Clinical Review

Fortnightly review: Epilepsy in childhood

BMJ 1997; 315 doi: (Published 11 October 1997) Cite this as: BMJ 1997;315:924
  1. B G R Neville, professor of paediatric neurologya
  1. a Neurosciences Unit, Wolfson Centre, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London Medical School, London WC1N 2AP, and St Piers, Lingfield, Surrey


    Childhood epilepsy requires integrated medical, educational, and community services, and its treatment spans acute and disability medicine.

    There are many childhood epilepsies, and seizures are the commonest paediatric neurological symptom. Epilepsy—that is, susceptibility to continuing seizures—occurs in 0.5-1.0% of the population and is intractable to current antiepileptic drug treatment in 20-25%. Epileptic seizures, including febrile convulsions, occur in 3-5% of children. Epilepsy starts in childhood in 60% of cases, and most of the clinically significant aspects of the disease occur during childhood.1


    I chose the studies on which I have based my review because they support the development of clinical guidelines. The six crucial clinical issues are:

    • Identifying non-epileptic seizure syndromes

    • Identifying benign epilepsy syndromes with a comitemtively good outcome

    • Identifying malignant syndromes in which continuing and increasing disabilities occur and need detailed investigation, aggressive treatment, and research

    • Identifying, assessing, and managing the four major disabilities that result from early brain damage or dysfunction and commonly coexist—epilepsy, motor disorder (cerebral palsies), cognitive disability, and psychiatric disability—particularly for the many epilepsy syndromes that start in the first two years of life

    • Ensuring that antiepileptic drugs are used in an ordered fashion with audit of results

    • Anticipating and managing status epilepticus.

    Summary points

    Identify non-epileptic attacks

    Identify benign and malignant syndromes

    Use predicted prognosis to guide management

    Identify and manage coexisting disabilities

    Ensure multidisciplinary and multiagency coordination of treatment

    Select cases amenable to surgery as soon as possible

    Non-epileptic attacks

    Non-epileptic attacks include simple blue breath holding attacks, white reflex asystolic attacks, reflex syncope, benign paroxysmal vertigo, benign myoclonus of infancy, vasovagal attacks, sleep phenomena, pseudoseizures, and Munchhausen syndrome by proxy. There are more than 20 such syndromes, identified by specific clinical characteristics2 and the setting in which they occur, particularly the provoking factors.

    Simple blue breath holding attacks, usually after the age of …

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