Evaluating New Onset of Seizures in Children

Children who present either to the pediatrician's office or the emergency department with seizures should undergo a careful and detailed history and physical examination. This is done to distinguish between epileptic and nonepileptic events and to characterize among acute symptomatic, remote symptomatic, and idiopathic etiologies. An EEG is obtained both to assist in this differentiation and to help with medication selection and syndrome diagnosis. Brain imaging, where obtained, should be with a MRI scan except in specific incidences of acute symptomatic seizures. Most patients with idiopathic benign epilepsy will not require a brain image and may not require anticonvulsant medication. Prognosis is based on the etiology and syndrome and is usually excellent in acute symptomatic epilepsy (based on the source), very favorable in idiopathic epilepsy, and less favorable in remote symptomatic cases.