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How to approach first-time seizures

Dr. Chinasa Nwankwo

Dr. Chinasa Nwankwo

About 10 percent of the population will have a seizure at some point in their lives and half of these will be during childhood, with the biggest risk before age 1, according to Dr. Chinasa Nwankwo, pediatric neurologist and epileptologist at Akron Children’s Hospital.

“When a seizure occurs, parents want to know: Will it happen again? Could there be brain damage? How and when do you treat? Will activity be restricted?”

Dr. Nwanko shared answers at Akron Children’s recent Annual Pediatric Update for the Practicing Physician.

“I like to have a good rapport with primary care providers in case anything goes wrong, you’ll know who to call,” Dr. Nwankwo said.

She explained it’s important to distinguish whether the seizure is “real” or a “nonseizure” caused by a trigger such as breath holding or a sleep disturbance.

Next, is it provoked (resulting from an event such as head trauma, fever etc.) or unprovoked (doesn’t occur without a causal event)?

Most children with provoked seizures won’t experience recurrence. Unprovoked seizure recurrence risks range from 30-60%.

Dr. Nwankwo recommends an EEG be performed after the first non-febrile seizure, usually within the first few days. An abnormal EEG may trigger the need for an MRI.

Brain abnormalities can be found in 21% of children with neuroimaging after the first unprovoked seizure.

If and when to treat seizures is an individualized, pros-cons, risk-benefit discussion with the family, Dr. Nwankwo said.

Although she medicates some children immediately, there’s no evidence to prove an added benefit in medicating after the first seizure versus after a second.

As to activities after a seizure, she recommends general precautions such as wearing a helmet when cycling, swimming with a buddy, taking a shower versus bath, and waiting 6 seizure-free months to drive.

melo.michelson@gmail.com' About Melonie Michelson

Melonie Michelson is a freelance writer and science educator who spent over 30 years working as a genetic counselor and educator at Akron Children’s Hospital. During that time, she developed and coordinated Akron Children’s fetal treatment center and publications such as Teaching Human Genetics: Resources for Science and Biology. After having a child with a genetic condition, she switched career paths from journalism to medical genetics.

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