Pediatric seizures

Abstract

Seizures in children are challenging to both diagnose and treat. The first and most important step is to distinguish abnormal movements in children as seizures from the myriad of benign movements that children can exhibit. The second step is to distinguish whether the seizures are generalized or focal. Generalized seizures start in bilateral cerebral hemispheres and include multiple different types of seizures from nonconvulsive, i.e., absence, to convulsive, i.e., generalized tonic-clonic seizures (GTCs). Focal seizures originate in a particular region of the brain and have different manifestations depending on what part of the brain is activated. Any individual having more than one unprovoked seizure over a 24-h period is classified as having epilepsy. The evaluation of a patient presenting with a first time seizure differs if the seizure is febrile or nonfebrile. In children with febrile seizures, it is essential to rule out intracranial infection, but otherwise, these seizures are relatively benign and have a low chance of leading to epilepsy. Afebrile seizures require a more detailed evaluation for the underlying epilepsy syndrome or acute intracranial pathology. An electroencephalogram (EEG) is critical to classify seizure type and epilepsy syndrome. Neuroimaging may be required to evaluate for intracerebral pathology. The treatment of a prolonged seizure is standard; however, the treatment of different forms of epilepsy is individualized, tailored to both seizure type and side effect profile. In medication resistant seizures, diet and surgery are excellent options.