№ 34General Pediatrics19 min read
Epilepsy in children
1. Big picture
Epilepsy in children is not just “a child who had a seizure.” A seizure is a single event; epilepsy is a tendency to have recurrent unprovoked seizures.
The exam approach is:
Was it really a seizure? Was it provoked or unprovoked? What seizure type? What epilepsy syndrome? Is there an emergency cause? Does the child need antiseizure medication?
Most important pediatric exam patterns:
| Pattern | Think of |
|---|---|
| Fever + brief generalized seizure in 6 months–5 years | Febrile seizure, not epilepsy |
| Sudden staring spells, eyelid flutter, no postictal phase | Childhood absence epilepsy |
| Infant with clusters of flexor spasms + developmental regression | Infantile spasms / West syndrome |
| Morning myoclonic jerks in adolescent | Juvenile myoclonic epilepsy |
| Focal seizure + postictal weakness | Focal epilepsy, structural lesion possible |
| Seizure > 5 minutes or repeated seizures without recovery | Status epilepticus emergency |
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