Epilepsy is a broad term used for a brain disorder that causes seizures. There are many different types of epilepsy. There are also many different kinds of seizures. Learn more about epilepsy and how to keep children with epilepsy safe.
Seizures are typically classified into two main groups: Generalized Seizures & Focal Seizures
The person may feel tired after a tonic-clonic seizure.
Seizures may last as long as a few minutes.
(CDC, 2020)
Signs of Seizures in Children
Seizures in children can look different depending on the type, but some common signs to watch for include sudden staring spells with unresponsiveness, uncontrolled jerking movements, stiffening of the body, or loss of consciousness. Some children may appear confused, dazed, or unresponsive for a short period. Others might suddenly drop to the ground or experience repetitive movements like lip-smacking or blinking. In some cases, seizures can cause sudden changes in breathing or skin color. After a seizure, a child may feel tired, confused, or have difficulty speaking. If you suspect your child is having a seizure, stay calm, keep them safe, and seek medical attention.
Our Pediatric Neurology and Neurosurgery Team has extensive training in treating patients with epilepsy. We review all patient medical history to come up with a thorough plan to ensure your child is receiving the care they need. In addition to seeing our Pediatric Neuroscience Team, this care many consist of having the child undergoing an Electroencephalogram (EEG), Neurocognitive Testing, Autonomic Testing, or having a visit with our Nutritionist and/or Psychologist. If you are concerned your child may be having seizures, not matter the magnitude, please call our office to schedule a consultation.
Depending on the clinical situation and the pediatric neurologist assessment, an EEG(electroencephalogram) and MRI (magnetic resonance imaging) brain study may be needed to help with the diagnostic evaluation. It is helpful to prepare your child for the procedures to help reduce anxiety and ensure the process goes smoothly.
For an EEG (electroencephalogram), explain to your child that the test is a safe, painless test that uses small stickers (electrodes) to check brain wave activity by placing stickers on the patient's scalp. There are no needles involved and the EEG does not send any electrical current into your brain. The night before, wash their hair but avoid conditioner, oils, or styling products. Depending on the type of EEG, your child may need to stay awake later or wake up earlier to be sleep-deprived for the test. During the test, there are two important components of the EEG procedure involve activation tests with hyperventilation and photic stimulation. Hyperventilation is simply breathing forcefully for three minutes. There maybe a pinwheel that is used to help a child focus on breathing. Second portion of the activation testing involves Photic stimulation similar to a strobe light flashing. These two activation tests may provide helpful information regarding your child's seizure type. Reviewing the upcoming parts of the EEG study is helpful to improve the cooperation and anxiety for a child during the testing . Bringing your child's favorite toy, blanket, or book can help them feel more comfortable.
For an MRI (magnetic resonance imaging), let your child know the machine makes loud noises with beeping and pinging noises, but is not painful. Earrings and rings that are metal need to be removed due to restriction of the magnetic capabilities of the MRI machine. Your child will need to lie on a small mobile exam table which moves inside a tunnel-like machine. Some radiology facilities are able to allow a child to wear headphones or watch a movie. The children's hospital radiology department may have child life specialist to help ease the child's anxiety with music therapy or other forms of relaxation that may help prior to the procedure. If sedation is needed, follow the doctor’s instructions about food and drink beforehand. There maybe a need for intravenous contrast administration with an intravenous line requiring IV placement. Reassure your child that you will be close by and encourage relaxation techniques like deep breathing or listening to a favorite story before the scan.
Talking to your child in a calm and positive way can help ease their fears and make the experience easier for both of you.
A fun activity can be planned shortly afterwards the procedure, going to the park, or a favorite meal to look forward to can be helpful.
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Sudden Spells in Children: When there is a concern for a seizure ?
In childhood, a child may experience paroxysmal events, which are sudden, unexpected episodes that begin abruptly and last for a short time, involving unusual movements, behaviors, or changes in awareness. Most of these episodes are not epilepsy and are part of normal childhood development or other medical conditions. These events can mimic epileptic seizures, and accurate recognition relies on understanding their age-specific patterns and may require appropriate evaluations to differentiate from epileptic seizures.
Among infants and toddlers, gastroesophageal reflux and Sandifer syndrome present with back arching, neck extension, and torsional movements often associated with feeding. Shuddering spells, occurring between 6 months and 2 years, manifest as brief tremor-like movements of the head, shoulders, or arms, typically triggered by excitement or fear.
