Seizures in Children

Aetiologies of first-ever convulsive seizures may be diverse, not all leading to recurrence or epilepsy diagnosis. We aimed to describe the epidemiology of first-ever convulsive seizures in children, investigating risk factors for recurrence and epilepsy diagnosis. This was a retrospective study of children presenting with a first-ever convulsive seizure to a tertiary-care paediatric emergency department (PED) in Italy, in a 12-month period (2011-2012). One hundred and eight children (57 males, 51 females) presented to the PED for a first-ever convulsive seizure; 90.7% were 6months to 6years old (median age 1y 10mo, mean 2y 7mo, range 0mo-14y 4mo). Seizure duration was less than 5minutes in 76.8%. Seizures were 'unprovoked' in 19.4% and 'provoked' in 80.6%. At 4-year follow-up, 37.9% of patients experienced recurrence and 13.6% received a diagnosis of epilepsy. Factors significantly associated with recurrence were the 'unprovoked' nature of the first seizure, multiple seizures in the first 24hours, positive family history of febrile seizures or epilepsy, and pre-existing neurological conditions/problems. Factors significantly associated with a diagnosis of epilepsy were the 'unprovoked' nature of the first seizure, age older than 6years, pre-existing neurological conditions/problems, and focal onset of first seizure. Children presenting to the PED with first-ever convulsive seizures represent a heterogeneous group. The identification of prognostic factors for recurrence and epilepsy diagnosis may help provide tailored counselling and follow-up. Seizures were 'unprovoked' in 19.4% and 'provoked' in 80.6% of children presenting to the emergency department. At 4-year follow-up, 37.9% relapsed, and 13.6% received a diagnosis of epilepsy. 'Unprovoked' first seizure, family history of febrile seizures, and pre-existing neurological conditions were associated with recurrence. 'Unprovoked' first seizure, age younger than 6years, and pre-existing neurological conditions were associated with epilepsy diagnosis.

Sunday, December 3, 2006 Poster Session II 7:30 a.m.–4:30 p.m.

Accurate classification of epileptic seizures and epilepsy is essential for diagnosis, treatment, and research. This study evaluated inter-rater agreement in seizure and epilepsy diagnosis and classification using standardized clinical vignettes. Thirty-seven anonymized vignettes, based on adult cases from Merano Hospital (2010-2022), were independently assessed by four epileptologists from different Italian centers. Structured questions covered seizure diagnosis, categorization (acute symptomatic vs. unprovoked), seizure onset, epilepsy diagnosis (ILAE 2014), syndrome identification, etiology, and classification according to the 2017 ILAE basic and expanded systems. Inter-rater agreement was measured with Fleiss' κ and Gwet's AC1; only perfectly matching responses were considered concordant. Bootstrap resampling (1000 iterations) provided 95% confidence intervals. Agreement was almost perfect for seizure diagnosis (κ = .94, AC1 = .99), epilepsy diagnosis (κ = .96, AC1 = .97), seizure categorization (κ = .86, AC1 = .90), seizure onset (κ = .83, AC1 = .93), and etiology (κ = .84, AC1 = .92). Syndrome identification showed high agreement (κ = .82, AC1 = .97). The ILAE 2017 basic system yielded substantial reliability (κ = .72, AC1 = .82), whereas the expanded version showed lower consistency (κ = .65, AC1 = .77). This preliminary study, although based on adult emergency cases in one country and rated by only 4 specialists, demonstrates high inter-rater agreement supporting the reliability of current ILAE frameworks. Lower concordance in detailed classifications highlights interpretive variability and the need for refinement. The forthcoming 2025 ILAE updates may improve consistency and diagnostic precision in epilepsy care and research.

