Generalized seizures in children

Seizures in children may occur as a standalone event or may recur (epilepsy).

Etiology can be structural, genetic, infectious, metabolic, immune, or unknown.

An attempt should be made to identify the type(s) of epilepsy and the epilepsy syndrome by recognizing a pattern of seizure types, clinical features, and electroencephalogram characteristics.

Detailed history is of paramount importance in the diagnosis, as key diagnostic factors lie in the history as opposed to ancillary investigations.

Main treatment options will depend on the epilepsy syndrome and include anticonvulsant medication, a ketogenic diet, vagus nerve stimulation, and surgery, as well as consideration of lifestyle factors.

Generalized seizures are understood to originate at some point within the brain and rapidly engage bilaterally distributed networks. This can include both cortical and subcortical structures and may not necessarily involve the entire cortex.[1]Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):512-21. http://www.ncbi.nlm.nih.gov/pubmed/28276062?tool=bestpractice.com [2]Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):522-30. http://onlinelibrary.wiley.com/doi/10.1111/epi.13670/full http://www.ncbi.nlm.nih.gov/pubmed/28276060?tool=bestpractice.com The 2017 International League Against Epilepsy classification presents three levels to help guide the clinician: 1) diagnosis of the seizure type; 2) diagnosis of the epilepsy type (focal epilepsy, generalized epilepsy, combined focal and generalized epilepsy, and an unknown group); 3) these two levels help determine the epilepsy syndrome, which is often an electroclinical syndromic diagnosis. Etiology is taken into account along each step.[1]Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):512-21. http://www.ncbi.nlm.nih.gov/pubmed/28276062?tool=bestpractice.com

Seizures may occur as a standalone event or they may recur, in which case the term "epilepsy" is used. This topic addresses generalized epilepsies. Previous terminology of "secondarily generalized" seizure (i.e., a focal-onset seizure that spread to involve the rest of the body) has now changed to "focal to bilateral tonic-clonic seizure." It is also recognized that if the onset of a seizure is unwitnessed or cannot be described, this would be an "unknown onset tonic-clonic seizure."[2]Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):522-30. http://onlinelibrary.wiley.com/doi/10.1111/epi.13670/full http://www.ncbi.nlm.nih.gov/pubmed/28276060?tool=bestpractice.com

Febrile seizures are dealt with in a separate BMJ Best Practice topic. This topic does not include seizures in neonates.