|Seizures or convulsions are fairly common, occurring in about 3-5% of children. Epilepsy, having two or more seizures of unknown cause, is less common and only occurs in about 1% of children. It begins in childhood in about 70% of cases. Seizures in children can range from febrile seizures and occasional non-febrile seizures to infantile spasms that can occur daily and are difficult to treat.
Seizures, especially the first seizure that a child has, can be very frightening for both children and their parents. You should call your Pediatrician and seek medical attention if you suspect that your child has had a seizure. The first part of the medical evaluation of a child who has had a seizure, assuming that the seizure has stopped and the child is otherwise well, is to determine if the event that the child has was actually a seizure. If observed, provide your Pediatrician with as much information as you can about what happened before, during and after the presumed seizure.
Although seizures can sometimes be caused by specific medical problems, including fever, head trauma, poisonings, infections, especially meningitis and encephalitis, and brain tumors, the cause of most seizures is often not found (idiopathic seizures).
Among the tests commonly ordered (but not always necessary) for a child with a first non-febrile seizure, especially if they have symptoms or a history of vomiting, diarrhea, altered consciousness, or dehydration, include a complete blood count, serum electrolytes, BUN, creatinine, magnesium, calcium, glucose, and toxicology screen (if an ingestion is suspected). A lumbar puncture (LP) is usually only necessary if meningitis or encephalitis is suspected.
Although usually not necessary on an emergent basis, an electroencephalogram (EEG) is an important test and should be done routinely on all children with a first non-febrile seizure when the cause of the seizure is not known. An EEG can help to determine what type of seizure your child had and can help determine your child's risk of having another seizure. A normal EEG does not mean that your child doesn't have epilepsy, it only means that your child did not have a seizure during the test. It is reassuring to have a normal EEG though, since your child will have less of a risk of having another seizure.
In addition to possible seizure activity, an EEG can also cause slowing, either focal or generalized, which may indicate an underlying brain disorder, and spikes.
A Video EEG can be helpful when it is unclear if a child's 'episodes' or 'spells' are really seizures. By correlating the EEG with the child's activity on the video, it can help determine if the child is having a seizure.
An MRI (preferred) or CT scan of the head is also commonly performed (but not always necessary) for children with a first non-febrile seizure of unknown cause. Children should have an MRI or CT scan of their head if they have any neurological impairments after the seizure, if they had a focal seizure, or if they have an abnormal EEG.
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Seizures and Epilepsy Internet Resources:
- AAP Practice Parameter: The American Academy of Pediatrics endorses and accepts as its policy the Practice Parameter: The Evaluation of a First Non Febrile Seizure in Children.
- Epilepsy Foundation of America: The EFA Answer Place for parents of children with epilepsy. Includes info about treatment, medications, recognizing the signs of a seizure, managing seizures at school and questions to ask your doctor.
- Epilepsy Support Groups and Organizations: A comprehensive listing of support groups for parents of children with epilepsy and seizures.