Everything You Need To Know About Seizures In Babies: Causes, Symptoms, And Treatment
A baby’s brain is unique regarding its susceptibility to seizures and response to subsequent treatment. A seizure represents the abnormal electrical activity of the brain. This can occur in any person, but babies are especially susceptible due to immature connections within their brains. Seizures in babies can be broadly broken down into provoked, unprovoked and status epilepticus. Provoked seizures are associated with acute illnesses like fever, abnormal electrolytes, meningitis, or bleeding (1). On the contrary, unprovoked seizures occur despite obvious clinical pathology. Status epilepticus involves prolonged or recurrent seizure activity. Although babies are more prone to seizures, there is also a high chance that they outgrow them as they advance through childhood into adulthood.
Types Of Seizures In Babies
Focal (partial) seizures
Focal seizures occur in one half of the brain and can be broken down into simple and complex. A simple focal seizure usually lasts less than a minute and only causes small, localized muscle movements. Important to note is that during simple focal seizures, consciousness is generally not lost. A complex focal seizure typically involves loss of consciousness and more demonstrative behaviors, like crying, gagging, running, and laughing.
Generalized seizures involve both sides of the brain and typically result in loss of consciousness and a postictal state (fatigue) afterward.
- Febrile seizures: Most common between 6 months and five years. These typically only last a few minutes and rarely have long-term effects.
- Infantile spasms: This rare seizure disorder can result in hundreds of short seizures a day. If not treated, long-term complications can occur.
- Atonic seizures: The child experiences a sudden loss of muscle tone. A concern with this type of seizure is injury from falls and head trauma.
- Absence seizures: This type of seizure is characterized by a brief period of altered consciousness and staring. These are not common before the age of 4 years old.
The origin of some seizures is not able to be tracked and categorized. These seizures are labeled as “unknown” and can involve various symptoms, such as spasms and abnormal neck movement. (2)
What Are The Causes Of Infantile Seizures?
The cause of seizures in babies can be broken into six main categories. (3)
This is the most common cause of seizures worldwide. Infectious causes can include malaria, tuberculosis, meningitis, and sepsis.
Immune system malfunction can result in systemic inflammation and subsequent seizure. An example of this type of etiology is Rasmussen encephalitis, which is a chronic inflammatory neurological disorder.
Pathology that contributes to loss of homeostasis in the body can result in a seizure. Examples of metabolic causes include high fever, low blood calcium, and low blood sodium.
Minor head trauma, lesions, brain malformations, ischemia that causes damage to the brain tissue, or bleeding that causes damage to the brain tissue are all examples of structural etiologies leading to seizures.
Genetics can play a role when a baby inherits several genes that increase the risk of seizures. This increased risk often leads to an epileptic disorder versus an isolated seizure.
Unfortunately, the cause of some seizures can never be determined.
Symptoms of Seizures in Babies
Seizure activity can be difficult to recognize during the newborn period because it mirrors their everyday movements. Symptoms of subtle seizures in babies include (4):
- Protruding tongue.
- Uncontrolled eye movements.
- Pauses between breaths.
- Leg cycling.
Tonic seizures are a type of seizure that causes the baby to become physically stiff. This may present as:
- Completely stiff body.
- Eyes locked in one direction.
- Head turned to one side.
- Extremities stiffened in awkward positions.
Clonic seizures cause the baby to have abnormal jerking movements. This may present as the irregular movement of the:
Treatment Options for Babies Who Experience Seizures
The decision to start antiseizure medication is highly personalized to each patient. If a baby experiences a seizure brought on by an acute illness (provoked), the focus will usually be on treating the cause, not medication administration. After the first unprovoked seizure, many providers agree that monitoring the baby, especially in an otherwise healthy one, is a better option than initiating antiseizure medication. The consensus among neurologists is that antiseizure medication should be started after the second unprovoked seizure. This is the case because two unprovoked seizures significantly increase the risk of the baby developing an epileptic seizure disorder. If medication therapy is unsuccessful, additional treatments might be considered as the baby ages, such as (5):
Vagus nerve stimulation
This involves implanting a small device in the chest that stimulates the left vagus nerve. Stimulation of this nerve can significantly shorten or even stop seizure activity altogether.
