Dr. Nelson of Tulane University School of Medicine received honorariums from Sunovian and LivaNova and consulting fees from Supernus and BioMarin.)
Justine Ker of Tulane University School of Medicine has no relevant financial relationships to disclose.)
Dr. Schor of the National Institutes of Health and Deputy Director of the National Institute of Neurological Disorders and Stroke has no relevant financial relationships to disclose.)
The anxiety and fear surrounding childhood epilepsy can have a profound impact on the patients and their families. The diagnosis of seizure disorders during childhood can sometimes be challenging due to the variety of types of seizures and nonepileptic events that are seen in the pediatric population. Making the appropriate diagnosis is important to ensure proper treatment and accurate determination of prognosis. In this article, the author discusses some guidelines and pitfalls in diagnosing seizures and epilepsy in childhood and adolescence.
• The diagnosis of a seizure requires a thorough history of the event with an emphasis on recognition of features that may suggest a nonepileptic cause.
• EEG is the most useful diagnostic test in cases in which the history is not diagnostic, particularly if the event can be captured on EEG.
• In the absence of signs or symptoms of infection or trauma, MRI is the preferred imaging modality for those patients with new-onset afebrile seizures who require imaging.
• It is important to identify a patient's epilepsy syndrome to assist in choosing the appropriate treatment and to discuss prognosis.
Historical note and terminology
The childhood years represent a time of high seizure incidence. The wide variation in seizure type and epilepsy syndromes makes diagnosis challenging for the treating physician (Panayiotopoulos 2010). With up to 4% of children experiencing at least 1 seizure during childhood, physicians caring for children are likely to encounter patients with seizures or epilepsy (Friedman and Sharieff 2006; Camfield and Camfield 2008; Subcommittee on Febrile Seizures 2011).
Seizures during childhood have been described since ancient times and were often attributed to mystical causes. Nonepileptic syndromes were frequently misidentified as seizures or epilepsy. With the advent of the electroencephalogram (EEG) in the early part of the 19th century, researchers identified a variety of EEG findings diagnostic of certain types of seizures and epilepsy syndromes. Subsequently, EEG and neuroimaging have been invaluable in confirming, classifying, localizing, and identifying the etiologies of childhood seizures and epileptic syndromes (Kaplan and Fisher 2005; Panayiotopoulos 2010).
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