Diagnosing and Treating Epilepsy in Babies

About 1 in 1,000 infants will experience one or more seizures. Seizures are excessive or erratic surges of electrical activity in the brain, causing symptoms that can range from mild to severe. Epilepsy involves a person having two or more unprovoked seizures (seizures without a clear cause).

Some infants and children outgrow seizure occurrences, while others need seizure management their whole lives. This article will discuss the causes of seizures and epilepsy in infants, what to look for, and what treatment entails.

Types of Seizures

Infants can experience several types of seizures.

Neonatal Seizures

Neonatal seizures occur during the first 28 days of life. Premature babies or those with a low birth weight are more likely to experience neonatal seizures.

Neonatal seizures can be caused by many different factors. Typically, neonatal seizures are considered provoked, not a part of epilepsy. Neonatal seizures don't mean the baby will go on to have epilepsy, but the chances of their developing it at some point is increased.

Infant Seizures

Infantile spasms, also known as West syndrome, is a rare but serious type of epilepsy that affects about 1 in 2,000 children. It typically begins between the ages of 2 months and 12 months, peaking at about 4 to 8 months of age.

Febrile Seizures

Febrile seizures occur when a child is ill and has a fever. One in 25 children experiences a febrile seizure at some point. Up to one-third of these children will have febrile seizures with future fevers.

Febrile seizures typically occur in children age 6 months to 6 years. Febrile seizures are not epilepsy and generally do not raise the risk of the child developing epilepsy.

Symptoms of Epilepsy in Babies

Symptoms of seizures in babies depend on the type of seizure.

Symptoms of Neonatal Seizures

Neonatal seizures can be short and subtle, with many of the visible signs resembling the motions all babies make.

Subtle seizures (more common among full-term babies):

• Random or roving eye movements (eyelid blinking/fluttering, eyes rolling up, eye opening, staring)
• Sucking/smacking/chewing motions and protruding tongue
• Repetitive facial movements
• Unusual bicycling/pedaling movements of the legs
• Thrashing/struggling movements
• Apnea (long pauses in breathing)

Tonic seizures:

• Stiffening or tightening of the muscles
• Turning the head or eyes to one side
• Bending or stretching one or more arms or legs

Clonic seizures: Rhythmic jerking movements (may involve muscles of the face, tongue, legs, arms, or other areas of the body)

Myoclonic seizures: Quick, single jerking motions (involving one arm or leg or the whole body)

Infantile Spasms

Seizures associated with infantile spasms tend to only last a second or two but happen repeatedly in clusters that occur every five to 10 seconds in a series over several minutes' long. The seizures most commonly occur when the child first wakes up or falls asleep.

Symptoms of infantile spasms may include:

• Pause in activity (random and abrupt), with eyes slightly gazing to the side
• Small movements in the neck or other areas of the body (such as a widening and rolling up of the eyes)
• Eyes rolled back suddenly, with subtle head bobbing
• Dropping or bobbing their head briefly
• Head bent back and arms and legs straightened
• Arms raised over the head or sticking straight out to the side
• Sudden bend at the waist
• Stiffening legs or tucking them into the tummy (as if having stomach pain)
• "Jackknife" position (head bent forward, arms flung out, and knees pulled into the body)
• Loss of balance while sitting up, with their arms up in the air
• Repeated and rhythmic movements of arms or legs that can't be stopped
• Sudden flexing or extending of forearms, held for several seconds

A baby who has infantile spasms may also experience:

• Loss of developmental milestones​ previously met, such as sitting, rolling over, crawling
• Reduced social interactions and smiles
• Increase in fussiness or silence
  

Generalized convulsing (muscles involuntarily contracting and spasming) is not common in infants. Symptoms can resemble common actions in all babies and are sometimes mistaken for startle, hiccups, colic, or reflux.

The Infantile Spasms Project has provided a video of what infantile spasms can look like.

What to Do If Your Baby Has a Seizure

The American Academy of Pediatrics has created the acronym "STOP" to help parents and caregivers know what to do if they think their baby is having infantile spasms.

• S: See the signs, such as clusters of sudden, repeated, uncontrolled movements.
• T: Take a video of the symptoms, and show it to your child's healthcare provider immediately.
• O: Obtain a diagnosis confirming an irregular brain wave pattern with an electroencephalogram (EEG test).
• P: Prioritize treatment to control spasms and minimize developmental delays.

If your baby is having a seizure but not convulsing, stay calm, stay with them, and talk to them reassuringly. Time the seizure.

