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Rockin' and Rollin'

By Scott Hamilton, MD
September 1, 2022
Hamilton Blog Headshot Updated 12.21.21

When video recorders became available in the 1990s, parents used them to record children's behavior that looked like seizures. I attended a lecture titled “Things That Look Like Seizures, But Aren't,” where a neurologist showed tapes parents had brought him. The finale was a 6-year-old boy who, after a video electroencephalogram (EEG), was still on camera. While the neurologist explained to the parent the EEG results, the child saw his face on the monitor and began mugging for the camera- sticking his tongue out, rolling his eyes, pulling his lips out with his fingers to make a clown smile. The lecture hall was dying laughing.

Seizures are when the brain's electrical activity goes haywire. Patients suddenly go unconscious, stiffen and/or shake and may wet themselves. Usually, after two minutes, it's over, and kids gradually wake up. These can be very scary when they happen to your child. However, lots of things look like seizures, but aren't. 

Two common non-seizures are shaking chills and shudder attacks. Shaking chills are violent shivering as fevers come on. Parents worry that this might lead to convulsions, but rest assured that they aren't seizure precursors. Shudder attacks are the sudden chill feelings we all get, aka “shivers down the spine” or “the frissons” to the Cajuns. When infants and toddlers shudder, besides shaking, their faces can clench too. Since shaking chills and shudder attacks don't result in loss of consciousness, that’s how you know they aren't seizures.

Even if kids do have seizures, the good news is that they're rarely life-threatening. Seizures don't mean the brain is going bad. Though children may turn pale blue during a seizure, they're actually getting enough oxygen, so brain damage isn't a concern. Myth buster: kids don't swallow their tongues or choke during seizures, so no need to shove things in their mouths.

Kay, an adult with epilepsy, loves swimming. She joined a pool and warned lifeguards of her condition. A year later, as Kay was swimming with her mom, she felt a seizure coming on. She told her mom and went unconscious. Mom struggled to hold her up. Fortunately, a lifeguard, remembering Kay, was watching and in the pool in an instant to save her.

As we said above, seizures aren't life-threatening. The most common pediatric seizures are febrile seizures. Infants and toddlers sometimes get these when they have fevers. Like epileptic seizures, kids suddenly fall unconscious, stiffen and shake but recover within minutes. They are terrifying for parents to watch, but when kids arrive at the Emergency Department, they're often waking up and later, ready to go home. Children outgrow febrile seizures by age 6.

Sometimes kids have shaking that isn't related to seizures, as discussed above. Tics, shudder attacks (“the frissons”) and shaking chills aren't convulsions. However, if kids have seizures without fevers, or have multiple episodes, this could be epilepsy. These children sometimes need medication to prevent convulsions, particularly if they're going to drive or swim. Epilepsy is diagnosed by electroencephalogram (EEG), a test where wires are stuck on the scalp (like EKGs on chests) and brain electrical activity is recorded. EEGs help neurologists diagnose epilepsy and decide which medication is best.

Kids with epilepsy shouldn't swim or take tub baths, and teenagers shouldn’t drive until cleared by their neurologist. If cleared, children should still only swim in pools with lifeguards. Besides warning lifeguards, kids should stick to the pool edge where rescue will be easier. Of course, infants and toddlers shouldn't be left alone in tubs, epilepsy or not. Drowning or car crashes are way more dangerous than seizures themselves!