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Nonfebrile seizures occur at all ages. The term "seizure" designates a clinical event that represents dysfunction of the central nervous system (CNS) and may signal a serious underlying epelepsy abnormality; however, more often in children the seizures result from a transient disturbance of brain function. The cause of the seizure should be determined and treatment of the epilepsy.
Epidemiology and Classification of Seizure Types
The ages of greatest risk for nonfebrile seizures are during infancy, childhood, and adolescence. The annual incidence rate from birth to 20 years of age, epilepsy is 0.56 per 1000.
The two primary forms of epilepsy are generalized seizures and focal (partial) seizures.
Partial Seizures (focal)
Partial seizures are the most common form of epilepsy in children.
Simple partial epelepsy (SPS)
Simple partial seizures are most commonly focal, asynchronous, clonic or tonic motor movements, such as forced deviation of the head and eyes to one side. An SPS typically is short-lived, rarely persisting longer than 10 to 20 seconds, and the child remains conscious and is able to verbalize throughout the seizure. The EEG characteristically shows unilateral spikes or sharp waves in the anterior temporal region.
Complex Partial Seizures (CPS) CPS initially may be similar in appearance to an SPS, but they are followed by impairment of consciousness. CPS may begin with a loss of consciousness. The average duration of a CPS is 1 to 2 minutes.
Aura signals the onset of a seizure in 30% of children who have CPS, with the child complaining of epigastric discomfort, fear, or an unpleasant feeling.
Automatisms are repetitive, stereotyped behaviors. These are the hallmark of CPS and occur in 50-75%. Automatisms follow the loss of consciousness, but unlike aura, the child is not aware of their presence. Automatisms may include lip smacking, chewing, repetitive swallowing, excessive salivation, picking and pulling at clothing, constant rubbing of objects, and walking and running. Automatisms are often associated with a fearful expression.
During the partial, the epileptiform discharge may spread from the temporal lobe to throughout the cortex, causing a generalized tonic-clonic convulsion.
Treatment