Seizures in Kids: Benign or Concerning?

Christopher J. Chiu, MD; Justin L. Berk, MD, MPH, MBA


May 13, 2021

This transcript has been edited for clarity.

Christopher J. Chiu, MD: Welcome back. We are The Cribsiders. Here on Medscape, we recap some of our favorite podcast episodes, in which we interview leading experts in the field to bring you clinical pearls, practice-changing knowledge, and answers to lingering questions about core topics in pediatric medicine.

Justin L. Berk, MD, MPH, MBA: Today we are recapping our podcast on pediatric seizures. Our leading specialist on this topic is Dr John Gaitanis, a neurologist and expert on seizures. We discussed diagnosis and treatment, febrile seizures, epilepsy, and even some of the underlying genetic causes of seizures. We learned a ton — not only about the basic management principles, but also about complicated cases and how to keep an eye out for them.

We talked about the simple febrile seizures that can occur in 2%-5% of all children. Simple febrile seizures are pretty common and benign in children with a normal neurologic exam. Testing (lumbar puncture, EEG, neuroimaging) and even treatment aren't necessary, according to the most recent febrile seizure guidelines.

We also talked about characterizing febrile seizures. What did you take away from that discussion?

Chiu: Simple febrile seizures are generalized, last 15 minutes or less, and occur only once within a 24-hour period. Complex febrile seizures are focal and prolonged (longer than 15 minutes) and may occur multiple times in 24 hours.

Simple seizures have a favorable prognosis but do recur in about one third of children. Furthermore, children with febrile seizures have a 1%-2% risk of developing epilepsy later in life, which is only slightly higher than the 0.5%-1% risk among the general population.

Berk: That is pretty reassuring. The risk is a bit higher, but they are essentially in the clear.

Chiu: We talked about medications also, which helped quite a lot.

Berk: A big question has always been, when do you start antiseizure medicines? We learned that antiepileptic drugs (AEDs) should be started after two unprovoked seizures, excluding febrile seizures, which aren't as worrisome. The AED should be continued for at least 2 years without a seizure.

At that point, patients should be seen by the neurologist to determine whether it is time to discontinue the medication.

Chiu: We also talked about alternative treatments for seizures that we shouldn't overlook — ketogenic diet, surgery, cannabidiol — for refractory seizures and certain types of epilepsy. Some of this was stuff I hadn't heard before, so you should be sure to check out this podcast, #18: Pediatric Seizures & Epilepsy: Shaking Things Up!.

Berk: The different types of medicines and alternative treatments are based on the underlying disease.

After this podcast, I felt relatively comfortable prescribing AEDs in the primary care setting.

Chiu: At least doing the initial evaluation and starting medicines on a child with seizures.

Berk: Thank you for joining us for this Medscape video recap of The Cribsiders pediatric medicine podcast. You can download the full episode on any podcast player or visit our website.

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