain activity that cause changes in attention or behavior.  Although much more common than a disorder like ALS (Lou Gehrig’s disease), which affects nerve cells in the brain and spinal cord that control voluntary muscle movement, epilepsy has yet to be a primary focus of extensive attention and research, says Dr. Zupanc.

The epilepsy specialists at CHOC Children’s are determined to help change that.

Grace was diagnosed with so-called absence seizures, which usually last less than 30 seconds and start and end quickly. She was unaware of her seizures—which is common. Sometimes episodes of absence seizures are mistaken for inattentiveness, as was the case with Grace.  Sensing something wasn’t right, her kindergarten teacher called Grace’s mom.

“That’s when I knew I wasn’t imagining things—that I wasn’t crazy,” Debbie says.

Grace ended up in the care of the Neuroscience Institute in June 2011. An EEG detected abnormal activity in Grace’s brain, and she was put on medication.

The medication controlled her seizures, but Grace still was sleeping an abnormal amount, which is common for people with epilepsy. CHOC neurologist, Anjalee Galion, M.D., conducted a sleep study in Orange.

A positive place

Grace was among the first patients to stay in the new EMU at CHOC Mission when admitted in January 2013.

Hospital volunteers kept Grace busy with crafts and activities. She even made a banana split. Therapy dogs also regularly visited her. A television and various electronic devices helped Grace pass the time.

“She would love to order food,” Debbie says. “with the room service and all the fun activities, it was almost like a hotel for kids”

CHOC epilepsy specialists still are working to determine what’s happening inside Grace’s brain. Recent tests have detected abnormal brain activity but no seizures, though Grace continues to sleep as much as 16 hours a day. Another sleep study at the EMU at CHOC Mission is planned.

Says Debbie: “We’re going to keep digging. The doctors say that Grace is a unique patient. She doesn’t fit into a pretty box.”

But it sure is a gift, Debbie adds, that Grace, now 7, is being treated at CHOC.

“It’s been wonderful.”

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Febrile Seizures: What Parents Need to Know

Baby - febrile seizures

FEVER PITCH

About one in every 25 children experience febrile seizures. Brought on by a fever and commonly seen in children between six months and five years, they can last less than 15 minutes (simple) or longer than 15 minutes (complex). “Typically, they last a couple of minutes,” says Dr. Tran.

SEIZURE SYMPTOMS

Seeing your child experience a febrile seizure can be scary, but unless they go on for five minutes or longer, they mare not life-threatening, says Dr. Tran. “Overwhelmingly, the kids will turn out fine,” says Dr. Tran. “If it’s the first time, it’s not unusual to take the child to the emergency room to identify the cause of fever and have a medical evaluation.” Typically there is a family history of febrile seizures.

TREATMENT TIME

If your child experiences a febrile seizure, use these tips when responding:

  • Lay the child on the ground, on his or her side
  • Time the seizure
  • Take the child’s temperature

If it’s the first seizure, seek medical attention and call 911 if it lasts longer than 5 minutes. “If a child has a fever, take the routine practice to treat it, including keeping your child well hydrated and seeking medical advice regarding treatment of the fever,” says Dr. Tran.

FEBRILE FOLLOW UP

“Parents may see their child be tired, sleepy or irritable following a seizure, but he/she should return to his/her baseline self within a couple of hours and continue to recover to their normal self. If parents have any concerns, they should contact their medical provider.” says Dr. Tran.

FAST FACTS

  • PERCENT OF PEDIATRIC POPULATION THAT HAS FEBRILE SEIZURES: 2 to 5 
  • AMOUNT OF FEBRILE SEIZURES THAT OCCUR AFTER THE FIRST ONE: 30%
  • PERCENT OF CHILDREN THAT WILL DEVELOP RISK OF EPILEPSY AFTER FEBRILE SEIZURE: 2 to 3

View the full feature on Febrile Seizures

Dr. Lily H. Tran - Expert in Febrile Seizures
Dr. Lily H. Tran
Pediatric Neurologist

PHYSICIAN FOCUS: DR. LILY H. TRAN

Dr. Tran did her internship and residency at the Rainbow Babies and Children’s Hospital and her fellowship at both Rainbow Babies and Children’s Hospital and University Hospital. Her special interests include epilepsy. Dr. Tran’s philosophy of care:”Teamwork between myself and the family/primary caregiver to provide the best care for my patients.”

EDUCATION:
University of Rochester School of
Medicine and Dentistry

BOARD CERTIFICATIONS:
Psychiatry, Neurology and
Child Neurology

More about Dr. Tran | More about the CHOC Neuroscience Institute

This article was featured in the Orange County Register on October 22, 2013 and was written by Shaleek Wilson.

CHOC Mom, Co-Founder of Epilepsy Support Network of OC Offers Helpful Tips

In honor of National Epilepsy Awareness Month (November), Janna Moore, whose daughter is being treated for epilepsy at CHOC and who also co-founded the Epilepsy Support Network of Orange County, provided the following guest post. These tips are intended to help parents cope with the diagnosis of epilepsy and ensure their children get the best possible treatment and experience the best possible outcomes.  This list was compiled from a survey Janna completed with 70 parents, who have more than 275 years of epilepsy experience, combined.

Attention Parents of Children with Epilepsy: Here’s a “Top 10” List You Won’t Want to Miss!

1) Find an experienced pediatric epileptologist at a pediatric epilepsy center.

2) Try and video/digitally record your child’s seizure to show the doctor at your child’s appointment.

3) Get an accurate epilepsy diagnosis detailing the seizure type or syndrome to ensure the most effective treatment for your child.

4) Join a local epilepsy advocacy organization, like Epilepsy Support Network of Orange County, to connect – through educational and emotional support groups – with other parents who have many years of experience caring for their children with epilepsy.

5) Join an on-line support group to learn as much as you can about your child’s seizure type.

6) Start a medical notebook: track/record seizures – dates, times, triggers, in addition to how it started and what it looked like. Details are very important for the doctor.  Get yourself a calender, a log sheet, or sign onto “Seizure Tracker”.

7) Ask your child’s doctor about the emergency epilepsy medication, Diastat, if your child’s seizures last longer than 5 minutes or cluster.  Call 911 if child is experiencing 1st time seizure or if a child with epilepsy has a seizure lasting longer than 5 minutes.

8) Educate yourself about your child’s specific seizure type once you get an accurate diagnosis.

9) Train your family members, child care providers and teachers on seizure recognition and first aid so your child is safe in any environment. You can schedule this presentation through Epilepsy Support Network.

10) Keep an eye on cognitive abilities and report to the doctor if you see a decline, which could be seizure -related.  Watch for behavioral changes, as well.  Be sure to address cognitive, behavioral, social issues if they arise – the sooner, the better.

Janna Moore’s daughter was diagnosed with epilepsy when she was 3 ½ years old.  She and her family experienced several challenges along the way, until arriving at CHOC Children’s, where she was seen by Dr. Mary Zupanc, director of CHOC’s Comprehensive Epilepsy Program.  Janna is a co-founder of the Epilepsy Support Network of Orange County, for which she currently serves as director of programs and services. 

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