Epilepsy in Newborns and Infants

Epilepsy is the tendency to have recurrent seizures. There are many different causes of seizures in babies. Seizures are relatively common in the first year of life. In very premature babies the most common causes are reduced blood and oxygen flow to the brain, and bleeding into the brain.

Seizures in newborn babies may be difficult to recognize, because the immature brain is unable to produce the more obvious seizures seen in older children. Seizures may be subtle, and consist simply of changes in breathing patterns, movements of the eyelids or lips, or bicycling movements of the limbs.

The baby may have jerking or stiffening of a leg or arm that alternates from side to side or the whole upper body may suddenly jerk forward, or both legs may jerk up towards the belly with the knees bent. The baby’s facial expression, breathing and heart rate may change, and their face may become pale or grey.

Febrile seizures. Babies may roll their eyes, and limbs may either stiffen or twitch and jerk. Up to 4 out of every 100 children age 6 months to 5 years have one of these seizures, which are triggered by high fevers, usually above 39°C.

Infantile spasms. This rare type of seizure occurs during an infant’s first year (typically between 4 and 8 months). Your baby may bend forward or arch the back as the arms and legs stiffen.

These spasms tend to occur when a child is waking up or going to sleep, or after feeding. Infants can have hundreds of these seizures a day.

Focal seizures. Your baby may sweat, vomit, become pale, and experience spasms or rigidity in one muscle group, such as fingers, arms, or legs. You may also observe gagging, lip smacking, screaming, crying, and loss of consciousness.

Absence (petit mal) seizures. Babies appear to be staring into space or daydreaming. They may blink rapidly or appear to be chewing. These episodes typically last less than 30 seconds and may occur several times a day.
Atonic (drop attack) seizures. Babies experience sudden loss of muscle tone that makes them limp and unresponsive. The head may drop suddenly, or if crawling or walking the baby may fall to the floor.
Tonic seizures. Parts of your baby’s body (arms, legs) or the entire body suddenly stiffen.
Myoclonic seizures. A group of muscles, usually in the baby’s neck, shoulders, or upper arms, starts to jerk. These seizures usually occur in clusters, several times a day and several days in a row.

It is important that any baby suspected of having seizures is referred promptly to a specialist for further diagnostic tests. This will usually include an EEG (electroencephalogram). Depending on the medical history and examination, the doctor may also order other tests, including a scan, blood and urine tests, chromosomal studies and a lumbar puncture. Doctors will try to identify the cause of the seizures, although in some cases no cause can be found.

Treatment for young infants will depend on the cause and type of seizures that occur. In some cases, no treatment is needed if the seizure is an isolated event.