The first time you see your child have a seizure, time stops. Your body floods with adrenaline. You do not know what to do. And afterward, you live with a new kind of fear, the fear that it will happen again and you will not be ready. If your child has cerebral palsy and epilepsy, or if you are worried they might develop seizures, this guide gives you the knowledge to recognize, respond, and manage with confidence.
How Common Is Epilepsy with CP?
Epilepsy is one of the most common conditions that co-occurs with cerebral palsy. According to research published in Developmental Medicine and Child Neurology, approximately 30 to 50 percent of children with CP develop epilepsy. The risk varies significantly based on the type and severity of CP.
Children with spastic quadriplegic CP (affecting all four limbs) have the highest epilepsy rates, approaching 50 to 60 percent. Children with hemiplegic CP (one side affected) have rates around 30 to 40 percent. Children with dyskinetic CP tend to have lower rates. Children whose CP was caused by HIE, stroke, or cortical brain malformation have higher epilepsy risk than those whose CP resulted from periventricular leukomalacia (PVL), which primarily affects white matter.
The connection between CP and epilepsy is straightforward: the brain injury that caused CP can also disrupt the normal electrical signaling between neurons, creating abnormal circuits that fire spontaneously and produce seizures. The more extensive the cortical (gray matter) damage, the higher the epilepsy risk.
Types of Seizures in CP Children
Not all seizures look the same. Understanding the different types helps you recognize what is happening and communicate effectively with your child’s neurologist.
| Seizure Type | What It Looks Like | Duration |
|---|---|---|
| Focal (partial) | Twitching of one limb or side of face, head turning, staring, unusual sensations | Seconds to minutes |
| Generalized tonic-clonic | Whole-body stiffening (tonic) followed by rhythmic jerking (clonic), loss of consciousness | 1-3 minutes typically |
| Absence | Brief staring episodes, unresponsive, may have subtle eye blinking | 5-20 seconds |
| Infantile spasms | Brief clusters of body flexion (jackknifing) or extension, often on waking | 1-2 seconds each, in clusters |
| Myoclonic | Sudden brief jerks of a muscle group, like an electric shock | Less than 1 second |
| Tonic | Sudden stiffening of the body or limbs without jerking phase | Seconds to a minute |
Focal seizures are the most common type in children with CP because the brain injury is often localized to a specific area. However, focal seizures can spread to become generalized tonic-clonic seizures, and some children have multiple seizure types.
What a Seizure Looks Like in an Infant
Recognizing seizures in babies is more difficult than in older children because infant seizures can be extremely subtle, and babies with CP already have unusual movements that can look seizure-like. Here is what to watch for.
Rhythmic jerking that you cannot stop. If your baby’s arm, leg, or face is twitching rhythmically, try gently holding the limb. Normal jitteriness or CP-related movements will stop or change with restraint. Seizure activity will continue regardless of what you do.
Infantile spasms. This is the most important seizure type to recognize because it requires urgent treatment. Infantile spasms typically begin between 3 and 12 months of age and look like brief, sudden body flexion (the baby’s trunk curls forward, arms flex up, and legs draw up, like a jackknife) or extension (sudden arching). They occur in clusters, often 5 to 20 spasms in a row, frequently just after waking. Parents often describe them as a “startle” that keeps repeating. According to the Child Neurology Foundation, treatment within two weeks of onset produces better outcomes, so early recognition is critical.
Staring with unresponsiveness. Brief episodes where your baby stares blankly and does not respond to your voice or touch, followed by a return to normal awareness.
Repeated stereotyped movements. Lip smacking, tongue thrusting, eye fluttering, or bicycling leg movements that look the same each time and are different from your baby’s usual movement patterns.
If medical errors contributed to your child’s brain injury and epilepsy, your family may have legal options.
How Epilepsy Is Diagnosed
If your child’s neurologist suspects epilepsy, several diagnostic tools are used to confirm the diagnosis and characterize the seizure type.
Electroencephalogram (EEG). This is the primary diagnostic test. Electrodes are placed on the scalp to record the brain’s electrical activity. The EEG can show seizure patterns (epileptiform discharges) even between seizures, helping to confirm epilepsy and identify where in the brain the seizures originate. A routine EEG takes about 30 to 60 minutes. Children with CP who already have abnormal EEG findings from their brain injury may need the EEG interpreted by a neurologist experienced in distinguishing seizure-related activity from background abnormality.
Video-EEG monitoring. For difficult-to-diagnose cases, your child may be admitted for continuous video-EEG monitoring for 24 to 72 hours. This captures actual seizure episodes on camera while simultaneously recording brain activity, providing definitive diagnosis and characterization.
Brain MRI. Most children with CP have already had an MRI, which identifies the structural brain injury causing both the CP and the epilepsy. The location and extent of brain injury on MRI helps predict seizure type and treatment response.
A formal diagnosis of epilepsy requires either two or more unprovoked seizures occurring more than 24 hours apart, or one seizure with EEG or MRI findings that indicate a high probability of recurrence (greater than 60 percent over 10 years).
