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(Pediatrics in Review. 2007;28:363-371.)
© 2007 American Academy of Pediatrics

Seizures in Children

Determining the Variation

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Classify the different seizure types.
   
2. Distinguish seizures from other paroxysmal phenomena.
   
3. List the possible causes of seizures according to age and mode of presentation.
   

	Introduction

 
Seizures are among the most common pediatric neurologic disorders. The overall prevalence of epilepsy is approximately 1%, and as many as 5% of all children experience febrile seizures before the age of 6 years. Seizures are caused by an abnormal and excessive discharge of neurons, usually accompanied by behavioral or sensorimotor manifestations. Epilepsy is defined classically as the occurrence of two or more unprovoked seizures.

A seizure can be viewed as a symptom of an underlying central nervous system disorder that requires thorough evaluation and specific treatment. In addition to the consequences of the seizures, 50% of those who have epilepsy experience learning difficulties, and 30% to 50% have mental health and behavioral issues.

In this first of two articles on seizures in children, we review the diagnosis and classification of seizures as well as possible causes of seizures in childhood. The second article, to be published in the November 2007 issue of Pediatrics in Review, focuses on the laboratory diagnosis and management of seizure disorders.

	Diagnosis and Causes of Seizures

 
The diagnosis of epilepsy and classification of specific seizure types are essential to determining a prognosis and choosing an appropriate treatment. The investigation of a child experiencing seizures begins with a medical history and physical examination. Although significant technologic advances have been made in electrophysiology and neuroimaging, the diagnosis of seizures and epilepsy remains largely clinical. Table 1 lists key features of the medical history and physical examination of a child presenting with paroxysmal events.

Table 1. Questionnaire and Physical Examination of the Patient Experiencing Paroxysmal Events

Questionnaire Handedness Pregnancy history: Ultrasonography results, infections, medications, alcohol use, cigarette smoking, drug abuse, trauma, prematurity Prenatal history: Labor duration, spontaneous vaginal delivery or cesarean section, birth difficulties (resuscitation, intubation), birthweight, head circumference at birth Development: Fine motor, language, gross motor, and social skills School functioning General medical history: Head trauma, meningitis, stroke Medications Family history: Epilepsy, febrile seizures, mental retardation Description of the events: aura; motor (myoclonic or clonic jerk, hypertonia, atonia, chewing movements), sensory (somesthetic, auditive, visual, gustatory), autonomic, or psychologic phenomena; automatisms; level of consciousness; tongue-biting; fecal or urinary incontinence; episode length; postictal state Age at event onset Event frequency Precipitating factors: Fever, sleep deprivation, stress, photosensitivity, drugs, alcohol withdrawal, or others Diurnal and nocturnal patterns Travel history Employment Driving Physical Examination State of consciousness, language, social interactions Observation of the events (if possible); hyperventilation sometimes can provoke absence seizures Global development Dysmorphic features, limb asymmetry, neurocutaneous skin findings, organomegaly Head circumference Neurologic examination: Cranial nerves, motor strength and tone, osseotendinous reflexes, sensory and cerebellar function tests, gait

The first diagnostic step is to determine if the clinical presentation is compatible with seizures . . . [Full Text of this Article]