Generalised seizures in children

Seizures in children may occur as a stand-alone event or may recur (epilepsy).

Aetiology 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 recognising a pattern of seizure types, clinical features, aetiologies, 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.

Treatment will vary depending on the epilepsy syndrome. Options include anticonvulsant medication, ketogenic diets, vagus nerve stimulation, and surgery, as well as consideration of lifestyle factors.

Generalised 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. https://onlinelibrary.wiley.com/doi/10.1111/epi.13709 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. https://onlinelibrary.wiley.com/doi/full/10.1111/epi.13670 http://www.ncbi.nlm.nih.gov/pubmed/28276060?tool=bestpractice.com ​ The 2017 International League Against Epilepsy (ILAE) classification presents three levels to help guide the clinician: 1) diagnosis of the seizure type; 2) diagnosis of the epilepsy type (focal epilepsy, generalised epilepsy, combined focal and generalised epilepsy, and an unknown group); 3) these two levels help determine the epilepsy syndrome, which is often an electroclinical syndromic diagnosis. Aetiology and comorbidities are 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. https://onlinelibrary.wiley.com/doi/10.1111/epi.13709 http://www.ncbi.nlm.nih.gov/pubmed/28276062?tool=bestpractice.com ​ A detailed ILAE classification and definition of epilepsy syndromes was published in 2022.[3]Wirrell EC, Nabbout R, Scheffer IE, et al. Methodology for classification and definition of epilepsy syndromes with list of syndromes: report of the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022 Jun;63(6):1333-48. https://onlinelibrary.wiley.com/doi/10.1111/epi.17237 http://www.ncbi.nlm.nih.gov/pubmed/35503715?tool=bestpractice.com

Seizures may occur as a stand-alone event. If unprovoked seizures recur, or have a high likelihood of recurrence, the term 'epilepsy' is used. This topic addresses generalised epilepsies. Previous terminology of 'secondarily generalised' 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 recognised 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. https://onlinelibrary.wiley.com/doi/full/10.1111/epi.13670 http://www.ncbi.nlm.nih.gov/pubmed/28276060?tool=bestpractice.com

This topic does not include seizures in neonates.

For information on febrile seizures, see the topic Febrile seizure.