Childhood Epilepsy: Management from Diagnosis to Remission

Epilepsy is defined as the tendency for recurrent seizures to occur without acute provocation. Every child’s (and adult’s) brain is capable of generating a seizure with certain pro-convulsive drugs and it should therefore be of no surprise that seizures may be provoked by numerous other factors including: an acute metabolic (biochemical) disturbance, central nervous infection, drug intoxication or acute head trauma. The risk of epilepsy developing after acute and provoked (symptomatic) seizures is low (3–5%) and therefore the occurrence of acute seizures cannot contribute to, and should not influence, the diagnosis of epilepsy. Emotional stress is not considered to be a provoking factor. Epilepsy has protean manifestations. Some children present with generalized tonic-clonic seizures (convulsions), while others present with staring spells (usually absence seizures), periods of confusion with or without automatisms (usually complex partial [focal] seizures), limb or body jerks (myoclonus), spasms (infantile or epileptic spasms), falls or drops (usually atonic or astatic but also tonic seizures), loss of speech and social interactions and/or cognitive function (Landau–Kleffner syndrome), and variants of paroxysmal events during sleep (often frontal lobe or, less commonly, temporal lobe seizures). Epilepsy and some epilepsy syndromes may be diagnosed relatively quickly after a few tonic-clonic seizures (as these are usually dramatic and understandably frighten the family). Conversely, other syndromes may be diagnosed after some considerable time and only after the child has experienced a number of seizures. This is often because infrequent or only subtle seizures usually do not prompt parents to seek medical advice. Once seizures have been seen to occur very frequently, and specifically absence or myoclonic seizures, the diagnosis may be more straightforward; however, when patients present with only a few seizures the