Studies adherent to international guidelines and epilepsy classification are needed to accurately record the incidence of isolated seizures, epilepsy and seizure-mimics within a population. Because the diagnosis of epilepsy is largely made through clinical assessment by experienced physicians, seizures and epilepsy are susceptible to misdiagnosis. Previous epidemiological studies in epilepsy have not captured “seizure mimics”. We therefore sought to quantify the incidence of isolated seizures, epilepsy and seizure-mimics using the International League Against Epilepsy (ILAE) classification system. In this study multiple overlapping methods of case ascertainment were applied to a defined geographic region from January 1 to March 31, 2017 to identify all patients presenting with first seizures (provoked and unprovoked), new diagnoses of epilepsy and seizure mimics. Over a 3 month period, from a population of 542,869 adults and children, 442 potential presentations were identified, and 283 met the inclusion criteria. Radiology databases were the source of the largest number of individual cases (n = 153, 54%), while electroencephalogram (EEG) databases were the source of the highest number of unique-to-source cases (those not identified elsewhere, n = 60, 21%). No single case was picked up in every method of ascertainment. Among the 283 included presentations, 38 (13%) were classed as first provoked seizures, 27 (10%) as first unprovoked seizures, 95 (34%) as new diagnosis of epilepsy and 113 (40%) as seizure mimics. Ten (3%) presentations were indeterminate. We present and apply a rigorous study protocol for investigation of the incidence of first seizures, new diagnosis of epilepsy and seizure mimics in a geographically defined region which is adherent to recently published international guidelines for epidemiologic studies and epilepsy classification. We highlight the challenges in making a diagnosis of new-onset epilepsy in patients presenting with a first seizure using the current ILAE definition of epilepsy, when epilepsy can be diagnosed in situations where the treating physician anticipates the risk of further seizures exceeds 60%.

BackgroundEpilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition [1]. Studies...

Nonfebrile seizures.

OBJECTIVETo assess the accuracy of the diagnosis of a first unprovoked seizure in childhood, the recurrence rate within two years, the risk factors for recurrence, and the long term outcome...

Prevalence and spectrum of electroencephalogram-identified epileptiform activity among patients with long QT syndrome

1. Philippe Major, MD* 2. Elizabeth A. Thiele, MD, PhD* 1. *Department of Neurology, Massachusetts General Hospital, Boston, Mass After completing this article, readers should be able to: 1. Formulate an appropriate diagnostic plan for a child who has seizures. 2. Discuss the management of epilepsy. The initial article on seizures in childhood (October 2007) focused on the diagnosis and classification of seizures in children. This second article reviews investigational tools and management. The evaluation of a child who has a seizure disorder must be tailored to the findings on history and physical examination. The electroencephalogram (EEG) is the primary electrophysiologic tool; brain neuroimaging is the primary modality for evaluating neuroanatomic and functional features. The EEG can help confirm the clinical diagnosis of epilepsy, classify the type of epilepsy, localize the epileptic focus, and help determine if treatment can be discontinued safely. In general, 21 electrodes placed on specific locations on the patient's scalp measure voltage fluctuations of superficial neurons in relation to time. Figure 1 shows the position and labeling of the scalp electrodes; Figures 2through ⇓⇓⇓6 show examples of typical EEG tracings. Generalized epileptic syndromes are characterized by discharges recorded simultaneously at each electrode; partial epilepsy syndromes show localized spikes or slowing in the epileptogenic region. Epilepsy is a clinical diagnosis that cannot be made on the basis of abnormal EEG findings. In fact, EEG abnormalities can be found in 5% of children who have no history of seizures. Figure 1. Scalp electrode positions for EEG. By convention, electrodes labeled with an even number are placed over the right hemisphere, and odd-numbered electrodes are placed over the left hemisphere. Fp=frontopolar, F=frontal, T=temporal, C=central, P=parietal, O=occipital, z=midline Figure 2. Normal EEG tracing showing a reactive posterior alpha (9-Hz) rhythm in an 8-year-old boy who has no history of seizures. The slow waves observed in the frontal areas are associated with eye movements. Figure 3. EEG tracing showing frequent independent left and right …

Neurology| May 01 2009 Utility of Sleep Deprivation to Increase Yield of Pediatric EEG AAP Grand Rounds (2009) 21 (5): 56. https://doi.org/10.1542/gr.21-5-56 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Utility of Sleep Deprivation to Increase Yield of Pediatric EEG. AAP Grand Rounds May 2009; 21 (5): 56. https://doi.org/10.1542/gr.21-5-56 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: electroencephalography, sleep deprivation, sleep, seizures Source: DeRoos ST, Chillag KL, Keeler M, et al. Effects of sleep deprivation on the pediatric electroencephalogram. Pediatrics. 2009;123(2):703–708; doi:10.1542/peds.2008-0357 The value of a sleep-deprived outpatient EEG in diagnosing epilepsy was assessed in a randomized, blinded comparison of routine EEG (R-EEG) versus sleep-deprived EEG (SD-EEG) by investigators at Helen DeVos Children’s Hospital in Grand Rapids, MI. All children between the ages of five months and 18 years referred by a neurologist for an outpatient EEG between 2004 and 2006 were recruited. Criteria for enrollment included a diagnosis of first unprovoked seizure, established epilepsy, or spells being evaluated for seizures. Children assigned to the SD-EEG protocol went to bed at their normal bedtime. Children aged >11 years were to stay awake after 12:00 am; children aged 3–11 years were to stay awake after 2:00 am; and children aged <3 years were to stay... You do not currently have access to this content.

