Seizures in babies are instantaneous, uncontrollable electrical brain abnormalities that cause alterations in their actions, movements, and consciousness. If you notice two or more seizures without a known cause and within a gap of 24 hours, it could be a sign of an epileptic episode. A seizure is mostly triggered by a head injury or a brain-related disorder and is common in infants and children. It may be difficult to identify a definite cause for seizures; however, it is best to contact a specialist to seek immediate medical care and avoid future risks of seizures. Read on to discover the types, signs, causes, diagnosis, treatment options, and outlook of seizures in babies.
Types Of Seizures In Infants
Infant seizures can be of various types depending on the affected brain area and the clinical symptoms. Many babies, especially newborns, can have subtle seizures with no obvious signs. Other types of seizures in infants may include the following (1) (2).
1. Focal seizures
Focal seizures (partial seizures) cause abnormal brain electrical activity in specific areas of the brain. Focal seizures are divided into the following subtypes.
Simple focal seizures involve only specific parts of the brain, and the symptoms are characteristic to them. The infant may not lose consciousness. For example, focal seizure of the occipital lobe triggers isolated muscle spasms on arms or legs. Precursor signs called aura are seen in infants before the onset of simple focal seizures. Fear, anxiety, and changes in hearing and vision are common precursor signs.
Complex focal (partial) seizures occur in one lobe of the brain and cause loss of consciousness in infants. This is also known as complex onset impaired awareness seizures. Infants may become unaware of their surroundings and often show unusual behaviors such as chewing and smacking.
2. Generalized seizures
Generalized seizures involve both sides of the brain and are often associated with a brief loss of consciousness. The following subtypes of generalized seizures are seen in infants.
Absent seizures or petit mal seizures cause a sudden loss of consciousness, and the eyes remain open with an abnormal gaze. Usually, this may last less than 20 to 30 seconds and can occur several times a day.
Atonic seizures cause sudden loss of muscle tone, making the baby like a rag doll or limp while walking or cause them to fall from a standing position. Head and arms may drop down in most babies, along with unresponsiveness.
Tonic seizures cause sudden stiffness in some parts of the body, and eyes and head may turn to one side.
Clonic seizures cause rhythmic jerking or twitching of an arm or leg, and this may switch from one side to another.
Myoclonic seizures may cause brief jerking or spasms of one muscle or muscle group in the body.
General tonic-clonic seizures or grand mal seizures are common types of seizures in babies. This may cause a series of events, including contraction of the body and straightening followed by tremors or shakes and then to a clonic phase where muscles gradually return to normal.
Other types of seizures common in infants may include:
Infantile spasms or West syndrome is a rare type of seizure with sudden spasm (stiffening) of the body, neck, or legs. This is common when the baby wakes up or falls asleep and often occurs several times a day.
Febrile seizures are seizures triggered by high fever and not triggered by neurological problems.
Simple focal seizures can progress to generalized seizures in some babies. It indicates that abnormal electrical activity can begin in one area of the brain and spread to other parts.
Causes Of Seizures In Babies
Various medical conditions and injuries can disrupt electrical activity in the brain and often result in seizures. Brain injury or damage such as hypoxic-ischemic encephalopathy (HIE) is the most common cause of seizures in newborn infants. Common causes of seizures in infants may include (3):
Stroke Brain tumors Brain hemorrhage or bleeding Infections such as encephalitis and meningitis Certain birth defects and genetic disorders
Metabolic disorders including hypoglycemia Electrolyte disorders like Hypocalcemia and hyponatremia are one of the most common causes of seizures in infants, which are treatable and have a good prognosis.
Newborns with seizures may have a history of oxygen deprivation or head injuries during delivery. Forceps or vacuum-assisted deliveries may increase the risk of head trauma and seizures in newborn babies.
Signs And Symptoms Of Seizures In Babies
Infant seizures can be challenging to recognize since they are short and subtle. In addition, symptoms of a seizure may vary according to the type of seizure. Most babies may have seizures when they are awake. However, some babies can have sleep seizures at night or during a daytime nap. Any type of seizure can occur during sleep and often impact the quality of sleep in babies. Subtle seizures that are seizures without tonic or clonic movements are common in full-term babies. Symptoms of subtle seizures in infants may include (3):
Sudden eye movements such as eyes rolling up, wide opening of eyes, and staring Eyelid blinking or fluttering Sucking, chewing, or smacking movements Protrusion of the tongue Apnea (long pause of breathing) Pedaling or unusual bicycling movements of the legs Struggling or thrashing movements
Symptoms of tonic seizures in infants may include:
Muscle stiffness or tightening Turns head or eyes to one side Stretch or bend one or both arms or legs
Symptoms of clonic seizures may include:
Rhythmic jerking movements of various muscles involving the tongue, face, legs, and arms
Symptoms of myoclonic seizures may include:
Quick and single jerking movements of the whole body or one arm or leg
Some symptoms of infant seizure can be similar to normal behaviors and movements. Therefore, you may seek medical care to diagnose and treat seizures in infants.
Diagnosis Of Seizures
Health history and details of symptoms may help to obtain a clinical diagnosis of seizures in babies. However, an electroencephalogram (EEG) is ordered to confirm the diagnosis. EEG records the electrical activity of the brain through electrodes placed on the scalp. Usually, EEG abnormalities are seen in babies with seizure disorders but sometimes EEG may be normal, especially in inter-ictal phases. Brain imaging studies such as computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are often done to visualize brain tissue abnormalities. In addition, blood tests and cerebrospinal fluid (CSF) analysis are also often ordered to identify underlying causes.
Treatment For Seizures In Infants
Various antiepileptic or antiseizure medications are used to treat seizures in infants. Doctors may opt for medicines according to the baby’s age, seizure type, underlying cause, and other medical conditions. Antiseizure or antiepileptic medications do not cure seizures; they help to control the condition. Infants may often require a longer course of medication to control seizure disorders. Pediatric neurologists or epilepsy specialists may give prescriptions of antiseizure medications. Some of the medications prescribed commonly are (4).
Carbamazepine Clonazepam Phenobarbital Phenytoin Sodium valproate Vigabatrin Stiripentol (Used only for a specific disorder, Dravet syndrome. Not a commonly prescribed medication.)
Appropriate regular doses of antiseizure medications can control seizures in most babies. However, certain seizures may not respond to treatment with antiseizure medications. For example, pyridoxine-dependent seizures (PDS) require daily vitamin B6 (pyridoxine) supplements for months or years to prevent seizures since it is caused by the inability of the infant’s body to metabolize vitamin B6. The American Academy of Neurology and the Child Neurology Society recommend using adrenocorticotropic hormone (ACTH) for infantile spasms. Antiseizure medication such as vigabatrin is tried if ACTH does not work. The ketogenic diet (high-fat, low-carb diet) is also recommended to control refractory seizures and infantile spasms.
Outlook Of Seizures In Babies
Babies who have seizures before one year of age may or may not continue to have seizures at a later age. The prognosis may vary depending on the onset and type of seizures. Premature infants may have a poorer prognosis than term infants. Seizure-related disabilities and mortalities are high among preemies. Babies with seizures can also get disability living allowance (DLA) in some countries since they require long-term care. This can be claimed from birth or three months if they require more medical care and supervision. You may inform the pediatrician if your baby has seizures since early diagnosis and treatment can improve outcomes.
