Pediatric Hospital Medicine

2 CHAPTER

Seizure

Lora G. Sowunmi and Christine Traul

■ INTRODUCTION Seizures can be defined as surges of abnormal and excessive electrical activity in any part of the brain that causes clinical symptoms ranging from brief lapses of awareness or muscle twitches to prolonged convul sions. 1 The terms seizures and epilepsy are often used interchangeably, but have different meanings. Epilepsy is defined as two or more recur rent, unprovoked seizures. Provoked seizures may occur with medical conditions including injury, electrolyte derangement, fever, or with drawal from drugs or alcohol. While the medical condition may have provoked one or more seizures, it is likely reversible and thus is not epilepsy. 1 Epilepsy has a wide spectrum of clinical characteristics due to vary ing seizure types. A very specific classification system has been im plemented to streamline the clinical descriptions of a seizure. These include onset, level of awareness, and whether movement is noted with the seizure. Classifications of seizure types can be found in Table 2.1.

TABLE 2.1 CLASSIFICATION OF SEIZURE TYPES ONSET AWARENESS

ABNORMAL MOVEMENTS

Focal

Aware or impaired awareness May be present

Generalized Impaired awareness

May be present May be present

Unknown

Impaired awareness

Data from Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia . 2017;58(4):522-530.

■ EPIDEMIOLOGY AND RISK FACTORS An underlying cause for seizures, and ultimately the diagnosis of epi lepsy, may be identified in almost two-thirds of pediatric patients. See Table 2.2 for the etiologies.

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