Cerebral palsy and epilepsy

What is epilepsy?

Epilepsy is a neurological disorder marked by an increased susceptibility to repeated, unprovoked seizures.

A seizure is a sudden episode of electrical activity in the brain that can cause involuntary movements and behavior changes.

Epilepsy is not a disease, but rather a spectrum condition characterized by unpredictable, recurrent seizures. Not all people will experience the same symptoms of epilepsy, and seizures can range from mild to severe.

Seizures are common among children with cerebral palsy because CP is caused by a brain injury occurring before, during or shortly after birth. Brain injuries increase the chance for abnormal nerve activity to occur within the brain, which can result in seizures. Children with hemiplegia and quadriplegia are most at risk for co-occurring CP and epilepsy.

Causes of epilepsy

There are about 180,000 new cases of epilepsy diagnosed every year, with about 40% of these occurring in children. Epilepsy is most commonly caused by some form of injury to the brain. However, there is often no clear indication of what exactly caused a seizure to occur.

Some main causes of epilepsy are:

• Low oxygen during birth
• Head injuries occurring during birth or young adulthood
• Brain tumors
• Genetic conditions that result in brain injuries
• Infections, such as meningitis or encephalitis
• Stroke or any other brain damage
• Abnormal levels of substances, such as sodium or blood sugar

Risk factors of epilepsy

About 70% of all cases of epilepsy in adult and children have no obvious cause. While locating a direct reason for seizures can be difficult, there are a number of risk factors that can increase one’s chance for developing epilepsy.

Risk factors for epilepsy include:

• Being diagnosed with cerebral palsy
• Babies who are born small for their age
• Bleeding in the brain
• Co-occurring conditions that involve intellectual or developmental disabilities
• A family history of epilepsy or fever-related seizures
• Being on the spectrum for autism

Types of seizures

While epilepsy is unique to each individual, there are two general categories of seizures that occur with this condition. Each type of seizure has different causes, symptoms and treatment methods. It’s important to seek medical professionals that are experienced in the specific form of epilepsy your child has.

The two main categories of epilepsy are:

• Focal seizures
• Generalized seizures

Focal seizures

Focal seizures occur when only one part of the brain experiences abnormal electrical activity. Focal seizures are usually named based on the area of the brain in which they take place. For example, an individual might be diagnosed with “focal frontal lobe seizures”.

About 60 percent of people with epilepsy are diagnosed with focal seizures. This type or seizure disorder can be further broken down into 2 additional sub-categories.

The categories of focal seizures are:

• Simple focal seizures – seizures in which the individual remains conscious while experiencing unusual feelings or sensations. They may have sudden and unexpected feelings of happiness, anger, sadness or nausea. Individuals with simple focal seizures may also hear, smell, taste, see or feel things that are not real.
• Complex focal seizures – seizures that cause an individual to lose consciousness and experience a “dreamlike” sensation. Individuals may also exert strange, repetitive behaviors such as blinking, twitching, mouth movements or walking in circles. These movements are referred to as automatisms.

In both simple and complex focal seizures, it is common that people report experiencing auras, or unusual sensations that warn of an impending seizure. The symptoms of an aura tend to remain consistent, which makes it easier for people with epilepsy to quickly identify the sensation and quickly prepare for the seizure or inform others around them.

Generalized seizures

Generalized seizures are caused by abnormal brain activity that begins on both sides of the brain, and this can result in a loss of consciousness. These types of seizures can be “convulsive” or “non-convulsive”, meaning that seizures can occur with generalized motor movements (convulsive) or without generalized motor movements (non-convulsive).

Generalized seizures can be further broken down into additional types:

• Absence seizures – can cause a person to stare into space or have jerking, twitching muscles
• Tonic seizures – can cause stiffening of the back, leg or arm muscles
• Clonic seizures – can cause repeated jerking movements on both sides of the body
• Tonic-clonic seizures – can cause a mixture of the above symptoms, such as stiffening of the body and repeated jerking of the arms/legs, as well as a loss of consciousness
• Atonic seizures – can cause a loss of normal muscle tone, causing a person to fall down or drop their head involuntarily

What do I do if my child has a seizure?

Witnessing your child have a seizure can be an incredibly stressful and scary situation, especially if it is one of the first times this has occurred. Fortunately, there are several things you can do to help keep things under control.

1. Stay calm and reassure others

Many people become nervous when they see someone having a seizure. Try to stay quiet, calm and reassuring to both your child and others.

2. Prevent further injury

If your child is near a stairway, busy street, or around other hazards, try to protect them from any further injury as much as possible. Remove any dangerous objects that may be nearby and place something soft under their head, such as a folded jacket.

3. Track the length of the seizure

Taking note of when the seizure began and ended is an important step. If it is your child’s first seizure, or it lasts longer than 5 minutes, call 911 immediately.

4. Make your child as comfortable as possible

This includes things such as removing glasses, loosening any tight or restrictive clothing around the neck and chest, and loosening belts or buttons. If possible, try to roll your child on their side so that any fluids can drain out of the mouth.

5. Do not insert anything into your child’s mouth

It is a common misconception that things such as spoons, fingers or other objects should be inserted into a child’s mouth to prevent them from swallowing their tongue. However, it is very important that nothing be inserted into the mouth during a seizure, as this can actually cause them to choke.

6. Keep bystanders at a distance

If the seizure occurs in a public place, try asking bystanders to keep their distance from your child. When they wake up, they may feel a rush of embarrassment or nervousness, so it is best to keep only necessary personnel around during a seizure.

7. Contact your child’s doctor

After your child experiences a seizure, it is important to contact their pediatrician to get further medical advice regarding the situation. If your child is experiencing pain, muscle aches, a bitten tongue or a fever following a seizure, this may require emergency medical attention.

Treatment for coexisting CP and epilepsy

Treatment for coexisting CP and epilepsy is dependent upon the type of cerebral palsy a child has, as well as the form of epilepsy they are experiencing. The rate of coexisting CP and epilepsy is relatively high, so parents should seek out medical professionals that are trained in the best treatment methods for this type of co-occurrence.

There are several methods that can be used to treat CP and epilepsy, such as:

• Physical therapy – Used to improve balance, posture and coordination
• Speech therapy – Used to help with articulation, communication and comprehension
• Occupational therapy – Used to increase independence when completing everyday tasks, such as getting dressed or eating.
• Medications – Used to reduce symptoms and increase overall health and well being
• Surgery – Used to locate brain damage and nerves that are not functioning properly.

Do you think that your child’s co-occurring cerebral palsy and epilepsy could have been caused by medical negligence? If you have any reason to believe that a medical team or hospital is to blame for your child’s condition, begin our free case review today.