What is the focus of clinical history in the evaluation of pediatric first seizure?

Updated: Aug 16, 2018
  • Author: Shelley R Waite, MD; Chief Editor: Amy Kao, MD  more...
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Answer

Answer

Because medical personnel often do not witness the first seizure, eyewitness accounts are a crucial step in evaluation. Collect information on what the patient was doing just before the seizure (eg, association with sleep onset or arousal from sleep). Seizure while watching television or flickering lights may suggest a photosensitive seizure.

An accurate description of seizure semiology can help differentiate between specific seizure types. One should ask about alteration of consciousness, lateralizing signs (eg, eye deviations, head turning, focal clonus) or automatisms (eg, lip smacking, picking at clothes, gestures such as fumbling or tapping). [6] An accurate description of seizure semiology at onset is particularly important, as this might give clues to whether a generalized seizure actually had a partial onset. [2]

If possible, getting the patient’s account of the event can provide further diagnostic clues. For example, olfactory or epigastric aura are suggestive of temporal lobe epilepsy, while visual hallucinations can occur with occipital lobe seizures.

In addition to events immediately surrounding the seizure, it is important to gather any history of recent illnesses, antibiotic treatment (which may raise suspicion for a partially treated meningitis), recent travel, recent head injury, chemical or toxin exposures, and intake of medications, supplements, alcohol, and/or illicit drugs.

Obtain a family history of epilepsy or febrile seizures, particularly among first-degree relatives. Elicit a history of fever, chronic medical conditions (eg, diabetes), medications, behavioral or dietary changes, and recent or remote history of head trauma or CNS infections. A developmental history is important in assessing possible etiologies and risk of future events.


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