Algorithm for the Approach to the Child with a Suspected Convulsive Disorder

Algorithm for the Approach to the Child with a Suspected Convulsive Disorder - Flowchart Seizures, New-Onset Seizures, New-Onset

«Flowchart»

Did the child have a seizure?

YES

Benign paroxysmal vertigo
Breath holding
Cough syncope
Familial choreoathetosis
Hereditary chin trembling
Shuddering attacks
Narcolepsy
Night terror
Pseudoseizures
Rage attack
Benign myoclonus of infancy
Tics

End

Initial Seizure
Fasting blood sugar, calcium, metabolic studies dictated by history and physical; EEG? CT scan? MRI? CSF examination?

Initial Seizure
Initial Seizure

Recurrent Seizures
Drug compliance?
Improper dose?
Incorrect drug?
Metabolic disorder?
Underlying structural lesion?
Drug interaction?
CNS degenerative disease?
Intractable seizures?

Recurrent Seizures

Recurrent Seizures

Studies and Examination

Abnormal
Symptomatic Seizures
Treat underlying cause (hypoglycemia, urea cycle abnormality, meningitis, temporal lobe tumor, etc.)
Antiepileptic drugs if necessary

Abnormal
Symptomatic

Abnormal

Normal
Isolated first seizure with normal EEG
Negative family history
No continuous drug treatment
Close observation
Prescribe rescue medications (rectal diazepam) for seizures longer than 5 min

Normal

Normal

Normal (except EEG)
Consider drug therapy

Normal (except EEG)
Consider drug therapy Normal (except EEG)

Follow-up

Good Control
Regular follow-up
Antiepileptic drug levels
Monitor toxicity (CBC, liver function, behavioral, learning)
EEG as indicated

Good Control

Good Control

Poor Control
Consider hospitalization
Prolonged EEG recording and video monitoring for possible epilepsy surgery candidacy
Readjust medication
Reconsider underlying pathology with reinvestigation with CT or MRI
Frequent follow-up

Poor Control

Poor Control