Retractable Seizures in Children

A seizure is abnormal electrical activity in the brain. Children can have seizures for many reasons. Some seizures are short-lived or occur only once. These may be the result of an acute illness or a trauma to the brain. Some conditions, such as epilepsy, manifest in repetitive or prolonged seizures.The treatment for seizures depends on the underlying cause, or etiology. Seizures that are not easily controlled with anticonvulsant medications are termed "retractable" seizures.

Definition

• Seizures, also known as convulsions, occur when electrical activity in the brain goes awry. Normally, the nervous system controls body functions such as muscle movements and thought processes with electrical impulses traveling up and down nerve fibers. Sometimes these signals malfunction, causing involuntary movements or a change in level of consciousness. A seizure can last only a few seconds, or it can be prolonged. If a seizure does not stop within a few minutes, it may develop into status epilepticus, a life-threatening condition.

Symptoms

• There are many kinds of seizures, depending on what parts of the brain are involved in the abnormal electrical activity. Partial seizures involve only one part of the brain. These convulsions may be very short---a few seconds---and the child may not lose consciousness. Generalized seizures involve both sides of the brain and thus manifest symptoms in many different body parts. Convulsions can be staring spells, jerking of arms or legs, smacking of the lips, eyes darting repeatedly to one side, and more, depending on the parts of the brain involved.

Causes

• There are many causes of seizures, but in children, seizures often occur with fever ("febrile seizures"). Other causes may be infections, head trauma, brain malformation, brain tumors, medications and metabolic imbalances in the body. Because the first year of life is a time of rapid brain growth, babies have a higher risk of seizures than older children. At times, the cause of a seizure may not be evident, even with a thorough medical work-up ("idiopathic seizures"). Children who have two or more seizures without a fever in a year may be diagnosed with "epilepsy."

Diagnosis

• Pediatric neurologists are physicians specially trained to diagnose seizures in children. An important part of this diagnosis is observation of symptoms. Tests can also help to determine the cause. An EEG (electroencephalogram) records brain wave patterns to determine if there is any abnormal electrical activity in the brain. A lumbar puncture, or spinal tap, helps determine if there is an infection in the central nervous system. MRI or CT scans both produce images of the brain to determine if there are any malformations, tumors or bleeding in the brain.

Treatment

• Not all seizures require treatment. Febrile seizures that occur during an illness are usually not treated. Treatments depend on the cause and frequency of seizures. Anticonvulsants are medications that control seizures. There are many medications in this class which have different actions in the brain. The medication is usually chosen based on the type of seizure (focal or generalized). Other treatments may include surgery or a ketogenic diet.

Retractable seizures

• Retractable seizures is a layman's term for prolonged, clustered or frequent seizures that are difficult to stop. It is not a medical diagnosis. It is possibly a portmanteau, or mixed word, which combines the medical terms "refractory" (meaning poorly controlled seizures) and "intractable" (meaning uncontrollable seizures). The medical term "intractable seizures" is defined by the Mayo clinic as, "failure to respond to at least two appropriate antiseizure medications." Whether intractable, refractory or retractable, these seizures, according to the Mayo Clinic, "have a disabling effect on quality of life."

Prognosis

• While there is no outright cure for seizures, many children with seizures have a good outcome and outgrow their seizures as their brains develop and mature. Often, the outcome is dependent on the cause of the seizures. Some children are able to be maintained seizure-free with anticonvulsants and eventually weaned off medications. Some require more vigorous treatment and closer monitoring, more trials and higher doses of multiple medications, but even these children may be able to lead normal lives as their brains grow and develop.