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Chapter 52: Seizures

George T. Koburov

High-Yield Facts

  • Seizures are the most common neurologic disorder in children in the United States.

  • Epilepsy is defined as two or more unprovoked (absence of fever, acute trauma, etc.) seizures.

  • Although 1 in 10 individuals will experience a seizure in their lifetimes, seizures are still poorly understood in regards to etiology and optimal treatment.

Seizures are the most common neurologic disorder in children in the United States.1 A seizure is defined as abnormal, excessive, transient paroxysmal electrical discharge of neurons within the brain. Epilepsy is defined as two or more unprovoked (absence of fever, acute trauma, etc.) seizures. Although 1 in 10 individuals will experience a seizure in their lifetimes, seizures are still poorly understood in regards to etiology and optimal treatment. As such, seizures can be a vexing and anxiety-provoking event for emergency medicine physicians, staff, and the families of affected children.

Classification

The etiology and pathophysiology of seizures is poorly understood and manifestations of this process are quite variable. These manifestations may include changes in behavior, consciousness, sensation, motor activity, or autonomic function. Some seizures are very subtle, described as daydreaming to the opposite extreme of generalized convulsing of the body with loss of consciousness. An international classification of epilepsies and seizures disorders was developed in 1989 and continues to serve to classify seizures (Table 52-1).1 A revised terminology for seizures and epilepsies was released by the International League Against Epilepsy (ILAE) Commission in 2009.2 Neither classification is particularly useful or prescriptive for guiding acute management in the emergency department (ED), but can be useful in communicating with neurologists when determining the need for ongoing anticonvulsive therapies.

TABLE 52-1International Classification of Seizures
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TABLE 52-1 International Classification of Seizures

Partial Seizures

  • Simple partial seizures (consciousness not impaired)

    • with motor symptoms

    • with sensory symptoms

    • with autonomic symptoms

    • with psychic symptoms

  • Complex partial seizures (with impaired consciousness)

    • simple partial seizures followed by impairment of consciousness

    • with impairment of consciousness at seizure onset

  • Partial seizures evolving to secondary generalized seizures

    • simple partial secondarily generalized

    • complex partial secondarily generalized

    • simple partial evolving to complex partial evolving to generalized

Generalized Seizures

  • Absence seizures (formerly called petit mal)

  • Myoclonic seizures

  • Clonic seizures

  • Tonic seizures

  • Tonic clonic seizures (formerly called grand mal)

  • Atonic seizures (drop attacks)

There are a few seizure types that are unique to pediatrics. These include benign Rolandic seizures, juvenile myoclonic epilepsy, and infantile spasms. These can often be diagnosed based on their unique presentations and may obviate the need for some diagnostic evaluations.

Infantile spasms (West syndrome) typically present between 4 and 18 months of age with males more commonly affected. The vast majority has mental retardation and the mortality rate is quite high. These seizures are characterized by clusters of sudden jerking contractions of the head, trunk, and ...

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