Seizures are one of the most common neurologic conditions affecting children. The majority are short, self-limited seizures that occur secondary to disorders originating outside the brain. Examples include high fever, infection, head trauma, hypoxia, and toxins. Less than one third of seizures in children occur as a result of epilepsy. When a child presents with a first-time seizure, or when a child with a known seizure disorder presents with prolonged seizure, metabolic causes should be considered. Obtaining stat serum glucose and sodium levels are essential in these children.

Initial assessment of any child with a seizure should include evaluation of the airway, breathing, and circulation (ABCs). The provider should perform vital signs and place the patient on a cardiac monitor and on supplemental oxygen. The provider should then obtain a detailed history and perform a quick physical examination, including a neurologic examination, searching for clues to the etiology of the seizure. Life-threatening conditions, such as meningitis, sepsis, head trauma, and toxin ingestion, should be considered in the differential diagnosis.

When a seizure lasts >5 minutes, intravenous access should be attained and stat serum glucose and sodium levels drawn. Serum calcium, phosphorus, magnesium, blood urea nitrogen, and a complete blood count may also be indicated. Urine for toxicology and serum anticonvulsant levels may be helpful. A benzodiazepine such as lorazepam or a barbiturate should be administered as a first-line drug to stop the seizure. Lorazepam administration can be repeated every 10 to 15 minutes if needed.

If the seizure continues for >10 minutes, a second anticonvulsant, such as phenobarbital or phenytoin, should be administered. Metabolic derangements, such as hypoglycemia and hyponatremia, should be treated as soon as they are diagnosed.