Suspected Convulsive Disorder

Did the child have a seizure? — NO (seizure mimics)

• • 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

YES — Initial Seizure

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

YES — Recurrent Seizures

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

Studies and Examination

• Abnormal — Symptomatic Seizures: Treat underlying cause (hypoglycemia, urea cycle abnormality, meningitis, temporal lobe tumor, etc.) Antiepileptic drugs if necessary
• 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 (except EEG) — Consider drug therapy

Follow-up

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