Tonic-Clonic Seizures in Children

Tonic-clonic, or grand mal, seizures occur most frequently in young children. The seizures typically cause children to lose consciousness, soil themselves and move uncontrollably for several minutes. Parents and other caregivers must understand how to keep children safe during a tonic-clonic seizure and know when to seek medical care beyond first aid for a child who has had a seizure.

Causes

• All tonic-clonic seizures occur when a large part of the network of synapses that transmit electrical signals across and from the brain malfunctions. The cause of this widespread malfunction varies from person-to-person and the specific cause of a single tonic-clonic may never be pinpointed. Doctors classify seizures with no known cause as "idiopathic." Recognized causes of tonic-clonic seizures include high and rapidly rising fevers (i.e., febrile seizures), epilepsy, brain injury, infections, stroke, kidney failure, brain tumors, electrolyte imbalances, malnutrition and alcohol or drug overdose, or acute withdrawal.

Prevalence

• Statistics compiled by the Epilepsy Foundation indicate that children are most prone to idiopathic, epileptic and febrile seizures. Of the 300,000 Americans who suffer a first seizure each year, 120,000 are children younger than 18 years old, while as many as 100,000 are children younger than 5 years old who experience a febrile seizure. Some 45,000 children under the age of 15 years get diagnosed with epilepsy each year, but not every one of these children suffer tonic-clonic seizures. The Epilepsy Foundation notes that tonic-clonic seizures occur most frequently in children younger than 10 years old.

Aura

• Before the onset of a seizure, a child may complain of foods tasting or smelling funny, being dizzy or having blurred vision. Doctors categorize these sensory changes, as well as mild hallucinations, as "aura." Once a child develops an aura, parents and caregivers need to begin making preparations for the occurrence of a seizure. The seizure cannot be prevented, but the child should, if possible, be moved to a private place free of objects that could cause injury.

Seizure Symptoms

• A tonic-clonic seizure has two distinct phases. During the brief---usually less than a minute--tonic phase, a child will breath slowly and may even stop breathing. If the child resumes breathing after the seizure, no resuscitative measures are necessary. The child will also become stiff to the point of rigidity and will almost always pass out. The loss of muscle control may result in a child peeing or defecating on himself.

  The clonic phase of a seizure is marked by rapid, sharp contractions of different muscles. A child may bite his tongue or the inside of his mouth. This can continue for two or three minutes, with the jerking motions becoming less frequent and less severe as the tonic phase passes. The child may remain unconscious for several minutes after he has stopped seizing.

Post-Seizure Symptoms

• A child will generally not remember what happened to him during a tonic-clonic seizure and will almost always be tired, weak and confused when he regains consciousness. General weakness can persist for up to two days and the child may complain of headaches following a seizure.

First Aid

• The Epilepsy Foundation strongly cautions parents and caregivers away from inserting objects into a child's mouth during a tonic-clonic seizure. Anything placed in a seizing child's mouth with the intent of keeping the airway open or preventing bite injuries is a choking hazard. The best method for protecting a child during a tonic-clonic seizure is to position him on his side, loosen any tight-fitting clothing, fight the urge to restrain him and ensure the mouth is free of obstruction---by inserting your fingers, if necessary. Only perform rescue breathing if he has not resumed breathing on his own once the clonic phase has passed. Lastly, as the Epilepsy Foundation advises, "Be reassuring and supportive when consciousness returns."

Seeking Medical Care

• Parents or caregivers should seek medical care for any child who has just experienced his first tonic-clonic seizure. A child with a history of seizures should see a doctor if his seizures last longer, or become more severe than usual, if he experiences new symptoms such as vomiting or hair loss, or if he has more than one seizure in rapid succession.