A practical approach to uncomplicated seizures in children

Uncomplicated seizures and epilepsy are common in infants and children. Fam ily physicians should be aware of certain epilepsy syndromes that occur in children, such as febrile seizures, benign focal epilepsy of childhood, com plex partial epilepsy, juvenile myoclonic epilepsy and video game-related e pilepsy. Not all uncomplicated childhood seizures require neuroimaging or t reatment. Febrile seizures, rolandic seizures and video game-related seizur es are childhood epileptic syndromes that are typically not associated with brain structural lesions on computed tomography or magnetic resonance imag ing, and are often not treated with anticonvulsant drugs. Juvenile myocloni c epilepsy does not require neuroimaging but does require treatment because of a high rate of recurrent seizures. Complex partial epilepsy often requi res both neuroimaging and treatment. Although seizures are diagnosed primar ily on clinical grounds, all children with a possible seizure (except febri le seizures) should have an electroencephalogram. Interictal EEGs may be no rmal. Computed tomography has demonstrated abnormalities in 7 to 19 percent of children with new-onset seizures. The yield of magnetic resonance imagi ng for specific childhood seizure types is not known, but it is the preferr ed modality of neuroimaging for many clinical presentations. Most children' s seizures treated with anticonvulsants are controlled by the first drug se lected. The value of "therapeutic" serum drug levels is questionable in the management of uncomplicated childhood seizures.