From the Guidelines
For a 10-year-old child presenting with seizures, the initial workup should prioritize a detailed history, thorough physical and neurological examination, laboratory tests, and an electroencephalogram (EEG), with neuroimaging using noncontrast MRI as the preferred modality if indicated, as suggested by the most recent guidelines 1. The initial evaluation of a child with seizures involves a comprehensive approach to identify the underlying cause and determine the appropriate management strategy. This includes:
- A detailed history focusing on seizure characteristics, developmental history, and family history of seizures
- A thorough physical and neurological examination to identify any potential focal neurological deficits or systemic abnormalities
- Laboratory tests such as complete blood count, comprehensive metabolic panel, glucose, calcium, magnesium, and electrolytes to rule out metabolic causes
- An electroencephalogram (EEG) to detect abnormal electrical activity, which should be performed both during sleep and while awake to increase sensitivity
- Neuroimaging, with noncontrast MRI being the preferred modality if indicated, due to its better resolution and absence of radiation, particularly to identify structural abnormalities like cortical dysplasia, tumors, or vascular malformations, as recommended by the American Academy of Pediatrics 1 Additional testing may include lumbar puncture if infection is suspected, genetic testing if there's a family history of epilepsy, and toxicology screening if substance exposure is a concern. The choice of antiepileptic drugs, such as levetiracetam, oxcarbazepine, or valproic acid, depends on the seizure type, potential side effects, and comorbidities, and should be guided by the most recent clinical guidelines and expert recommendations 1.
From the Research
Seizure Workup for a 10-year-old
- The diagnosis and treatment of seizures and epilepsy is a common task of the physician, with approximately 1 in 10 people experiencing a seizure during their lifetime 2.
- Evaluation of a patient presenting with a seizure involves excluding an underlying neurologic or medical condition, classifying the seizure type, and determining if the patient has epilepsy 2.
- For children presenting with seizures, early intervention improves treatment response, and the use of consensus guidelines is highly recommended to decrease drug side effects and reduce intensive care requirements 3.
- The risk of recurrence of a seizure depends on several clinical, etiological, EEG, and neuroimaging findings that should be approached on an individual basis 4.
Treatment Options
- Benzodiazepines remain the mainstay of first-line treatment for seizures 3.
- For generalized epileptic seizures, lamotrigine, levetiracetam, and topiramate are as effective as valproate, while valproate and ethosuximide are the best options for the treatment of absence seizures 5.
- For focal epilepsy, lamotrigine is superior to levetiracetam and zonisamide in terms of time to 12-month remission and time to treatment failure 6.
- For generalized and unclassifiable epilepsy, valproate is superior to levetiracetam in terms of time to 12-month remission and time to treatment failure 6.
Diagnostic Workup
- A diagnostic electroencephalogram (EEG) or neuroimaging may be necessary to determine the etiology of the seizure and the risk of recurrence 4.
- The presentation of the first seizure, diagnostic workup, treatment, and impact should be considered individually based on continuously updated knowledge of treating physicians 4.