“The main things to remember in any seizure are to protect the child from harm and to monitor the seizure. Do not attempt to hold the child still or to prevent physical movement; instead, make the environment safe so that she cannot be physically hurt. It is important to remain with the child during the seizure.

If the child is in a sitting position, or standing or walking when you observe the seizure, help her to lie down, so that she will not fall and get hurt. If at all possible, place the child on a blanket or protected surface. Position the child on her side, supporting the head. Move all sharp objects out of the way, as well as any furniture. Pad any sharp objects that cannot be moved, to prevent the child from getting hurt. If the child is wearing restrictive clothing, loosen it, especially in the chest and abdominal area.

Do not put anything in the child’s mouth. It used to be the practice to put a tongue depressor into the mouth and hold the tongue down. This is no longer done and can in fact be harmful. The child may clamp down hard with the teeth during the seizure and break either the tongue depressor or a tooth and choke on a piece of it.

Do not interfere with the seizure or try to stop it. Allow the seizure to continue without interruption. Check the child for breathing. If the child has stopped breathing, clear the airway and perform mouth-to-mouth breathing.

Call 911 or call for other emergency medical assistance if the following conditions occur:
1. Color change during seizure
2. Breathing problems during the seizure
3. A prolonged seizure lasting longer than 10 to 15 minutes
4. Repetitive seizures without recovery between seizures

Being able to describe the seizure for the doctor is very important, because it helps the doctor determine the diagnosis and management of the child’s seizures. If you observe a seizure, take note of the following:

1. Before seizure
a. Did the child experience an aura? An aura is any strange or unusual feeling, taste, sound (humming, ringing, etc.) or visual changes?
b. Did something trigger the seizure? Some seizure triggers are illness, stress, body changes, (adolescence), hyperventilation, and flashing lights.
2. During the seizure
a. The time of onset of the seizure and long it lasted.
b. The body parts affected by the seizure and what form the movement took (stiffening, jerking, shaking, twitching, etc.)
c. Any eye movements, such as staring, eyelid fluttering, eyes looking in a particular direction, etc.
d. Loss of control of bladder or bowels
e. Loss of consciousness or any type of confusion
f. General appearance
3. After the seizure
a. Confusion or disorientation
b. Fatigue or sleepiness
c. Headache
d. Injury

The most important thing to remember is to remain calm during a seizure. This will allow your to help your child during the seizure or get medical assistance if necessary." (Cerebral Palsy: A Complete Guide for Caregiving: p 334-335)

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“About 50 percent of children with cerebral palsy have seizures – episodes in which abnormal nerve activity disturbs the functioning of the brain. Children with quadriplegia or hemiplegia are most likely to have seizures.

Seizures are common among children with cerebral palsy because brain injuries provide focus for abnormal nerve impulses to occur. Depending on where the abnormal activity occurs in the brain, seizures may affect children in a variety of ways. A child may have staring episodes; minor involuntary movements such as eye blinking, lip smacking, or arm jerking; or major convulsions with unconsciousness, stiffening of the body, and then violent spasmodic jerking of the whole body. When seizures occur repeatedly, they are diagnosed as epilepsy.” (Children with Cerebral Palsy: p. 17)

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“Once a seizure has begun, there is nothing you can do to shop it. But if you stay calm, you can make your child more comfortable and keep her from hurting herself. First, help ease your child to the floor and move obstacles out of the way. Turn your child on her side so the saliva can flow out of her mouth. Don’t put anything between her teeth; no matter what you have heard, a child cannot swallow her own tongue. Also remember that it is usual for a child’s breathing to become irregular, so don’t be alarmed. After the seizure has run its course, let your child rest and be supportive. Help her get her bearings and understand what has happened.

If it is not your child’s first seizure, it is usually not necessary to call a doctor right away. You should, however, seek emergency care immediately if your child’s seizure is very active for more than ten minutes.” (Children with Cerebral Palsy: p. 66)

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“If your child’s EEG confirms that she has seizures, the neurologist will discuss possible treatments with you. Usually anticonvulsant medication is recommended, since medication can reduce or eliminate seizures in about 90 percent of children with epilepsy. Medication might not be necessary if your child has febrile seizures or infrequent or minimal seizures such as brief staring spells occurring only every several weeks.

The type of medication prescribed for your child depends on the type of seizures she has. For tonic-clonic seizures, phenobarbital and phenytoin (DilantinTM) are most often used. Carbamazepine (Tegretol TM) is frequently used for psychomotor seizures. Valproic acid (Depakene TM) helps control myoclonic, absence, and tonic-clonic seizures. Other medications that might be used include clonazepam (Klonipin TM), primidone (Mysoline TM), diazepam (Valium TM), and ethosuximide (Zarontin TM). These medications may be used alone or in combination.

Although medications are very effective in preventing or reducing seizures when given regularly, they may also produce a variety of side effects. For example, they may cause hyperactivity behavior, irritability, sleep problems, growth of body hair, lethargy, depression, or sedation, and can affect liver function or blood counts. Because of these possible side effects, your pediatrician and neurologist must monitor your child closely when she is on medication. Through periodic blood tests, they will determine your child’s therapeutic level – the amount of drug in the blood which usually controls seizures with a minimum of side effects”

If medications cannot control your child’s seizures, a dietary approach to seizure control may be suggested. Specifically, your child may be put on the Ketogenic Diet, a very strict diet high in fat and low in protein and carbohydrates. This diet alters the body’s metabolism so that the amount of ketone bodies – compounds normally excreted in the body’s fluids – are greatly increased. This metabolic state can help control seizures. The diet works best for children under the age of five whose nutrition can be closely monitored. If this approach is considered for your child, the neurologist will refer her to a nutritionist.” (Children with Cerebral Palsy: p. 65-66)

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“As many as half of all children with cerebral palsy have seizures. During a seizure, the normal, orderly pattern of electrical activity in the brain is disrupted by uncontrolled bursts of electricity.”
NINDS

“Physicians usually prescribe drugs for those who have seizures associated with cerebral palsy, and these medications are very effective in preventing seizures in many patients.”
MEDEM

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