The occurrence of seizures in children can generate tremendous levels of anxiety for children, parents, and pediatricians alike. Allaying these concerns and providing the right treatment rests on a systematic approach.
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Editors Toby Hindin, Jeannette Mallozzi, Jeff Ryan, and Karen Woldman disclose that they do not have any financial relationships with any manufacturer in this area of medicine.
Manuscript reviewers disclose that they do not have any financial relationships with any manufacturer in this area of medicine.
Author Paul Fisher, MD, discloses that he has received grant monies for contracted research from UCB Pharma.
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The nanny of a 5-year-old boy finds him unconscious and twitching his arms and legs synchronously for 90 seconds. The child is rushed to the emergency department, where he is found to be afebrile, and without any signs of illness. He has a normal neurological exam, too. After 30 minutes, the boy is less groggy, and returns to baseline behavior an hour later. Following an unremarkable evaluation, the child is discharged home. His parents are terrified and call you the next morning to request an emergency referral to a neurologist. What will you do? What should you do?
The 1, 2, 3s of seizures
Seizures are one of the most frightening events for a parent or family member to witness. Just as unsettling is the frequency of their occurrence. The cumulative incidence of a first seizure with or without a fever exceeds one in 20 children before age 18. However, few children with febrile seizures ever develop epilepsy, which is defined as recurrent, unprovoked seizures. With a first nonfebrile seizure, testing may not be necessary. Furthermore, most children who experience a nonfebrile seizure never go on to experience a second seizure. There is no known benefit to immediate treatment on the likelihood of further seizures.