Conduite à tenir devant une première crise d'épilepsie

How to evaluate a child following a first seizure? Following a first epileptic phenomenon in a child, detailed history-taking, age at onset and complete clinical examination are essential. Previously experienced paroxysmal episodes may correspond to undiagnosed seizures. It is important to inquire about the existence of subjective sensations preceding or initiating attacks, about postictal phenomena such as confusion or drowsiness and about the circumstances of occurence of the seizures.

Clinical examination should look for any neurological signs, cutaneous stigmata or dysmorphic features. Parents should be asked about any recent changes in behaviour or school performances.

Interictal, and eventually ictal, EEG data must be interpreted within the general neurological context. In the majority of cases, careful analysis of all the above mentionned data leads to a diagnostic hypothesis on the type(s) of seizures and, sometimes, on the epilepsy syndrome. Indications for further investigations, including MRI, will be discussed on the basis of a precise hypothesis.

Treatment with antiepileptic drugs should not usually be started at the first seizure, with the exception of some epilepsy syndromes characterized by regular seizure relapse.