CLINICAL ISSUES IN ACUTE CHILDHOOD SEIZURE MANAGEMENT IN THE EMERGENCY DEPARTMENT

Generalized tonic-clonic seizure activity in infants and children freq uently leads to an emergency department visit, often after emergency m edical set-vice personnel, such as paramedics, provide initial evaluat ion and treatment. Important subsets of patients who present to the em ergency department include those with non-seizure-mediated movements, those with nongeneralized seizure activity, those with complications o f anticonvulsant therapy, and those with status epilepticus. Recognizi ng, diagnosing, and treating these conditions and minimizing complicat ions are key issues to be considered in the refinement of emergency de partment practice. Of the children with seizures who are seen in the e mergency department, those with febrile convulsions or exacerbations o f underlying seizure disorders predominate, while those with new-onset epilepsy or other seizure disorders account for a smaller proportion. Current issues in the emergency department management of seizures in children include: (1) modifying interventions to stabilize patients an d simultaneously minimize the physiologic deterioration accompanying g eneralized seizures; (2) selection, initiation, administration, and re finement of anticonvulsant therapy; (3) minimizing complications of pr olonged seizures and their treatment; (4) rapid recognition and treatm ent of life-threatening illnesses that underlie seizure presentations; (5) selection of appropriate diagnostic measures; and (6) use of elec troencephalography in selected patients.