This is indicated when children don’t respond to antiseizure medications and have frequent seizures. This surgery involves removing the portion of the brain where the seizure originates.
A ketogenic diet has been shown to decrease the likelihood of seizures in children aged one through ten, by 50%. This diet focuses on high fat and low carbohydrate intake.
How to Cope with Having a Baby with Seizures
Most parents express that fear of the unknown can be the most significant factor regarding their baby’s seizures. Babies can be scary, let alone those struggling with health complications. The silver lining in this situation is that babies are prone to outgrowing seizures. It’s crucial to allow doctors the space to investigate the cause of the seizure, which can result in a more comprehensive picture of what parents should expect moving forward.
Parents can use preparedness as a form of coping.
- Ensure that anyone around the baby is trained and comfortable with what to do in the event of a seizure.
- Compose a written plan that can be set into action in the event of a seizure.
- Conduct “seizure drills” to instill confidence and ease the mind of anyone who will be in contact with the baby.
How to Help a Baby Having a Seizure
Witnessing a seizure can be scary, especially for parents. Fortunately, simple steps ensure the baby remains safe until help arrives. (6)
- First, place the baby side-lying on the floor, clearing any nearby objects on which the baby could injure themselves. Follow this step by surrounding the baby with soft padding (pillow, blankets, towels, etc.) to reduce the risk of injury.
- Remove any additional clothing or blankets that might prevent the baby from cooling down. If this can’t be done without the possibility of harm, wait until the seizure is complete.
- Finally, place the baby in the rescue position while you wait for help to arrive. This involves cradling the baby with their head slightly tilted down. The downward tilt will prevent the baby from aspirating if vomiting occurred during the seizure.
How to Prevent a Baby From Having a Seizure
Unfortunately, there is no way to prevent a seizure if it’s a first-time occurrence. Suppose the infant is already diagnosed with a seizure disorder. In that case, caregivers can use several interventions to prevent additional seizures.
- Ensure they are taking antiseizure medication on time and as prescribed.
- Ensure the child is getting plenty of rest at night.
- Avoid possible triggers (stress, flashing lights, etc.)
- Recognize early warning signs of the impending seizure (staring, jerking, change in mood, etc.)
Risks Associated with Seizures
The risk significantly increases when someone has epilepsy or greater than two unprovoked seizures.
- Fractures and broken bones can occur due to typical motor and sensory control loss.
- Aspiration (or inhaling food/liquid into the airways) is a massive risk among those suffering from seizures and epilepsy. Normal protective reflexes cannot be activated during a seizure, which can result in aspiration and pneumonia.(7)
- Infancy is a critical period of brain development. Undiagnosed seizures can disrupt pathways in the brain that lead to developmental delays.
- The risk of death is more significant for those with uncontrolled versus controlled seizures.
How common are seizures in babies?
Seizures aren’t as rare as some might expect. Studies have shown that about 100 per 100,000 infants are diagnosed with some sort of seizure. As discussed earlier, seizures can be challenging to recognize in babies. Prompt treatment should be sought if there is any suspicion that a baby is experiencing seizures.(8)
Can seizures be linked to malpractice?
Failure to diagnose seizure activity is a form of medical malpractice. Prompt diagnosis is crucial when it comes to identifying seizures in infants. A primary care provider should complete a thorough physical exam and collect a rigorous family history of the child. If suspected of seizure activity, the baby should be referred to a pediatric neurologist for further evaluation. Malpractice could play a role if the provider failed to appropriately recognize the signs of seizure activity and provide prompt consultation to neurology. Studies have shown that undiagnosed seizures in babies can lead to developmental delays and even death.
Medical Malpractice during the birthing process can also be a cause of seizures in neonates.
- Improper use of delivery assistive devices can result in brain bleeding or tissue damage, and seizure activity.
- Failure to recognize umbilical cord problems can lead to oxygen deprivation and subsequent seizure activity.
- Failure to recognize fetal distress can also lead to hypoxia, brain damage, and seizures.