My daughter had her first seizure when she was not even 4 months old. When I saw her first seizure, I realized something was terribly wrong. Kinsey became totally stiff, her breathing became very shallow and her eyes turned all the way up in her head. Her face turned white and her lips got a slightly bluish color.
Luckily her seizure lasted not that long, maybe about 30 seconds, but it sure felt like an eternity. Afterwards she took a deep breath, looked back at me and pretty soon thereafter she fell into a deep sleep.
We called her pediatrician, we met her in the local hospital (where she had a few more seizures) and her medical check-up started. We were so afraid that we thought we would never be able to take her back home again.
Much later, I got a better feeling of what happened, and hopefully this explanation will help you as well.
First of all, a seizure itself. A seizure is a temporary electrical problem in the brain. There are many different types of seizures, and they can have a very different effect. One very common form of a seizure is an "absence seizure", or in the older terminology, a "petit mal seizure". I think of an absence seizure as if the child seems to go on automatic pilot. They behave pretty normal, but nothing from the environment gets to them. Absence seizures are initially often thought to be day-dreaming, and there are probably many children where these seizures go undiagnosed.
Most people who have never dealt with epilepsy think of a seizure as an event where the person falls on the ground and makes very erratic movements. One of the more severe forms of seizures is a "complex tonic-clonic seizure", often still known as a "grand mal seizure". This is a seizure that starts with a tonic part (the stiffening of the body), followed by a clonic part (the rhythmic jerking of the body or a bodypart). The complex part of this type of seizure indicates that consciousness is lost.
Seizures can be hard to diagnose. After the seizure is over, the child returns back to normal, even though there is often sleepiness, weakness and/or confusion after a severe seizure. The period right after a seizure is called the post-ictal stage (Latin term for after seizure). Because a seizure is hard to diagnose, and because most seizures do not happen while a doctor is looking at your child, you'll find out that the doctor will ask you over and over again to describe what exactly happened. This information is essential to determine if it was a seizure and what type of seizure. Try to give as much detail as possible. I once used a video camera to record certain types of seizures, so that the neurologist could actually see the seizures, and it made the diagnosis clear right away (this was for absence seizures, my daughter developed these much later).
Once an episode is considered a seizure (or is possibly a seizure), the doctor will be most interested in trying to find the cause of the seizure. There are very many, very different causes for seizures. Some of these causes can require immediate medical attention. One of the likely causes for a seizure in a young child is a high fever. This high fever is caused by something else, it's not a part of the seizure. So the doctor will look for causes of the fever. Causes of high fever that requires immediate medical attention is meningitis (infection in the brain) or encephalitis (inflammation of the brain). Tests to identify these causes include labwork on spinal fluid, which is gotten by a lumbar puncture.
Another reason for high fever can be a normal childhood disease, in which case the seizure will be labeled "febrile seizure". These seizures might reoccur, but most children will grow out of it and treatment concentrates on treating the disease itself, not the seizure. While children get older, their "seizure threshold" increases, and the extreme high temperatures that is often seen in young children does not happen anymore.
If there is no fever, causes of seizures can be very different. Some of the causes that might require immediate medical attention include a tumor, brain damage (a fall or hit), a stroke and some types of chemical imbalances. Tests that will help identify these causes include a CAT scan and labwork.
In many cases, no cause for a seizure will be found. If there is no cause for a seizure, there are several different ways to continue. These depend very much on the doctors assessment of the (potential) and your own input. Sometimes the decision is made to not do any more work, but to wait and see if the seizure was a one-time event. Sometimes additional tests will be required, the most common one being an EEG. An EEG is the study of the electrical activity in the brain. In order to do that, several electrodes are "glued" on the head, and these electrodes will register the electrical activity of the brain. Patterns formed that way are very helpful in identifying seizures. Most children who have epilepsy (by definition, epilepsy is nothing else than more than one seizure of unknown cause) will show "abnormal EEG patterns", even if there were no seizures visible during the EEG. During the EEG, some tests can be done to see how the child responds. Most EEGs will include a period where the child is awake as well as a period where the child is sleeping. The reason for that is that certain types of seizures only happen in sleep periods or just after falling asleep.
However, even a normal EEG does not rule out epilepsy. It could be that the seizures happen in the deep parts of the brain, which is harder to see on an EEG. It can also be that the seizures only happen occasionally, and if none happens during an EEG, the EEG might look completely normal.
There are several options to increase the registration of seizure activity by an EEG. Often, a strobe light is used during the EEG. Some types of seizures are triggered by flashing lights in a certain frequency, and a strobe light is helpful to identify those. Also, a "sleep deprived EEG" might be ordered. This is the same as a normal EEG, only the child is not allowed to sleep the night before the EEG. This means that the child will be very tired (and irritated probably), and this might lower the threshold for seizures, making it more likely that the EEG will show abnormal patterns. This is very hard on parents, because keeping a child awake through the night is not an easy job, and it will not only make the child irritated, but also yourself. Yet another form of an EEG is a 24-hour EEG. This is often done in special set up rooms in a hospital, where the child is always connected to an EEG. Often the activities of the child are also videotaped. Parents who accompany the child will have some way of alerting the staff of a seizure, and diagnoses is done later by studying the "interesting" parts of the video and EEG.
First aid for seizures is very limited. It's best to put the child on their side and to loosen any tight clothing. Protect your child from any injury. Watch for rolling of the bed and remove any sharp objects.
DO NOT try to restrict the jerking movements. These jerks are caused by the abnormal electrical activity in the brain. These electrical patterns travel through the nerves in the body and tell muscles to contract or relax. These contractions are extremely powerful. If you would try to restrain these jerks, you're only fighting a muscle that REALLY wants to contract. The strength of the muscle during these jerks is many times the normal muscle strength, and if you try to stop it, you might actually cause additional injuries, including broken bones, that's how strong these jerks are.
Also, DO NOT put anything in your child's mouth. The same muscle strength can cause the jaws to be clenched extremely tight, and anything you would put in their mouth might brake (including your own fingers) and not do any good to the child.
Most seizures will stop in a few minutes. If the seizure lasts longer, or if there are additional problems, seek immediate medical help. A seizure that lasts a long time is called "Status Epilepticus" and is considered a medical emergency. It's not clear what exactly a "long time" is, but remember, better safe than sorry. In case of a Status Epilepticus, the seizures often have to be stopped with medication. A long period of continuos seizures is a possible cause of brain damage.
I hope this information will help to begin to answer some of your questions. Once again I would like to point out that I'm not a medical professional, and you should always seek professional help when dealing with seizures.
If you want to read more about seizures and epilepsy, I would strongly recommend to find the book "Seizures and Epilepsy in Childhood: A Guide for Parents". It's written by John M. Freeman, M.D., Eileen P.G. Vining, M.D., and Diana J. Pillas.
If you have any questions, comments or info you think I should add to this page, pleasee-mail me.