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Seizures and epilepsy in children: Initial treatment and monitoring

Angus Wilfong, MD
Section Editor
Douglas R Nordli, Jr, MD
Deputy Editor
April F Eichler, MD, MPH


Children with epilepsy, particularly infants, differ from adults not only in the clinical manifestations of their seizures, but also in the presence of unique electroencephalogram (EEG) patterns, etiologies, and response to antiseizure drugs. The immature brain, particularly in the neonate and young infant, differs from the adult brain in the basic mechanisms of epileptogenesis and propagation of seizures. It is more prone to seizures, but seizures are more apt to disappear as the child grows.

This topic presents an overview of the treatment of seizures and epileptic syndromes in children. Treatment of neonatal seizures and the treatment of specific epilepsy syndromes are presented separately. (See "Seizures and epilepsy in children: Classification, etiology, and clinical features" and "Clinical and laboratory diagnosis of seizures in infants and children" and "Epilepsy syndromes in children" and "Benign focal epilepsies of childhood" and "Treatment of neonatal seizures".)


A child's first seizure may be caused by an acute illness, such as a metabolic derangement or infectious disorder, and be nonrecurrent, or may represent the beginning of epilepsy. A decision must be made about initiating chronic antiseizure drug treatment if a potentially reversible acute cause is not found during the evaluation. (See "Clinical and laboratory diagnosis of seizures in infants and children" and "Clinical and laboratory diagnosis of seizures in infants and children", section on 'Setting in which episodes occur'.)

First-time unprovoked seizure — The decision whether to treat a child with an antiseizure drug after an initial unprovoked seizure should be individualized, weighing the risks of recurrent seizure against the potential risks and benefits of antiseizure drug therapy and incorporating patient values and preferences.

The term unprovoked seizure refers to a seizure of unknown etiology as well as one that occurs in relation to a preexisting brain lesion or progressive nervous system disorder (often referred to as a remote symptomatic seizure). Unprovoked seizures are distinct from seizures due to an acute condition such as a toxic or metabolic disturbance, fever, head trauma, or acute stroke (ie, acute symptomatic seizures). (See 'Acute symptomatic seizure' below.)


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Literature review current through: Sep 2016. | This topic last updated: Aug 26, 2016.
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