First and second seizure: What to know and do

April 1, 2007

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.

Key Points

CME

Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of CME2, Inc. ("cme2 ") and Contemporary Pediatrics. cme2 is accredited by the ACCME to provide continuing medical education for physicians.

cme2 designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

EDUCATIONAL OBJECTIVES

To earn CME credit for this activity
Participants should study the article and log on to http://www.contemporarypediatrics.com/, where they must pass a post-test and complete an online evaluation of the CME activity. After passing the post-test and completing the online evaluation, a CME certificate will be e-mailed to them. The release date for this activity is April 1, 2007. The expiration date is April 1, 2008.

Disclosures
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.

Resolution of conflict of interest
cme2 has implemented a process to resolve conflicts of interest for each continuing medical education activity, to help ensure content validity, independence, fair balance, and that the content is aligned with the interest of the public. Conflicts, if any, are resolved through a peer review process.

Unapproved/off-label use discussion
Faculty may discuss information about pharmaceutical agents, devices, or diagnostic products that are outside of FDA-approved labeling. This information is intended solely for CME and is not intended to promote off-label use of these medications. If you have questions, contact the medical affairs department of the manufacturer for the most recent prescribing information. Faculty are required to disclose any off-label discussion.

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.