Medications Used
Anti-seizure medications (ASMs) are the primary treatment for epilepsy in children with CP. The choice of medication depends on the seizure type, your child’s age, other medications they take, and the side effect profile.
Levetiracetam (Keppra) is often the first-line choice because it has few drug interactions, comes in liquid form for young children, and is effective for multiple seizure types. The most common side effect is irritability or behavioral changes, which can be significant in some children.
Oxcarbazepine (Trileptal) is commonly used for focal seizures. It can cause drowsiness and, rarely, low sodium levels that require monitoring. Valproic acid (Depakote) is effective for generalized epilepsy but has more potential side effects including weight gain, tremor, and liver effects. Lamotrigine (Lamictal) may have fewer cognitive side effects but requires a very slow dose titration to avoid a serious skin reaction. Topiramate (Topamax) can cause cognitive slowing and decreased appetite.
For infantile spasms, the treatment is different and time-sensitive. ACTH (adrenocorticotropic hormone) injections or vigabatrin (Sabril) are the first-line treatments and should be started as soon as possible after diagnosis. According to research published in Neurology, treatment within two weeks of spasm onset significantly improves developmental outcomes.
If your child’s CP was caused by a birth injury, a case review can help you access resources for your family.
Seizure Safety at Home
Every family of a child with epilepsy should have a seizure action plan and a safe home environment. Your neurologist can help you create a written plan that specifies what to do during different types of seizures, when to give rescue medication (such as rectal or nasal diazepam or midazolam), and when to call 911.
During a seizure: Stay calm. Place your child on their side (recovery position) to prevent choking. Clear the area of hard or sharp objects. Do not put anything in their mouth. Do not restrain them. Time the seizure from beginning to end. If your child is in a wheelchair or adapted seat, secure the belt and protect the head if possible.
Home safety modifications: Use padded crib bumpers or a safety bed for children who seize at night. Install non-slip mats in the bathroom. Supervise bath time closely (drowning during a seizure is a real risk). Use a shower seat rather than a standalone bath for older children. Keep rescue medication accessible and ensure all caregivers know where it is and how to use it. Consider a seizure monitor for nighttime (audio, movement-sensor, or video-based) to alert you to nocturnal seizures.
Communication with caregivers: Every person who cares for your child (grandparents, daycare providers, babysitters, therapists) needs a copy of the seizure action plan, needs to know what your child’s seizures look like, needs to know where the rescue medication is kept, and needs to know when to call 911. Do not assume anyone knows this without explicit training.
How Epilepsy Affects Development
Epilepsy compounds the developmental challenges that CP already presents. Understanding how seizures affect development helps you prioritize seizure control as a critical component of your child’s overall care plan.
Direct effects of seizures. During a seizure, normal brain function is disrupted. Frequent seizures, even brief ones, interfere with the brain’s ability to learn, form memories, and maintain attention. This is particularly impactful during the first three years when the brain is developing most rapidly and when early intervention is most effective.
Infantile spasms and regression. Infantile spasms are associated with developmental regression (loss of previously acquired skills) if not treated promptly. A baby who was making progress may stop babbling, stop reaching, or lose social responsiveness. This regression can be partially reversed with early and effective treatment, which is why urgent recognition and treatment of infantile spasms is so critical.
Medication side effects. Anti-seizure medications can cause sedation that reduces alertness during therapy, cognitive slowing that affects learning, behavioral changes that affect social interaction, and appetite changes that affect nutrition. These effects can be subtle but significant, and they should be discussed with your neurologist if you notice changes in your child’s engagement, alertness, or behavior after starting or changing medication.
Sleep disruption. Nocturnal seizures disrupt sleep architecture, reducing the restorative quality of sleep even when the child appears to sleep through the night. Poor sleep increases spasticity, reduces learning capacity, and worsens behavior and mood.
When to Call 911
Most seizures end on their own within 1 to 3 minutes and do not require emergency medical attention. However, certain situations are medical emergencies.
Call 911 if: The seizure lasts longer than 5 minutes (this is called status epilepticus and is a medical emergency). Your child stops breathing or turns blue during the seizure. Your child does not regain consciousness within 10 to 15 minutes after the seizure stops. A second seizure occurs before your child has fully recovered from the first. Your child is injured during the seizure (head injury, severe bite to the tongue). This is your child’s first seizure and you do not have a seizure action plan. Anything about the seizure is different from your child’s usual pattern and concerns you.
If your child has a rescue medication prescribed (such as diazepam rectal gel or midazolam nasal spray), follow your seizure action plan for when to administer it. Generally, rescue medication is given if a seizure lasts longer than a specified time (usually 3 to 5 minutes) and 911 is called simultaneously.
After any seizure, even one that resolves on its own, note the time, duration, type of movements, which body parts were involved, and how your child behaved afterward (the postictal period). This information helps your neurologist adjust treatment.
If your child’s cerebral palsy and epilepsy were caused by a birth injury such as HIE from medical errors during delivery, your family may have legal options that can provide the financial resources to fund medications, neurology specialist care, seizure safety equipment, and a lifetime of support.
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