Toddlers aged 1–4 years frequently display stereotypic movements such as hand flapping, body rocking, or head banging; these are repetitive and suppressible with distraction. Breath-holding spells, most common between 6 months and 4 years, are triggered by frustration, pain, or emotional distress, leading to apnea, cyanosis or pallor, brief loss of consciousness, and occasionally stiffening or myoclonic jerks. These resemble seizures but are characterized by rapid return to baseline and normal neurologic examination between events.
Self-stimulatory behaviors in toddlers and preschool-aged children involve rhythmic genital rubbing/posturing during quiet wakefulness, often noted in car seats or strollers with restraints. Delayed processing staring spells are most common in preschool and school-aged children (3–10 years), presenting as brief inattentive episodes without automatisms, often mistaken for absence seizures.
Other significant mimickers include motor tics (5–10 years), sudden, brief, repetitive movements that are voluntarily suppressible and can resemble myoclonic seizures. Movement disorders such as dystonia or paroxysmal kinesigenic dyskinesia may occur across childhood, generally preserving awareness.
Syncope and reflex anoxic events, particularly in toddlers and school-aged children, may mimic seizures with brief tonic posturing or myoclonic jerks due to cerebral hypoperfusion. Triggers include pain, emotional stress, or orthostatic changes, with rapid recovery and no postictal confusion.
Sleep-related physiological movements, including benign sleep myoclonus and hypnagogic/hypnopompic twitches, are normal developmental phenomena that stop immediately upon arousal.
Importantly, Psychogenic Nonepileptic Seizures (PNES)—also termed functional neurologic disorder (conversion disorder)—can present with convulsive-appearing episodes, eye closure, asynchronous movements, or prolonged unresponsiveness. PNES is rare in early childhood but increases in prevalence in preadolescents and adolescents. These events can closely resemble epileptic seizures, and clinical evaluation alone is insufficient in many cases; video-EEG monitoring is required to confirm diagnosis and avoid unnecessary antiseizure therapy. Associated psychological stressors, anxiety, or trauma history may be present, and multidisciplinary management (neurology, psychology/psychiatry) is recommended.
Clinical evaluation of seizure mimickers:
Careful observation helps differentiate non-epileptic events from seizures. Caregiver-obtained videos improve diagnostic accuracy. During episodes, testing responsiveness to verbal/tactile stimuli assists in determining level of awareness. Key features of non-epileptic events include preserved consciousness, identifiable triggers, absence of postictal confusion, and age-congruent patterns. Video-EEG remains the diagnostic gold standard, particularly when differentiating epilepsy from PNES or other mimickers.
Pediatric Epilepsy Syndromes
While seizure mimickers are common, true pediatric epileptic syndromes demonstrate characteristic developmental and electroclinical profiles. Infantile spasms (West syndrome) present between 3–12 months with sudden flexor or extensor spasms in clusters, often upon awakening. Prevalence is 2–5 per 10,000 live births. Early recognition is critical due to risk of developmental regression or stagnation.
In toddlers and preschool-aged children (1–5 years), febrile seizures are most common, affecting 2–5% of children and typically manifesting as brief generalized tonic-clonic seizures associated with fever.
School-aged children (4–10 years) may develop childhood absence epilepsy, characterized by frequent brief staring episodes with impaired awareness and subtle automatisms, representing 10–15% of pediatric epilepsies. At this age, benign epilepsy with centrotemporal spikes (Rolandic epilepsy) manifests with unilateral facial twitching, hypersalivation, and speech arrest, commonly during sleep, accounting for 10–20% of childhood epilepsies.
Less common but clinically significant syndromes include Landau-Kleffner syndrome (LKS), typically between 3–8 years, characterized by acquired epileptic aphasia and language regression with abnormal sleep-activated epileptiform activity. Prompt treatment is crucial to prevent long-term language impairment.
Juvenile myoclonic epilepsy (JME) appears in late childhood or adolescence (10–16 years) with morning myoclonic jerks and risk of generalized tonic-clonic or absence seizures, representing 5–10% of childhood epilepsy.
