What causes provoked pediatric first seizure?

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

Answer

Some etiologies of provoked (symptomatic) childhood seizures include central nervous system (CNS) infections, metabolic alterations, head trauma, and structural abnormalities.

CNS infections, such as meningitis, encephalitis, and empyema, can present with seizures. Identifying and treating the underlying infection is imperative.

Metabolic alterations can precipitate seizures and can be directly treatable targets. In children who are receiving intravenous (IV) fluids, are diabetic, or who may otherwise be prone to electrolyte abnormalities, consider evaluating glucose, sodium, and calcium levels. For patients with chronic hyponatremia, rapid sodium correction should be avoided to prevent central pontine myelinolysis. Also consider obtaining toxicology screens to evaluate for medication or toxic exposures.

Head trauma can precipitate seizures and requires immediate evaluation with appropriate neuroimaging studies to rule out hemorrhage, contusion, or other serious injuries.

Structural abnormalities, such as congenital cerebral malformations, ischemic or hemorrhagic strokes, tumors or other mass lesions are less common etiologies of seizures, but can be ruled out with appropriate neuroimaging studies. Focal cortical dysplasias are a frequent cause of medically-refractory epilepsy.


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