Approach to diagnosis

Up to 3% of children under the age of 15 years will experience a seizure and many more will have a paroxysmal event.

It is a common reason for children to present to health care professionals. Interpretation of these events can be challenging.

The doctor is initially presented with a description of a seizure type. It is important to identify the seizure type and collect information such as its time of occurrence, frequency, age of onset. Using this information together with the EEG, a diagnosis of a particular childhood epilepsy syndrome should be reached upon which management can be based.

The importance of the interictal EEG is emphasized in syndrome classification. An MRI is the imaging test of choice and is important in epilepsies where a structural abnormality is suspected. The yield in genetic epilepsy is low.

The International League Against Epilepsy (ILAE) is closely involved in the classification of Seizures and Epilepsies. Children should have a diagnosis in keeping with this classification. 

The following documents provide detailed information on the revised classification of seizure types and epilepsy syndromes by the ILAE in 2017:

In 2014, the ILAE Commission on Classification and Terminology also released an online Diagnostic Manual for Epilepsy, called epilepsydiagnosis.org which provides further useful information.

 

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References:

  • Fisher et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017:58(4): 522-530.
  • Fisher et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia, 2017:58(4): 531-542.
  • Scheffer et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017:58(4): 512-521.
Information last reviewed: 14/09/2022.