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Pinpointing the cause of epilepsy is difficult at any age. In seven out of every ten cases, there is no known cause. These children are then said to have idiopathic epilepsy. “Idiopathic” is a Latin word meaning “of unknown cause.” There are many possible causes of epilepsy in children, including: problems with brain development before birth; lack of oxygen during or following birth; a head injury that leaves a scar in the brain; unusual structures in the brain; tumors; a prolonged seizure with fever, or the after-effects of severe brain infections such as meningitis or encephalitis. When a cause can be identified, children will be described as having symptomatic epilepsy. The seizures are thought to be a symptom of the underlying brain injury.

Epilepsy is a common disorder. Frequently, more than one person within an extended family may have seizures. In most cases, a clear pattern of inheritance of epilepsy within a family cannot be determined. However, there does seem to be a slightly increased risk among close relatives of people with seizures, compared to risk in the general population. It is therefore important to ask your relatives about a family history of seizures, and to share this information with your doctor. Some disorders that may cause symptomatic epilepsy are genetically caused, and in some families there is a clear pattern of inheritance. The Epilepsy Foundation is helping the search for genes through its Internet-based Gene Discovery Project. The project invites families with a history of seizures in various members to post their family trees (called pedigrees) on the project site for future review by genetics researchers.

Febrile (fever-caused) seizures affect many children between the ages of 3 months and 6 years. Febrile seizures are not the same as epilepsy, although in rare cases they may be the first seizures experienced by a child who develops epilepsy later on. Febrile seizures occur when a child’s temperature rises rapidly, usually to 102 degrees or higher. There is often a family history of febrile seizures; they are most common around 18 months of age and affect between 3 and 4 percent of all children. Thirty to 40 percent of children who have a febrile seizure will have another one, but most children grow out of the tendency as they grow older. About 3 percent of children with febrile seizures go on to develop epilepsy. In children with epilepsy, fever (as well as some drugs, medications and sleep deprivation) may trigger seizures. Having a seizure is a sign of an underlying condition in the brain. In many cases it is the only sign of a brain disorder. In other cases it may be just one of many symptoms. Common brain conditions that may also be associated with seizures include tuberous sclerosis, cerebral palsy, mental retardation, autism and neurofibromatosis. Epilepsy associated with other brain disorders is usually treated in the same way as epilepsy from an unknown cause.

In most cases, seizure management or first aid means keeping a child safe while the seizure runs its course. Fortunately, most seizures are brief and stop within a few minutes. The first step in any seizure management plan is to get your doctor’s advice. He or she knows your child’s seizure history and is in the best position to help you plan an appropriate response.

-Protect the child from injury while the seizure continues, but don’t forcefully restrain movements. -Whenever possible, try to lay the child on a soft surface and turn on one side. -Place something flat and soft under the head; loosen tight neckware. -Do not place anything in the mouth. -CPR should not be given during a seizure. -Record approximately how long the seizure lasts. -As the jerking slows down, make sure breathing is unobstructed and returning to normal. -Do not try to give medicine or fluids until the child is fully awake and aware. -Reassure the child and gently help to re-orient him or her as consciousness returns.

Unless your doctor tells you otherwise, a seizure in a child with epilepsy that ends after a couple of minutes does not usually require a trip to the emergency room. However, if it lasts more than 5 minutes without any sign of slowing down, is unusual in some way, or if a child has trouble breathing afterwards, appears to be injured or in pain, or recovery is different from usual, call 911 for emergency help. It is always a good idea to discuss with your doctor in advance what to do if your child should have a prolonged seizure.

Most doctors will never see your child have a seizure — they don’t happen often in the doctor’s office. It will help the doctor if you write down what the child was doing just before the seizure began, what happened during the seizure, how long it lasted, and how quickly your child recovered afterwards.