Seizures and epilepsy are common, serious neurologic diseases in children and adolescents.1,2 Convulsions can be a manifestation of epilepsy or occur secondary to a complication of a systemic or central nervous system disorder. The emergency physician is usually the first provider to evaluate and stabilize children with suspected seizures. Here, we will review recent literature and share our personal experience in the approach to a seizing child in the emergency department.
Epilepsy is defined as the predisposition to generate seizures.3,4 While generalized or focal shaking in a child readily raises a concern for seizure in caregivers and doctors alike, subtle manifestations, such as brief episodes of lip smacking in temporal lobe epilepsy or head bobbing in infantile spasms, can be challenging to correctly detect as signs of a serious neurologic disorder.
As with any other patient presenting to the emergency department, assessment of seizing children starts with determining stability and urgently addressing the ABCs. Careful attention should be given to the possibility of continuous seizure activity even if no apparent convulsions are seen. It’s helpful to consider the possibility that seizures were provoked so that their causes can be diagnosed and addressed.3 Table 1 enumerates causes of provoked seizures in patients without epilepsy.