Benign General and Partial Seizures in Infants

How New Parents Can Relax Despite Their Child's Epilepsy

Newborn baby boy crying
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Few things are as heart-wrenching as having a child who has serious neonatal seizures. But while some seizures can cause serious problems in children's development, thankfully not all seizures that affect newborns are so serious.

Generalized Epilepsy Syndromes in Infants

Generalized seizures are so named because they seem to occur all over the body simultaneously. An electroencephalogram (EEG) shows abnormal electrical activity involving the entire brain at once.

  • Benign Neonatal Convulsions
    • There are two types of neonatal seizures that do not have serious consequences for a newborn child. Benign familial neonatal seizures (BFNS) and benign idiopathic neonatal seizures are usually associated with a good outcome.
    • BFNS typically begins in the first few weeks of life with brief but very frequent seizures. Between seizures, the child is normal. The most important piece in making a diagnosis of BFNS is a family history of seizures. BFNS is inherited in an autosomal dominant fashion, meaning that if a child has it, one of the parents likely has it too. While seizures usually resolve in early to mid-infancy, about 8 to 16 percent of children go on to develop epilepsy later in life.
    • Benign idiopathic neonatal seizures also occur in otherwise completely normal newborn children. Symptoms usually begin on the fifth day of life and become more serious, sometimes culminating in status epilepticus. After 24 hours, the seizures improve.
  • Generalized Epilepsy with Febrile Seizures Plus
    • Generalized epilepsy with febrile seizures plus (GEFS+) can affect children from infancy to adolescence, but fortunately, febrile seizures are usually relatively harmless and generally don't lead to further problems. In GEFS+, though, the febrile seizures go beyond the age of 6 years and are also accompanied by other types of seizures. Like BFNS, GEFS+ is inherited in an autosomal dominant fashion. But due to what is called variable penetrance of the mutation, between 20 to 40 percent of parents may not have symptoms, even if they do have the mutated gene.
    • Most children with GEFS+ will improve, though up to 30 percent may develop a more severe epilepsy.
  • Myoclonic Astatic Epilepsy (Doose Syndrome)
    • Myoclonus is a very fast muscle movement with a variety of causes, including epileptic seizures. Myoclonic astatic epilepsy (MAE) affects about one in 10,000 children. In addition to myoclonus, the children have other seizure types as well including atonic seizures, in which they suddenly go limp. Doose syndrome can begin as early as seven months, or as late as 6 years of age. An electroencephalogram (EEG) can be helpful in making the diagnosis.
    • Doose syndrome is not always associated with a good outcome. While the majority of children with MAE will develop normally, up to 41 percent will have a borderline IQ or a mental handicap. Some will develop intractable epilepsy.

Partial Epilepsy Syndromes in Infants and Children

Unlike generalized seizure, partial seizures start in one area and then can spread to involve other parts of the brain. While sometimes partial seizures are due to an underlying brain abnormality like a blood vessel abnormality, the problem is sometimes there from birth.

  • Benign Infantile Familial Convulsions
    • Benign infantile familial convulsions start when a child is between 3.5 to 12 months old. The child first stops moving and then has jerking of the limbs about 5 to 10 times a day. As the name implies, the seizure disorder is genetically inherited. There is a characteristic pattern on the EEG that may be helpful in making the diagnosis. Usually, seizures resolve spontaneously as the child gets older, and development is normal.
  • Benign Partial Epilepsy in Infancy
    • This seizure syndrome is very similar to benign infantile familial convulsions -- the main difference is that in this form, a genetic mutation is typically not identified.
  • Childhood Epilepsy with Occipital Paroxysms (Panayiotopoulos Syndrome)
    • This syndrome usually occurs in preschool aged children but can occur as early as one year of age. The seizures of Panayiotopoulos syndrome are particularly associated with dysautonomia, with symptoms such as nausea, vomiting, and paleness. An EEG has a characteristic pattern of sharp waves at the back of the head, called occipital paroxysms. Seizures usually resolve in 1 to 2 years.
  • Benign Childhood Epilepsy with Centrotemporal Spikes (Benign Rolandic Epilepsy)
    • Benign rolandic epilepsy most typically begins in children 7 to 10 years of age, but can sometimes be seen in children as young as one year old. Seizures are associated with drooling and sensory changes. Seizures usually arise from drowsiness or sleep. An EEG is very helpful in this syndrome, as it shows sharp waves in the centrotemporal regions of the brain. While these seizures are frightening to children (who remain awake throughout), they are not dangerous and usually resolve on their own by the age of 16 years.

Bottom Line

As you've seen, while most of these seizure syndromes have a good outcome, some of them do increase the risk that a child will not have a normal life. As sad as this is, compared to other syndromes in which a poor outcome is virtually certain, these syndromes allow parents to have some degree of optimism.

While few parents would ever wish their child to have seizures, with many of the syndromes above, the most likely outcome is a relatively normal life — sometimes even without medication. Focusing on the positives, while realistically planning for worse possible outcomes, can allow children to live the best life they can with epilepsy.

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Article Sources
  • Elaine Wirrell, Katherine C. Nickels. Continuum: Epilepsy, Volume 16, Number 3, June 2010.
  • Gerald M Finichel. Clinical Pediatric Neurology. 6th Edition. Sanders-Elsevier, 2009.