What are the signs and symptoms of an epileptic syndrome etiology for pediatric first seizure?

Updated: Aug 16, 2018
  • Author: Shelley R Waite, MD; Chief Editor: Amy Kao, MD  more...
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An exhaustive list of seizure types and pediatric epilepsy syndromes is beyond the scope of this article. However, familiarity with some of the most common seizure syndromes can aid the clinician in obtaining an appropriate workup and evaluation.

Infantile spasms typically begin in infants aged 4–8 months (although earlier and later presentations do occur) and consist of clusters of myoclonic spasms, typically upon awakening or falling asleep. The presentations can be more subtle and include slight eye flutter or head drop. If infantile spasms are suspected, appropriate diagnosis and swift management is essential to improve developmental outcome.

Absence epilepsy, also known as petit mal epilepsy, is manifested by frequent (as many as 100 times per day or more) episodes of brief staring spells, often with fluttering of the eyelids, lasting only a few seconds (typically up to 15 seconds) at a time. Following a typical absence seizure, patients return immediately to their baseline mental status. Absence seizures are primarily generalized in onset. The diagnosis can be assisted by classic EEG features and hyperventilation trial, which often provokes the seizures.

Benign rolandic epilepsy occurs in children aged 3–13 years. [5] The typical presentation is a seizure characterized by perirolandic or perisylvian sensorimotor features including speech arrest or guttural sounds and facial numbness or twitching, which may progress to generalized tonic-clonic activity. The majority of seizures occur during sleep or upon awakening. Classic EEG features can aid in the diagnosis of this syndrome.

Other benign partial epilepsies of childhood include benign occipital epilepsy of childhood (Gastaut syndrome), in which visual symptoms predominate, and Panayiotopoulos syndrome, in which autonomic changes, vomiting, sweating, and pallor are prominent ictal symptoms.

Juvenile myoclonic epilepsy (JME) may present in the teen years. In JME, individuals may present with generalized tonic-clonic seizures, myoclonic jerks (typically seen within hours of awakening), and staring spells.

For more information regarding specific pediatric epilepsy syndromes, please refer to the International League Against Epilepsy.

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