Pediatric Hospital Medicine

10

Part I • Neurology

TABLE 2.2 ETIOLOGY OF EPILEPSY IN CHILDREN Genetic

• Sodium, potassium, or calcium channel gene alterations or deletions

■ CLINICAL MANIFESTATIONS Clinical manifestations vary depending on their individual character istics. For some, an aura may precede the seizure, such as a sensation or feeling. 2 A generalized seizure may be followed by a postictal state: a period of time when the child is sleepy, confused, disoriented, or exhibits weakness in a part of the body. Lasting seconds to hours, the postictal state ends when the child returns to baseline. 3 ■ DIAGNOSTIC STUDIES A seizure is a clinical diagnosis based on medical history focusing on age, duration, triggers, and state of awareness during the event. Past medical history, family history, exposures, and psychiatric history are also pertinent. See Table 2.3 for additional diagnostic studies to con sider after an initial unprovoked seizure. ■ MANAGEMENT Table 2.4 lists the high-value approach for management of a child with an unprovoked first seizure and considerations if an infectious cause is suspected. • Chromosomal abnormalities (eg, Wolf-Hirschhorn 4p-syndrome, Angelman syndrome [del 15q11-13]) Metabolic • Inborn errors of metabolism (eg, urea cycle disorders, phenylketonuria) • Lysosomal storage disorders (eg, Tay-Sachs, Gaucher disease) Structural • Cortical malformations during development • Stroke or trauma Immune • Anti– N -methyl- d -aspartate (NMDA) receptor encephalitis • Paraneoplastic due to underlying cancer Infectious • Bacterial central nervous system infections ( Neisseria menin gitidis , Streptococcus pneumoniae , gram-negative bacteria) • Viruses: Zika, HIV, and CMV • Other infectious agents: tuberculosis, neurocysticercosis, malaria, syphilis HIV, Human Immunodeficiency Virus; CMV, Cytomegalovirus. Data from Fine A, Wirrell EC. Seizures in children. Pediatr Rev . 2020;41(7):321-347.

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