Seizures in the context of acute illness.

PURPOSE OF REVIEW: Seizures during an acute illness demand immediate evaluation, as they indicate an acute central nervous system insult. There are three goals: identify and treat the precipitating cause; determine the need for antiepileptic drug therapy; and recognize nonconvulsive seizures. Management depends upon whether there is a primary or secondary central nervous system insult. Seizures may persist despite antiepileptic drugs if the precipitating cause is untreated.

RECENT FINDINGS: Seizures and epilepsy and children with neurodevelopmental disabilities comprise a significant percentage of acute care in children. A continuum exists from a single seizure and escalating seizures to status epilepticus. Seizure treatment is more successful when given earlier, and prognosis depends on the cause. Guidelines for the diagnostic evaluation and treatment of status epilepticus have been produced. Continuous electroencephalographic monitoring reveals frequent nonconvulsive seizures and nonconvulsive status epilepticus in the sick child.

SUMMARY: The recognition and rapid treatment of clinical and electrographic seizures is important during acute illness.