Petit mal versus Grand Mal Seizure Activity in Children

Children who begin to show signs of petit mal (or absence) seizures are experiencing changes in the electrical activity within their brain. There are neurons and synapses that transmit the information across the brain and with a petit mal seizure; this action is traveling back and forth in a three-second pattern instead of completing the action in one fell swoop.

This causes an interruption in the brains activity and therefore an interruption in the child’s behavior. These changes may be very subtle; sometimes it is just like daydreaming or staring into space. Other sign include rapid back and forth eye movement or fluttering of the eyelids, movements of the hands or arms or the child may just stop whatever they are doing for a moment or two. Petit mal seizures last very briefly but they do damage and the child needs to be seen by the neurologist and sometimes medication will be prescribed.

Rarely will the child fall during a petit mal seizure but you must guard against certain activities such as swimming because in just that short amount of time the risk of drowning is extremely high. Also of a good note is that many children tend to grow out of having the petit mal seizures, however, if as a teenager the seizure activity is still occurring then driving also becomes a high-risk activity.

Only your physician can diagnose and evaluate your child. Often electrocardiogram, a picture of the brain wave activity and or an MRI (magnetic resonance imaging) may be given to properly diagnose the problem and again, medication may be prescribed.

Prepare for the physician appointment. Write down any symptoms you have noticed, ask questions such as what precautions to take, is there a generic form of the medication(to help with the cost) how long will your child have to take the medication, what to do if symptoms worsen or what are the side effects to watch for with the medication. Are there printed materials in his or her office that you can take with you to study? Ask a lot of questions and expect to receive in depth answers.  Hold onto your physician until you have all of your questions and worries answered to your specification. Physicians can be very busy, get their attention as long as possible. This is your child and you want the very best.

Some of the causes of petit mal seizures are not known, some are genetic, some may be due to a growing brain, which is good because this will increase the chance your child will grow out of the seizure activity altogether! Sometimes it is the synapses that are the cause and the neurotransmitters are firing continuously. Whatever the cause constant vigilance and safety for the child is your main concern. Keep all your physician appointment and be sure to administer the medication, if any, is prescribed exactly as the doctor has ordered and call the physician if any complications occur. Sometimes learning difficulties is the main problem associated with petit mal seizures, as the child cannot pay attention. Sometimes the petit mal seizures will develop into a condition where the seizure activity lasts longer than just a moment or two.

Where petit mal seizures occur in isolated neurons in the brain, a grand mal seizure encompasses the electrical activity of the entire surface of the brain. It is a short-circuiting of all of the electrical impulses of the brain and can be very frightening, especially when it is happening to your child. Most grand mal seizures are caused by epilepsy itself, however, sleep deprivation, previous brain injury or trauma, stroke, use or misuse of mediations, even infection can trigger a grand mal seizure. 

The important thing to remember when you see a grand mal seizure is safety of the person having the seizure. Do not force anything, like a spoon or other object into their mouth. This used to be done in an attempt to keep the airway open however, the tongue cannot be swallowed and while a person may lose consciousness during a seizure, they will keep their airway open. All you have to do is turn them onto their side, put something soft, like a pillow, under their head, and push other objects, like furniture away from the person. This will protect the person and help prevent secondary injury. However, the seizure itself can cause injury, such as broken bones, if the fore of the seizure is too great or the person has repeated seizures.

Anyone who has a grand mal seizure should be seen by a physician immediately. A grand mal seizure is a 911 event in anyone and especially in children. Also, if the seizure activity continues or is repeated without rest periods call 911.

Generally speaking, there are phases to a grand mal seizure. The first is called the tonic phase, where the child falls to the ground then the clonic phase, where the muscles are contracting and loss of movement occurs. This results in a jerking movement and tightening of muscles. Loss of consciousness, bowel and bladder function can occur during this phase. The final phase is called the postictal phase, where the child is awake but may be confused, extremely sleepy, and disoriented. Usually the tonic phase lasts around 10 to 20 seconds, the clonic phase lasts  anywhere from two to ten minutes and the postictal phase may be different every time.

Sometimes only one grand mal seizure will occur; sometimes they come in groups or clusters. Sometimes a grand mal seizure has a pattern and is the same every time. Sometimes there may be a cry just before the child falls to the ground; this is due to air being force out of the lungs by muscles contracting on the trachea.

Again, your child will need to be evaluated by a neurologist and the same tests are done for both petit mal and grand mal seizure activity. These tests are an EEG (electroencephalogram) and a MRI (magnetic resonance imaging) of the brain activity. Your child may need to be on seizure medication such as keppra, Dilantin, lyrica or phenobarbitol. Some of these medications cause extreme fatigue, rash, weight gain. A lot of times the  neurologists may not order any medication if there is only one seizure but this still means there is a need of special care and safety awareness for your child. One thing that is warned against is allowing the child to go swimming alone, as there is a real risk of drowning. For the same reason showers’ may be safer than a tub bath.

Whether your child is having petit mal or grand mal seizures can only be diagnosed by your physician and usually there will be a neurologist in the care of your child. It is important to keep all physician appointments, take all medications to every appointment and a seizure log will also help the physician in determining the correct course of treatment.

Anyone, including children who are prone to seizures, needs to wear a medical alert bracelet. This will give information about whom to contact and the physician number. Following the advice of your child’s physician is paramount. Alert the physicians to side effects that may be occurring with your child but never stop the medications abruptly or without the doctor giving the OK. Everyone involved in the child’s care needs to be kept informed of all changes, including the last seizure, on a regular basis.

Grand mal seizures can be very frustrating, embarrassing and frightening, especially for a child. It is important that the child be educated as to what they can do if a grand mal seizure occurs. For instance, teach the child about what may occur prior to a seizure, a foul smell, a sense of doom; bright lights are all part of the aura that occurs before some seizure activity.

You are your child’s advocate. Be prepared to ask questions of your physician at all MD appointments, keep good records, including a seizure log, that tells how long each phase lasts and the child’s response following the seizure. On the other hand, other children may be frightened so prepare to teach any of your other children of what is happening and include them in their siblings care. The most comforting thought is that grand mal seizures are not as common in children as petit mal and that there is medication that can control the seizure activity. Continue to be your child’s best advocate, ask questions and follow your physician’s advice in order to give your child the best care they deserve.