Summary
Definition
History and exam
Key diagnostic factors
- tonic-clonic seizures
- staring spells or inattention
- brief, arrhythmic muscular jerking movements
- eyes rolling back in head
- unexplained falls
Other diagnostic factors
- incontinence
- tongue biting
- postictal phenomena
- seizure precipitated by fatigue or lack of sleep
- seizure precipitated by light or noise
- intercurrent illness
- developmental delay
- neurocutaneous stigmata
Risk factors
- genetic predisposition or family history
- perinatal asphyxia
- metabolic/neurodegenerative disorders
- head trauma
- structural abnormalities of the central nervous system
- autistic spectrum disorder
- central nervous system (CNS) infection
- neurocutaneous syndromes
- history of febrile seizures
Diagnostic investigations
1st investigations to order
- electroencephalogram (EEG)
- blood glucose level
- basic metabolic panel
- CBC
- ECG
Investigations to consider
- MRI brain
- CT brain
Treatment algorithm
generalized onset seizure in progress
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 topic.
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.
Differentials
- Nonepileptic seizures or "dissociative seizures"
- Breath-holding spells (prolonged cyanotic expiratory apnea)
- Long QT syndrome
More DifferentialsGuidelines
- Epilepsies in children, young people and adults
- Antiseizure medication withdrawal in seizure-free patients: practice advisory update summary
More GuidelinesPatient leaflets
Epilepsy: what is it?
Febrile seizures
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