Seizures and Cerebral Palsy
Though symptoms of cerebral palsy vary among children afflicted with the disease, many children experience seizures. According to the Epilepsy Foundation, seizures involve sudden and temporary bursts of electrical activity, which can change or disrupt the way messages are sent between brain cells. They can occur as a result of abnormal and excessive discharges of nerve impulses originating from certain brain cells, some of which reach skeletal muscle fibers and trigger the violent contractions witnessed with a variety of seizures. For children with CP, the underlying cause of seizures is most often brain damage.
What are Some Examples of the Types of Seizures Experienced by Children with CP?
There are various types of seizures that can affect children with CP. Partial (focal)l seizures, for example, occur in only one part of the brain or one hemisphere, while generalized seizures occur in both hemispheres of the brain. Partial (focal) seizures result from electrical impulses from one part of the brain and are usually a motor or sensory seizure that is restricted to one side of the body. The individual remains conscious, however, if the seizure progresses to a more generalized seizure, a loss of consciousness will occur.
Simple partial seizures can cause muscle twitching, chewing movement, and numbness or tingling. Partial complex seizures are characterized by a brief loss of consciousness, behavioral and emotional symptoms, loss of memory, and automatisms. Temporal lobe and frontal lobe seizures are often in this category.
Other classifications of seizures include:
- Atonic Seizures. Characterized by a sudden loss of muscle tone, particularly in the lower extremities. This often results in falls which can result in traumatic brain injuries, along with other physical injuries, to the individual.
- Generalized Tonic-Clonic Seizures. Also known as generalized convulsions or grand mal seizures, commonly seen with cerebral palsy.
- Tonic Seizures. Spread throughout the brain, normally followed by unconsciousness, twitching of the legs and arms, convulsive body movements, and loss of bladder control. A child may bite their tongue during a tonic seizure episode. The “tonic phase” of this particular type of seizure is characterized by sudden muscle contractions and rigidity (hypertonia/spasticity).
- Clonic Seizures. Involves recurring and coordinated jerking movements involving both sides of the body, as well as rhythmic contractions of the affected muscle groups and violent and extreme gross motor movements. It is also common to see convulsive gross motor involvement throughout clonic seizure episodes.
- Complex Seizures. Involves involuntary, but possibly coordinated movements such as lip smacking, chewing, and abnormal oral motor activity. The oral motor involvement exhibited during a complex seizure can involve repeatedly opening and closing the mouth.
- Myoclonic Seizures. Characterized by sporadic jerking movements, usually involving both sides of the body that may progress to violent gross motor convulsive movements.
- Petit mal (Absence) Seizures. Also known as Absence Seizures, this type of seizure may cause the individual to appear to be “staring off into space,” and will be unresponsive to stimulation or their environment. These seizures don’t pose the same hazards as previously discussed seizures do, but they can still put a child at risk of aspiration if recurring episodes take place while a child is eating.
- Fever (Febrile) Convulsions. Febrile seizures are convulsions brought on by a fever in infants and small children. During the seizure, a child may lose consciousness, accompanied by tremors or shaking. A majority of febrile seizures are harmless, and there is no evidence to suggest that they cause brain damage. However, children who have experienced lengthy febrile seizures or recurring within 24 hours are at greater risk of developing epilepsy. The National Institute of Neurological Disorders and Stroke (NINDS) provides a comprehensive fact sheet on febrile seizures that provides a detailed and informative description of this type of seizure as well as information on diagnosis and treatment.
How are Seizures Diagnosed?
There are various tools that your child’s medical team may use to diagnose seizures. Your child’s neurologist will probably want to do an electroencephalogram (EEG) if they suspect seizure activity. Although EEGs are often helpful in diagnosing some types of seizures, they may not detect all of them. EEGs are typically performed in the hospital’s sleep clinic and involve placing electrodes on the child’s scalp.
