Generalised seizures in children

Last reviewed: 3 Sep 2022
Last updated: 14 Jun 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • staring spells or inattention
  • tonic-clonic seizures
  • brief, arrhythmic muscular jerking movements
  • eyes rolling back in head
  • intercurrent illness
  • unexplained falls
More key diagnostic factors

Other diagnostic factors

  • incontinence
  • tongue biting
  • post-ictal phenomena
  • precipitated by fatigue or lack of sleep
  • precipitated by light or noise
  • developmental delay
  • neurocutaneous stigmata
Other diagnostic factors

Risk factors

  • genetic predisposition or family history
  • perinatal asphyxia
  • metabolic/neurodegenerative disorders
  • head trauma
  • structural abnormalities of the central nervous system (CNS)
  • autistic spectrum disorder
  • central nervous system (CNS) infection
  • neurocutaneous syndromes
  • history of febrile seizures
More risk factors

Diagnostic investigations

1st investigations to order

  • electroencephalogram (EEG)
  • blood glucose level
  • basic metabolic panel
  • full blood count (FBC)
  • ECG
More 1st investigations to order

Investigations to consider

  • magnetic resonance imaging (MRI) brain
  • computed tomography (CT) brain
More investigations to consider

Treatment algorithm

ACUTE

generalised onset seizure in progress

ONGOING

epilepsy syndromes in children <1 year of age (excluding neonates)

epilepsy syndromes in early childhood

epilepsy syndromes in middle childhood

epilepsy syndromes in late childhood or adolescence

unidentified epilepsy syndrome

Contributors

Authors

Leena Mewasingh, MBChB, MSc, FRCPCH

Consultant Paediatric Neurologist

St. Mary's Hospital

Imperial College Healthcare NHS Trust

London

UK

Disclosures

LM has attended educational events hosted by Eisai (Perampanel/fycompa) and by Novartis (Everolimus for Tuberous Sclerosis patients).

Alla Nechay, MD

Pediatric Neurologist

Pediatric Hospital No 1

Kiev

Ukraine

Disclosures

AN declares that she has no competing interests.

Acknowledgements

Dr Leena Mewasingh and Dr Alla Nechay would like to gratefully acknowledge Dr Ewa Posner, a previous contributor to this topic.

Disclosures

EP declares that she has no competing interests.

Peer reviewers

Adam L. Hartman, MD

Assistant Professor of Neurology and Pediatrics

Johns Hopkins Hospital

Baltimore

MD

Disclosures

AH has received research support from the National Institutes of Health that is greater than 6 figures. ALH's research is funded in part by the National Institutes of Health. He is the co-author of one review that is referenced in this monograph.

Roger Weis, MD

Pediatric Neurologist

Kinderneurologisches Zentrum Mainz

Mainz

Germany

Disclosures

RW declares that he has no competing interests.

John Stephenson, MA, BM, DM, FRCP, HonFRCPCH

Consultant

Paediatric Neurology Emeritus

Fraser of Allander Neurosciences Unit

Royal Hospital for Sick Children

Honorary Professor in Paediatric Neurology and Senior Research Fellow

Department of Child Health

Division of Developmental Medicine

University of Glasgow

Glasgow

UK

Disclosures

JS declares that he has no competing interests.

Anna Basu, BM, BCh, PhD, MA, MRCPCH

Honorary Clinical Lecturer

Paediatric Neurology

Newcastle General Hospital

Newcastle-upon-Tyne

UK

Disclosures

AB has previously worked as part of a clinical team with Dr Ewa Posner, a previous contributor to this topic. AB declares that she has no competing interests.

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