If your baby or child is having a convulsive seizure:

• Remain calm and stay with them.
• Have someone call the child's healthcare provider (if alone, follow these steps, then call).
• Time the seizure.
• Lay them down on their side on the floor or a soft, low surface (to prevent them from inhaling vomit or saliva).
• Loosen neckwear and headwear.
• Move anything that they could bang into and hurt themselves.
• Don't try to restrain them or stop the movements.
• Don't put anything in their mouth (they cannot swallow their tongue, and putting something in their mouth could cause harm to them or you).
• Monitor their breathing.
• Talk to them and comfort them.
• Call 911 or your local emergency number if the seizure lasts longer than five minutes, if your child stops breathing, and/or if your child turns blue.

It may take a bit for them to get back to normal after a seizure. They may be sleepy. Let them rest, stay with them, and don't give them anything by mouth (food, drink, medicine, etc.) until they are awake and aware.

Causes of Epilepsy in Babies

There are many potential causes for seizures in children before the age of 1 year. In some cases, the cause may never be identified.

Some causes of neonatal seizures and/or infantile spasms include:

• Lack of oxygen before or during birth
• Infection before or after birth, such as bacterial meningitis, viral encephalitis, toxoplasmosis, rubella, or syphilis
• Stroke (before or after birth)
• Blood clot or bleeding in the brain
• Imbalances in blood sugar or electrolytes
• Abnormal brain development
• Metabolic and/or genetic disorders
• Drug withdrawal if the baby was exposed as a fetus to substances such as barbiturates, alcohol, heroin, cocaine, or methadone
• Vitamin B6 (pyridoxine) deficiency (rare, but treatable)

More than 50 genetic and/or metabolic disorders are associated with seizures in infants including:

• Dravet syndrome
• Ohtahara syndrome
• Rett syndrome
• Angelman syndrome
  
• Tuberous sclerosis
• Sturge-Weber syndrome

Diagnosis

Early diagnosis is important. If you think your baby may be having seizures, see your child's healthcare provider right away. Try to take a video of the seizures, which can help determine a diagnosis.

The healthcare worker will do a physical examination, ask about symptoms, and ask about the baby's medical and family history. They may also refer your child to a pediatric neurologist.

Tests will be run to confirm seizures, look for a cause, and make a diagnosis. These may include:

• EEG: Records electrical activity of the brain
• Magnetic resonance imaging (MRI): Looks for structural abnormalities in the brain
• Computed tomography (CT) scan: Creates images of the brain
• Blood or urine tests: Looks for chemical disorders and/or metabolic problems
• Chromosomal studies: Looks for genetic disorders
• Spinal tap (lumbar puncture): Looks for infection, metabolic disorders, and chemical disorders

Treatment and Long-Term Outlook

Early treatment can lead to a better prognosis, so it is important to develop a treatment plan with your baby's healthcare provider as soon as possible.

Treatment depends on a number of factors, including the age of the child, the type of seizure, and the underlying causes.

Adrenocorticotropic hormone (ACTH) therapy is the first-line treatment for infantile spasms. It is given as an injection. This therapy can help relieve infantile spasms by stimulating cortisol production in the brain.

Anticonvulsant medications may be prescribed, including:

• Phenobarbital
• Ativan (lorazepam)
• Dilantin (phenytoin)

Seizures can be controlled with medication in about 85% of babies.

If a cause can be identified, addressing it may happen before giving anti-seizure medications.

Condition-specific treatment may be given. For example, a baby who has infantile spasms and tuberous sclerosis may be prescribed another epilepsy medication Sabril (vigabatrin). Newborns who have experienced oxygen deprivation to the brain may receive hypothermic treatment. This involves lowering the body temperature for several hours or days under careful monitoring.

If medication isn't adequately controlling the seizures, measures such as a special diet or surgery may be advised by a healthcare provider.

Prognosis

There are too many factors to give a general outlook for babies who experience seizures. Some babies have mild, short-lasting seizures and experience no long-term effects. Other babies, particularly babies with a serious underlying condition, may experience types of epilepsy, and/or cognitive, neurological, sensory, or developmental problems.

About half of newborns who experience neonatal seizures will later develop epilepsy. Most children with infantile spasms will experience developmental difficulties, but typical development is also possible.

Summary

Infants can experience several types of seizures, including neonatal seizures, febrile seizures, and infantile spasms. Not all seizures indicate epilepsy. Symptoms of infant seizures can be subtle. If seizures are suspected, prompt medical care is needed.

Causes of seizures in babies include pregnancy and birth complications, infection, brain abnormalities, genetic or metabolic conditions, and electrolyte imbalances.

Seizures in babies may be treated with medication, and/or by treatment specific to the underlying cause of the seizures.