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Child with New Onset Convulsive Seizure

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Symptom-Based Approach to Pediatric Neurology
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Abstract

A first unprovoked convulsive seizure is a frequent neurological symptom in children. It is a common reason for pediatric emergency department visits and hospitalizations. Its presentation is often dramatic and is a major cause of anxiety and concern to parents and caregivers. The initial step is to distinguish the spell from other paroxysmal episodes that may mimic epileptic convulsive seizures like syncope, functional nonepileptic attacks, or functional seizures. It is important to determine if there are any provoking factors that may suggest an acute symptomatic etiology. An accurate history and comprehensive workup after a first unprovoked convulsive seizure is needed to determine the recurrence risk and the need to initiate antiseizure medication. Our review focuses on the differential diagnoses, evaluation, and management approach of first unprovoked convulsive seizure, also referred to as generalized tonic–clonic seizure.

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References

  1. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82.

    Article  Google Scholar 

  2. Hauser WA, Beghi E. First seizure definitions and worldwide incidence and mortality. Epilepsia. 2008;49(Suppl 1):8–12.

    Article  Google Scholar 

  3. Pohlmann-Eden B, Beghi E, Camfield C, Camfield P. The first seizure and its management in adults and children. BMJ. 2006;332(7537):339–42.

    Article  Google Scholar 

  4. Pallin DJ, Goldstein JN, Moussally JS, Pelletier AJ, Green AR, Camargo CA. Seizure visits in US emergency departments: epidemiology and potential disparities in care. Int J Emerg Med. 2008;1(2):97–105.

    Article  Google Scholar 

  5. Olafsson E, Ludvigsson P, Gudmundsson G, Hesdorffer D, Kjartansson O, Hauser WA. Incidence of unprovoked seizures and epilepsy in Iceland and assessment of the epilepsy syndrome classification: a prospective study. Lancet Neurol. 2005;4(10):627–34.

    Article  Google Scholar 

  6. Bergey GK. Management of a first seizure. Continuum (Minneap Minn). 2016;22(1 Epilepsy):38–50.

    Google Scholar 

  7. Rizvi S, Ladino LD, Hernandez-Ronquillo L, Téllez-Zenteno JF. Epidemiology of early stages of epilepsy: risk of seizure recurrence after a first seizure. Seizure. 2017;49:46–53.

    Article  Google Scholar 

  8. Camfield P, Camfield C. Epilepsy can be diagnosed when the first two seizures occur on the same day. Epilepsia. 2000;41(9):1230–3.

    Article  CAS  Google Scholar 

  9. Lee WL, Ong HT. Afebrile seizures associated with minor infections: comparison with febrile seizures and unprovoked seizures. Pediatr Neurol. 2004;31(3):157–64.

    Article  Google Scholar 

  10. Nardone R, Brigo F, Trinka E. Acute symptomatic seizures caused by electrolyte disturbances. J Clin Neurol. 2016;12(1):21–33.

    Article  Google Scholar 

  11. Shorvon S. The concept of symptomatic epilepsy and the complexities of assigning cause in epilepsy. Epilepsy Behav. 2014;32:1–8.

    Article  Google Scholar 

  12. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009;30(21):2631–71.

    Article  Google Scholar 

  13. Cheshire WP. Syncope. Continuum (Minneap Minn). 2017;23(2, Selected Topics in Outpatient Neurology):335–58.

    Google Scholar 

  14. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69–72.

    Article  Google Scholar 

  15. Stephenson JB. Syncopes and other paroxysmal events. Handb Clin Neurol. 2013;112:861–6.

    Article  Google Scholar 

  16. Tinuper P, Provini F, Bisulli F, Vignatelli L, Plazzi G, Vetrugno R, et al. Movement disorders in sleep: guidelines for differentiating epileptic from non-epileptic motor phenomena arising from sleep. Sleep Med Rev. 2007;11(4):255–67.

    Article  Google Scholar 

  17. Luat AF, Kamat D, Sivaswamy L. Paroxysmal nonepileptic events in infancy, childhood, and adolescence. Pediatr Ann. 2015;44(2):e18–23.

    Article  Google Scholar 

  18. Loewenberger A, Cope SR, Poole N, Agrawal N. An investigation into the preferred terminology for functional seizures. Epilepsy Behav. 2020;111:107183.

