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October 2002 • Volume 20 • Number 6

 

 

Original Contributions
Infant seizures not so infantile: First-time seizures in children under six months of age presenting to the ED

Data regarding first-time seizures in children 6 months of age is limited. This retrospective study, therefore, reviews the presentation, management, and outcome of children 6 months of age presenting to a pediatric tertiary care facility with a first-time seizure. Charts for 31 patients were identified and reviewed. Nineteen patients (61%) received sepsis work-ups. Two of the 31 (7%) had infectious etiologies. One of these infants, a 3-month-old who presented with only a history of fever and eyes rolling back but otherwise appeared well on initial presentation, had pneumococcal meningitis. Neuroimaging studies were performed in 22 (71%) patients with 12 of 22 (54%) having abnormal findings. Electroencephalogram (EEGs) were performed on 22 patients (71%) with 11 (50%) showing seizure activity. Electrolytes were checked on 19 patients (61%) with 5 being clinically significant. Etiologies included idiopathic (32%), congenital anomalies (26%), inborn errors of metabolism (16%), electrolyte abnormalities (16%), infection (7%), and trauma (3%). In conclusion, unlike children >6 months of age in whom febrile seizures and idiopathic seizure disorders are most common, a large percentage of children 6 months of age presenting with first-time seizures have significant underlying pathology. This pathology often includes immediately life-threatening conditions in these children who may look deceptively well on initial evaluation. (Am J Emerg Med 2002;20:518-520. Copyright 2002, Elsevier Science (USA). All rights reserved.)

 

• From the Department of Pediatrics, Division of Emergency Medicine, Emory University/Children's Healthcare of Atlanta, Atlanta, GA.
• Manuscript received November 20, 2001.
   
• Accepted December 22, 2001.
• Presented in part at the Pediatric Academic Societies' annual meeting in Baltimore, MD, in April 2001 and at the Society for Academic Emergency Medicine's annual meeting in Atlanta, GA, in May 2001.
   
• Address reprint requests to Thuy T. Bui, MD, 1645 Tullie Circle, Atlanta, GA 30029. E-mail: Thuy.bui@oz.ped.emory.edu
   
• Copyright 2002, Elsevier Science (USA). All rights reserved.
   
• 0735-6757/02/2006-0006$35.00/0
   
• doi:10.1053/ajem.2002.34796