Evaluate the frequency of abnormal electroencephalograph (EEG) records during pediatric polysomnography (PSG) at a tertiary referral center and determine frequency with which these records may predict future seizures and a diagnosis of epilepsy. Retrospective review of all pediatric PSG reports from 2013 was performed. Demographics, medical history, indications, diagnoses, and EEG reports were collected. Patients were evaluated for follow-up of future diagnosis of seizure or epilepsy over a 30-month period. A total of 1,969 studies (56.9% males, median age 7 years) were analyzed. Abnormal EEG results were detected in 314 studies (15.9%); abnormalities included slowing in 75 (3.8%) and interictal epileptiform discharges (IEDs) in 239 (12.1%). Incidental abnormal EEG recordings were found in 186 patients (9.4%) without a prior diagnosis of seizure or epilepsy. Incidental IEDs were recorded in 126 (6.4%) and were most commonly focal (66.7%). Ten patients received follow-up EEG without clinical follow-up, 68 received clinical follow-up without follow-up EEG, and 29 received both within a 30-month period. Follow-up EEG was normal in only 30.8% of cases. Thirteen patients in the 30-month window received a new diagnosis of epilepsy. Each new diagnosis occurred in patients with preexisting neurodevelopmental disorders at high risk for seizures. Abnormal EEG during pediatric PSG without additional history of seizure is a poor prognosticator for a future diagnosis of epilepsy. Abnormalities detected on PSG did not always portend abnormal diagnostic EEG and thus its utility to corroborate findings does not appear to be supported without additional clinical context concerning for seizure.

Epilepsy is a chronic neurological disorder characterized by recurrent seizures that are caused by abnormal and excessive cerebral neuronal discharges. The clinical symptoms are paroxysmal, and may include impaired consciousness and/or motor, sensory, autonomic, or psychic events. Diagnosis of epilepsy is not always straightforward and clear-cut. A seizure is only a symptom that indicates neuronal dysfunction. Other diseases can cause paroxysmal events, which look very much like a seizure but in fact are nonepileptic. Such nonepileptic events include syncope, acute symptomatic seizures, and psychogenic nonepileptic seizures. To identify epileptic seizures and to classify the type of epilepsy, clinical, electroencephalographic (EEG), and/or neuroimaging findings are the fundamentals. Knowledge of the different types of seizures is essential to guide the physician in obtaining the history which leads to the diagnosis of seizure and epilepsy. In real situations, however, it is rare for physicians to actually witness the event of seizure. This lecture provides valuable opportunity to experience "real life" clinical diagnosis of epileptic seizures by showing the video of patient under seizure and EEG data. Representative visual examples of symptoms together with the detailed medical knowledge will greatly enhance the capability of diagnosis, the effectiveness of treatment, and help develop clinical strategies.

Introduction. Epilepsy has been considered to be more frequent in Greenland than in Denmark, where the prevalence among children is 0.40 %. Study design. Evaluation of the prevalence, diagnosis and treatment of epilepsy among children in Greenland aged 0–15 years. Methods. During autumn 2000, 13 out of 18 hospitals in Greenland were visited. The population of children in the areas visited was 11,965 of a total of 15,226 in Greenland. All children with the diagnosis of epilepsy were referred for evaluation and the diagnosis was confirmed. When possible, informed consent was obtained to collect data from medical records Results. 43 children (18 boys) had the diagnosis of epilepsy. For 38 (15 boys) further data were obtained. Mean age was 8.5 years (3-14) for boys and 7.9 years (2-14) for girls. The age at diagnosis was 4.9 years (1-11) for boys and 4.2 years (0-10) for girls. The prevalence of epilepsy was 0.34%. In 31 cases an electroencephalograph (EEG) recording was done, comprising sleep recordings in 26 cases. Medication was according to recommendations in Denmark. Conclusion. The prevalence of epilepsy in children and the medical treatment of epilepsy among children in Greenland is the same as in Denmark.

Objective: To assess the interrater agreement of the diagnosis and the classification of a first paroxysmal event in childhood. Methods: The descriptions of 100 first paroxysmal events were submitted to...

80 - Diagnosis and Classification of Seizures and Epilepsy