    Article  Google Scholar 

  19. Hopp JL. Nonepileptic episodic events. Continuum (Minneap Minn). 2019;25(2):492–507.

    Google Scholar 

  20. Benbadis SR. Psychogenic nonepileptic “seizures” or “attacks”? It’s not just semantics: attacks. Neurology. 2010;75(1):84–6.

    Article  Google Scholar 

  21. Benbadis SR. Nonepileptic behavioral disorders: diagnosis and treatment. Continuum (Minneap Minn). 2013;19(3 Epilepsy):715–29.

    Google Scholar 

  22. Doss RC, LaFrance WC. Psychogenic non-epileptic seizures. Epileptic Disord. 2016;18(4):337–43.

    Article  Google Scholar 

  23. Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F. Value of tongue biting in the diagnosis of seizures. Arch Intern Med. 1995;155(21):2346–9.

    Article  CAS  Google Scholar 

  24. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Book  Google Scholar 

  25. Bayram AK, Canpolat M, Karacabey N, Gumus H, Kumandas S, Doğanay S, et al. Misdiagnosis of gastroesophageal reflux disease as epileptic seizures in children. Brain Dev. 2016;38(3):274–9.

    Article  Google Scholar 

  26. Panayiotopoulos CP. Visual phenomena and headache in occipital epilepsy: a review, a systematic study and differentiation from migraine. Epileptic Disord. 1999;1(4):205–16.

    CAS  Google Scholar 

  27. Nowacki TA, Jirsch JD. Evaluation of the first seizure patient: key points in the history and physical examination. Seizure. 2017;49:54–63.

    Article  Google Scholar 

  28. Muayqil TA, Alanazy MH, Almalak HM, Alsalman HK, Abdulfattah FW, Aldraihem AI, et al. Accuracy of seizure semiology obtained from first-time seizure witnesses. BMC Neurol. 2018;18(1):135.

    Article  Google Scholar 

  29. Tatum WO, Hirsch LJ, Gelfand MA, Acton EK, LaFrance WC, Duckrow RB, et al. Assessment of the predictive value of outpatient smartphone videos for diagnosis of epileptic seizures. JAMA Neurol. 2020;77(5):593–600.

    Article  Google Scholar 

  30. Fogarasi A, Janszky J, Faveret E, Pieper T, Tuxhorn I. A detailed analysis of frontal lobe seizure semiology in children younger than 7 years. Epilepsia. 2001;42(1):80–5.

    Article  CAS  Google Scholar 

  31. Fogarasi A, Boesebeck F, Tuxhorn I. A detailed analysis of symptomatic posterior cortex seizure semiology in children younger than seven years. Epilepsia. 2003;44(1):89–96.

    Article  Google Scholar 

  32. Rossetti AO, Kaplan PW. Seizure semiology: an overview of the ‘inverse problem’. Eur Neurol. 2010;63(1):3–10.

    Article  Google Scholar 

  33. Nypaver MM, Reynolds SL, Tanz RR, Davis AT. Emergency department laboratory evaluation of children with seizures: dogma or dilemma? Pediatr Emerg Care. 1992;8(1):13–6.

    Article  CAS  Google Scholar 

  34. Hirtz D, Ashwal S, Berg A, Bettis D, Camfield C, Camfield P, et al. Practice parameter: evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, the Child Neurology Society, and the American Epilepsy Society. Neurology. 2000;55(5):616–23.

    Article  CAS  Google Scholar 

  35. Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz-Pannier L, et al. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia. 2009;50(9):2147–53.

    Article  Google Scholar 

  36. McAbee GN, Barasch ES, Kurfist LA. Results of computed tomography in “neurologically normal” children after initial onset of seizures. Pediatr Neurol. 1989;5(2):102–6.

    Article  CAS  Google Scholar 

  37. Stroink H, Brouwer OF, Arts WF, Geerts AT, Peters AC, van Donselaar CA. The first unprovoked, untreated seizure in childhood: a hospital based study of the accuracy of the diagnosis, rate of recurrence, and long term outcome after recurrence. Dutch study of epilepsy in childhood. J Neurol Neurosurg Psychiatry. 1998;64(5):595–600.

