EVALUATION OF THE CHILD WITH A FIRST SEIZURE WITHOUT FEVER: EXAMINATIONS AND TESTS

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EVALUATION OF THE CHILD WITH A FIRST SEIZURE WITHOUT FEVER: EXAMINATIONS AND TESTS

Tuesday, February 22, 2011 | 2:40 am

A careful neurologic exam does not necessarily require a neurologist. If your physician is concerned about some of the findings or discovers suspicious abnormalities, he may want to refer you to a specialist, a child neurologist.

“You mean that’s all there is? You tell us our son has had a seizure and you’re only going to talk to us and examine Peter. Aren’t you going to do any tests?” you ask. The physician’s appropriate response to that question is, “There is no laboratory test for a seizure. The diagnosis of a seizure depends on your description of what happened.”

Some tests can be of help in looking for a cause of the seizure. Certain tests help the physician rule out other peculiar episodes that simulate seizures. He may want to do an electrocardiogram if he is concerned about abnormalities of heart rate or rhythm. He may order blood tests if he suspects anemia, diabetes, or other chemical problems. But the diagnosis of a seizure itself can only be made by direct observation of the spell by a physician or by his careful interpretation of the observations of others.

The most common tests performed when a child has had a seizure are an EEG and a CT or MRI scan. Some people think that a brain wave test, an electroencephalogram (EEG), will diagnose epilepsy. But an EEG does not diagnose a seizure unless a seizure occurs during the EEG. The EEG may, however, be very helpful in suggesting the appropriate treatment of children with seizures. A CT scan or MRI may, in the proper circumstances, be useful in searching for the cause of the seizure, but a brain scan does not diagnose epilepsy itself. Nor does it rule it out. Although they may be useful in determining the cause of a seizure, both EEGs and scans can be normal in the child who has had a seizure and either or both may be abnormal in an otherwise normal child who has not and never will have a seizure.

Just as after a first febrile seizure, after a first afebrile seizure you will have many questions: “Will it recur?” “Can it be prevented?” “What are the risks of prevention?” The remainder of the book will address these questions for you.

Your first questions may be, “Will he have more seizures?” “Can’t they be prevented?” Yes, there is some risk of another seizure occurring. There are medications that may prevent further seizures, but they entail risks. Therefore, let’s begin by discussing risks and benefits.

*40\208\8*

EVALUATION OF THE CHILD WITH A FIRST SEIZURE WITHOUT FEVER: EXAMINATIONS AND TESTSA careful neurologic exam does not necessarily require a neurologist. If your physician is concerned about some of the findings or discovers suspicious abnormalities, he may want to refer you to a specialist, a child neurologist.”You mean that’s all there is? You tell us our son has had a seizure and you’re only going to talk to us and examine Peter. Aren’t you going to do any tests?” you ask. The physician’s appropriate response to that question is, “There is no laboratory test for a seizure. The diagnosis of a seizure depends on your description of what happened.”Some tests can be of help in looking for a cause of the seizure. Certain tests help the physician rule out other peculiar episodes that simulate seizures. He may want to do an electrocardiogram if he is concerned about abnormalities of heart rate or rhythm. He may order blood tests if he suspects anemia, diabetes, or other chemical problems. But the diagnosis of a seizure itself can only be made by direct observation of the spell by a physician or by his careful interpretation of the observations of others.The most common tests performed when a child has had a seizure are an EEG and a CT or MRI scan. Some people think that a brain wave test, an electroencephalogram (EEG), will diagnose epilepsy. But an EEG does not diagnose a seizure unless a seizure occurs during the EEG. The EEG may, however, be very helpful in suggesting the appropriate treatment of children with seizures. A CT scan or MRI may, in the proper circumstances, be useful in searching for the cause of the seizure, but a brain scan does not diagnose epilepsy itself. Nor does it rule it out. Although they may be useful in determining the cause of a seizure, both EEGs and scans can be normal in the child who has had a seizure and either or both may be abnormal in an otherwise normal child who has not and never will have a seizure. Just as after a first febrile seizure, after a first afebrile seizure you will have many questions: “Will it recur?” “Can it be prevented?” “What are the risks of prevention?” The remainder of the book will address these questions for you.Your first questions may be, “Will he have more seizures?” “Can’t they be prevented?” Yes, there is some risk of another seizure occurring. There are medications that may prevent further seizures, but they entail risks. Therefore, let’s begin by discussing risks and benefits.*40\208\8*

—admin
(posted in Epilepsy)

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