One of the first discussions that I remember having about seizures was with a professor of neurology, Dr. Frank Freemon. He said that there are three questions that one must ask about the patient presenting with a presumed seizure. First, was it a seizure? Children are a clinically rich source of a variety of spells, most of which are not seizures. Distinguishing those that are benign from those that are life threatening and those that are truly seizures is perhaps the pediatrician's most important task. The diagnosis of the spell determines further studies, consultations, and treatment when indicated. The differential diagnosis of spells was covered in a previous edition of Pediatric Annals.1
Second, what caused the seizure? Seizures are either symptomatic of an acute illness or recurrent and unprovoked and, therefore, epilepsy. Seizures that are provoked by an acute illness must be identified and the underlying illness treated appropriately. In this issue, the articles by Evans and Vedanarayanan review the diagnosis of symptomatic seizures and the diagnosis and evaluation of the child with epilepsy, respectively.
Third, what is the treatment? Not every seizure needs treatment. As described in the article by Bebin, prolonged convulsions are a medical emergency and require a plan of management, whether they occur in the home, office, or emergency department. Children with epilepsy usually require prophylactic therapy, generally with medication. The article by Snodgrass points out that choosing the right drug and instituting therapy is important, as is the monitoring of side effects. There are many new anticonvulsants available to the pediatrician, and these are summarized in the article by Russell and Parks.
The management of epilepsy is much more than the prescribing of drugs. Dealing with safety issues, school, driving, sports, and many other problems that affect the quality of life is more important than managing the seizures. This important topic is also covered in the articles by Snodgrass and Parker. The pediatrician plays a pivotal role in the total management of the child because of the unique relationship he or she has with the child and the family. The pediatrician can make the difference in the success of the treatment and a positive outcome for both the child and the family.
1. Evans OB. Episodic disorders of childhood. Pediatr Ann. 1997;26: 397-433.