    Article  CAS  Google Scholar 

  38. Veerapandiyan A, Aravindhan A, Takahashi JH, Segal D, Pecor K, Ming X. Use of head computed tomography (CT) in the Pediatric Emergency Department in evaluation of children with new-onset afebrile seizure. J Child Neurol. 2018;33(11):708–12.

    Article  Google Scholar 

  39. Kleinerman RA. Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol. 2006;36(Suppl 2):121–5.

    Article  Google Scholar 

  40. Shinnar S, O’Dell C, Mitnick R, Berg AT, Moshe SL. Neuroimaging abnormalities in children with an apparent first unprovoked seizure. Epilepsy Res. 2001;43(3):261–9.

    Article  CAS  Google Scholar 

  41. Al-Shami R, Khair AM, Elseid M, Ibrahim K, Al-Ahmad A, Elsetouhy A, et al. Neuro-imaging evaluation after the first afebrile seizure in children: a retrospective observational study. Seizure. 2016;43:26–31.

    Article  Google Scholar 

  42. Guo BJ, Yang ZL, Zhang LJ. Gadolinium deposition in brain: current scientific evidence and future perspectives. Front Mol Neurosci. 2018;11:335.

    Article  Google Scholar 

  43. Hirtz D, Berg A, Bettis D, Camfield C, Camfield P, Crumrine P, et al. Practice parameter: treatment of the child with a first unprovoked seizure: report of the quality standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2003;60(2):166–75.

    Article  CAS  Google Scholar 

  44. Shinnar S, Berg AT, Moshe SL, Shinnar R. How long do new-onset seizures in children last? Ann Neurol. 2001;49(5):659–64.

    Article  CAS  Google Scholar 

  45. Valeant Pharmaceuticals North America LLC. Diastat (diazepam) [package insert]. www.accessdata.fda.gov/drugsatfda_docs/label/2014/020648s012lbl.pdf. Revised December 2014. Accessed 13 Dec 2020.

  46. Neurelis. Valtoco (diazepam intranasal) [package insert]. U.S. Food and Drug Administration website. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/211635s000lbl.pdf. Revised January 2020. Accessed 13 Dec 2020.

  47. Proximagen, LLC. Nayzilam (versed) [package insert]. U.S. Food and Drug Administration website https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/211321s000lbl.pdf Revised May 2019. Accessed 13 Dec 2020.

  48. Berg AT. Risk of recurrence after a first unprovoked seizure. Epilepsia. 2008;49(Suppl 1):13–8.

    Article  Google Scholar 

  49. Shinnar S, Berg AT, O’Dell C, Newstein D, Moshe SL, Hauser WA. Predictors of multiple seizures in a cohort of children prospectively followed from the time of their first unprovoked seizure. Ann Neurol. 2000;48(2):140–7.

    Article  CAS  Google Scholar 

  50. Hesdorffer DC, Benn EK, Cascino GD, Hauser WA. Is a first acute symptomatic seizure epilepsy? Mortality and risk for recurrent seizure. Epilepsia. 2009;50(5):1102–8.

    Article  Google Scholar 

  51. Kho LK, Lawn ND, Dunne JW, Linto J. First seizure presentation: do multiple seizures within 24 hours predict recurrence? Neurology. 2006;67(6):1047–9.

    Article  Google Scholar 

  52. Metsäranta P, Koivikko M, Peltola J, Eriksson K. Outcome after prolonged convulsive seizures in 186 children: low morbidity, no mortality. Dev Med Child Neurol. 2004;46(1):4–8.

    Article  Google Scholar 

  53. Ramos Lizana J, Cassinello Garciá E, Carrasco Marina LL, Vázquez López M, Martín González M, Muñoz Hoyos A. Seizure recurrence after a first unprovoked seizure in childhood: a prospective study. Epilepsia. 2000;41(8):1005–13.

    Article  CAS  Google Scholar 

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Correspondence to Aimee F. Luat .

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Weber, A., Luat, A.F. (2022). Child with New Onset Convulsive Seizure. In: Kamat, D.M., Sivaswamy, L. (eds) Symptom-Based Approach to Pediatric Neurology . Springer, Cham. https://doi.org/10.1007/978-3-031-10494-7_7

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  • DOI: https://doi.org/10.1007/978-3-031-10494-7_7

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