The first seizure and its management in adults and children

摘要: This review presents a comprehensive approach to children and adults with first seizure, an event that may have profound emotional, social, vocational consequences. A “grand mal” convulsion is frightening, yet prospective, population-based studies indicate we all face 8-10% lifetime risk of one seizure1 3% chance epilepsy.2 It seems likely everyone could seizure if particular set circumstances occur—but some people lower threshold than others. A caused by acute disturbance brain function (acute symptomatic or provoked) unlikely recur (3-10%). If unprovoked, however, meta-analyses suggest 30-50% will recur; after second unprovoked 70-80% recur, justifying the diagnosis epilepsy (a tendency for recurrent seizures).3–5 When person healthcare system it almost always convulsive either generalised focal. Other types such as absence complex partial seizures typically occur several times before family become concerned. We reviewed literature listed in PubMed under headings “first seizure” “initial seizure.” Two us helped develop practice parameter on treatment children, conducted prospective seizures. We are unaware any systematic (Cochrane) this topic. All references cited were judged give strong evidence. The differential wide. Most important our experience syncope (including breath holding pallid syncope), transient ischaemic attacks, metabolic encephalopathy hypoglycaemia electrolyte disturbance), sleep walking, night terrors, migraines, cardiac arrhythmias, pseudoseizures. “Convulsive syncope” challenge when provokes post-anoxic convulsion. detailed …