Across all pediatric ages, generalized tonic-clonic seizures manifest with abrupt loss of consciousness, tonic stiffening, clonic jerking, and postictal sleepiness. Focal seizures may occur at any age, producing motor, sensory, autonomic, or behavioral symptoms with or without impaired awareness.
Early recognition of age-specific seizure types, developmental trajectory, language and cognitive function, and behavioral red flags supports timely diagnosis and optimized neurocognitive outcomes.
An electroencephalogram (EEG) is a safe and completely painless test that helps us understand how the brain is working. Small stickers called electrodes are gently placed on the scalp by one of our experienced EEG Technologists. These electrodes do not send electricity into the brain, they simply record the brain’s natural activity, which is always happening, even during sleep.
The EEG shows this activity as gentle wave patterns on a computer screen. Sometimes, we use a video EEG to record what’s happening during the test so our team can see how changes in brain activity relate to movements or symptoms.
An EEG records patterns of normal and unusual brain activity. When doctors review it, they look at several key features:
EEG is an important part of diagnosing and managing epilepsy, alongside detailed medical history and other tests. However, some unusual patterns may occur in other conditions too, such as head injuries, infections or inflammation of the brain, stroke and brain tumors.
For someone being evaluated for seizures or epilepsy, an EEG can help:
Done right in our office by an EEG Technologist. After placing the electrodes, the test records brain activity for about an hour. During this time, the technologist may ask your child to look at flashing lights or take deep breaths to see how their brain responds.
When the EEG is complete, our Epileptologist carefully reviews and interprets the recording. The results are discussed with you at your next visit, along with any next steps or treatment plans.
At NJPNI, our goal is to make every EEG experience as comfortable, calm, and informative as possible for both children and parents.
Neurocognitive Testing is an assessment procedure that utilizes scientifically validated, objective, and reliable computerized neuropsychological tests to evaluate the neurocognitive status of patients. The testing covers a range of mental processes from simple motor performance, attention, and memory, to executive functions. Age-standardized scoring of the assessment eliminates variability and rater bias. The assessment can be repeated over time to monitor progression of disease and/or response to treatment. With a epilepsy, this will help our team to evaluate your child’s thinking ability and how different areas and systems of the brain are working.
A pattern of your child's strengths and weaknesses will be used to help diagnose the type of epilepsy and plan treatment.
The evaluation will assess:
Autonomic testing is a neurologic procedure in which the function of the autonomic nervous system is evaluated. The autonomic nervous system is the part of the nervous system that controls your breathing, your blood pressure, your heart rate, the movement of your gastrointestinal tract, your skin temperature, and numerous other functions. To assist in the treatment plan of epilepsy, Autonomic Testing may be recommended by your Pediatric Neurologist to see what might be contributing to the epileptic episodes. This is a pain-free test as well!
Vagus Nerve Stimulation (VNS) Therapy is a proven neuromodulation treatment for children ages 4 and older with drug-resistant epilepsy and partial onset seizures. Used as an add-on therapy alongside medication, VNS delivers gentle electrical stimulation to the vagus nerve to help reduce seizure frequency and severity over time. It has been used in more than 40,000 children worldwide and is the most prescribed neuromodulation device for pediatric drug-resistant epilepsy. Studies show that children treated with VNS Therapy often experience fewer, shorter, and less severe seizures, improved recovery after seizures, and meaningful improvements in quality of life during critical stages of development
A balanced diet from different food groups help the body and brain to function, helping us to stay healthy! Our Pediatric Nutritionist can provide you with suggestions on a healthy diet, such as ketogenic diet or modified Atkins diet, that may help reduce the risk of seizures for some people with epilepsy. We will provide you with easy safe recipes to help stay on a healthy track.
Pediatric Psychological evaluations are individualized comprehensive assessments that target an individual’s patterns of current functioning to better understand cognitive abilities, socio-emotional functioning, behavior, and/or personality. We may refer you to see our Pediatric Psychologist to assist in finding a psychological intervention to fit the needs of your child. This may include, relaxation therapy, cognitive behavior therapy, and education interventions that have been used in studies to reduce the frequency of seizures and improve the quality the life.
Additional Epilepsy Resources:
For more information about epilepsy and seizures, you may find these resources helpful:
Epilepsy Foundation: epilepsy.com
CDC Epilepsy Information: cdc.gov/epilepsy
Download this Epilepsy Information here:
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