Brain scans and MRIs are also helpful. The neurologist may order a CAT scan or magnetic resonance imaging (MRI) to be performed. Although these studies don’t show electrical impulses, they may show lesions or other possible suspected causes of seizure activity. Additionally, a video EEG may be ordered; this study is usually performed overnight at a hospital’s sleep clinic. It involves a video camera and constant EEG monitoring throughout the study. With the video and EEG combined, the physician can collate any suspected abnormal physical motor occurrences with the EEG, better identifying the seizure activity with the physical manifestations.
What Treatments and Medications are Available to Help with Seizures?
In many cases, seizures can be alleviated by medication and other treatments. First and foremost, while a seizure is occurring, think protection: shielding the individual from harm during a seizure. One of the complicated risks of seizures is that further damage can occur in the brain with severe seizures. The individual can also be hurt while falling or during spastic episodes resulting from grand mal seizures.
There are medications and treatments that can help with seizures:
- Anticonvulsant medications. These are generally prescribed in the management of a seizure disorder. Tegretol, Phenobarbital, Dilantin, Klonopin, Valium, and Topamax are several examples of medications that may be prescribed.
- Vagus nerve stimulation therapy. This treatment is relatively new. A battery is surgically implanted with leads threaded under the skin and attached to the vagus nerve. Vagus Nerve Stimulation involves a device that sends short bursts of electrical energy into the brain via the vagus nerve.
- A ketogenic diet. A diet high in fats and low in carbohydrates that makes the body burn fat for energy instead of glucose can also help control the frequency of seizures but is likely to be used only if medications fail. Should medications and treatments fail, surgery may also be an option for treating seizures.
What Should You Do if Your Child is Experiencing Seizures?
If you suspect your child may be experiencing seizures, keep a journal and document episodes or behaviors you suspect to be seizure related. If possible, have someone record the episode. This will give your child’s pediatrician or neurologist insight into what you are witnessing—after all, it’s unlikely your child will experience a seizure during your 15 to 30 minutes visit with the physician.
In terms of documentation, take note of the following cases throughout the duration of the episode. Did your child become cyanotic or have blue lips which would indicate they weren’t breathing properly? What was your child doing at the time? Note any abnormal behaviors your child may have exhibited that made you suspect the behavior as seizure activity. Some children experience seizures that may be triggered by different environmental or dietary factors. Ask your physician if there are any environmental factors or dietary issues that you need to be aware of.
If your child has already been diagnosed with a seizure of some type, and you don’t feel that their current medication is managing their seizures effectively, keep a journal of any suspected breakthrough seizure activity you may see. There are many medications and combinations of medications that can be used for seizure control. If the seizures are adversely impacting your child’s quality of life, don’t give up. Persevere and continue to question your child’s physicians until you find the right medication or combination of medications that offer a better level of control.
There are some specific questions to ask your child’s physician regarding any medications, as well. Ask about what side effects to expect with any medication; what contraindications you need to be aware of; and what to do in the case of a serious adverse side effect. Discuss whether your child should take the medication with or without food. Make your child’s neurologist aware of any other medications your child may be on, whether it’s seizure-related medication or not.
Also, be sure you’re aware of any blood work or lab work that needs to be done and the frequency. Many anticonvulsants require blood work to monitor the levels of the medication in the blood and to monitor possible kidney and liver function in relation to the medication.
If you suspect that your child’s cerebral palsy was the result of preventable medical error, contact the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs to discuss your options. With a depth of legal and medical expertise, we have helped over 30,000 families make the best choices for their families regarding their cerebral palsy medical malpractice case.
Claire Surles, RN
Claire comes to JJS after a 10-year career as a labor and delivery nurse. She dedicated her hospital efforts to advocating for families, providing the safest birthing environment possible as Newborn Admission Nurse at UMMC St. Joseph Medical Center in Towson, Maryland. Her passion for helping those who experienced losses at any stage of gestation led to her appointment as Coordinator of the hospital’s ROOTS perinatal loss program. READ FULL BIO