Seizures in Children (cont.)
Frank L Christopher, MD, FAAEM
Robert R Westermeyer II, MD, FAAEM
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
Thomas Rebbecchi, MD, FAAEM
Exams and Tests
For all children, a thorough interview and examination
should occur. It is important for the caregiver to tell the doctor about the
child's medical history, birth history, any recent illness, and any medications
or chemicals that the child could have been exposed to. Additionally, the
doctor asks for a description of the event, specifically to include where
it occurred, how long any abnormal movements lasted, and the period of sleepiness afterward. A wide variety of tests can be performed on a child who is thought to have seizures. This testing depends on the child's age and suspected type of seizures.
- Febrile seizures
- Children should receive medication for the fever such as acetaminophen (for
example, Tylenol) or ibuprofen (for example, Advil).
- Depending on the age of the child, the doctor may order blood or urine tests or both, looking for the source of the fever.
- If the child has had his or her first febrile seizure, then the doctor may want to perform a lumbar puncture
(spinal tap) to test for possible meningitis. The lumbar puncture should be performed in children younger than 6 months, and some doctors perform them in children as old as 18 months.
- Most children do not get a CT scan of the head, unless there was something unusual about the febrile seizures, such as the child not returning to his or her normal self shortly afterward.
- Very few children with febrile seizures are admitted to the hospital. The treatment for febrile seizures is keeping the temperature down, and possibly a medication if a specific infection is found such as an ear infection. Follow up with the child's doctor in a few days.
- Movement seizures
- Movement seizures, which include partial seizures and generalized (grand mal) seizures, can be very dramatic. If the child is having a seizure in the emergency department, he or she is given medications to stop the seizure.
- If the child has returned to normal in the hospital,
then the child will probably have a few tests performed. Blood is drawn to
check the child's sugar, sodium, and some other blood chemicals.
- If the child is on antiseizure medications, then the medication's levels in the blood are checked (if possible).
- Most children undergo a CT scan or MRI (studies
looking at the structure of the brain), but this may be scheduled for
several days later rather than in the emergency department. In children,
these imaging studies are usually normal but are performed to look for
unusual causes of seizure such as bleeding or tumor.
- Most children eventually undergo an EEG, which is a
study looking at the brain waves or electrical activity of the brain. An EEG is almost never performed in the emergency department but is performed later.
- The child will probably be admitted if he or she is
very young, has another seizure, has abnormal physical examination
findings or lab test results, or if you live far from a hospital. Children
in status epilepticus are admitted to an intensive care unit.
- If the child is doing well, doesn't have recurring seizures, and has a normal physical examination findings and blood test results, then the child will most likely be sent home to follow up with a pediatrician in a few days to continue the evaluation and arrange other tests, such as the EEG.
- Absence seizures (petit mal)
- These can be evaluated without going to an emergency department. Most likely, the doctor will only order an EEG. If the EEG tells the doctor that the child is having absence seizures, then the child will most likely be placed on medications to control them.
- Neonatal seizures and infantile spasms
- Seizures of this type occur in young children and
are often associated with other problems such as mental retardation.
Children suspected of having these seizures may have multiple lab tests done
in the emergency department. They would include blood and urine samples,
lumbar puncture, and possibly a CT scan of the head. These children are
usually admitted to the hospital and may even be referred to a pediatric
specialty hospital. In the hospital, these children undergo several days of testing to look for the many possible causes of the seizures.
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