《儿童首次非发热性惊厥发作评估实践指南》内容预览

    practice parameters as strategies for patient management based on analysis of evidence. For this practice parameter, the authors reviewed available evidence on evaluation of the first nonfebrile seizure in children in order to make practice recommendations based on this available evidence. Methods: Multiple searches revealed relevant literature and each article was reviewed, abstracted, and classified. Recommendations were based on a three-tiered scheme of classification of the evidence. Results: Routine EEG as part of the diagnostic evaluation was recommended; other studies such as laboratory evaluations and neuroimaging studies were recommended as based on specific clinical circumstances. Conclusions: Further studies are needed using large, well-characterized samples and standardized data collection instruments. Collection of data regarding appropriate timing of evaluations would be important.
    scientifically sound, clinically relevant practice parameters for physicians for diagnostic procedures, treatment modalities, and clinical disorders. Practice parameters are strategies for patient management that might include diagnosis, symptom, treatment, or procedure evaluation. They consist of one or more specific recommendations based on the analysis of evidence.
    Every year, an estimated 25,000 to 40,000 US children experience their first nonfebrile seizure, a dramatic and frightening event.1-4 This practice parameter reviews available evidence concerning the value of diagnostic testing after a first nonfebrile seizure in a child, and provides recommendations based on this evidence. It addresses the evaluation of children age 1 month to 21 years who have expeirenced a first nonfebrile seizure that cannot be explained by an immediate, obvious provoking cause such as head trauma or intracranial infection. Reports concerning serum laboratory studies, CSF examination, EEG, CT, and MRI are reviewed. This parameter concerns diagnostic evaluation; a subsequent parameter will focus on treatment of the first nonfebrile seizure.
    The seizure types covered by this parameter include partial (simple or complex partial, or partial with secondary generalization), generalized tonic-clonic, or tonic seizures. We are specifically not including children diagnosed with epilepsy, defined as two or more seizures without acute provocation. For this reason, myoclonic and atonic seizures are excluded because they typically are not recognized until there have been multiple occurrences. We defined the first seizure using the International League Against Epilepsy (ILAE) criteria to include multiple seizures within 24 hours with recovery of consciousness between seizures.
    Children with significant head trauma immediately preceding the seizure or those with previously diagnosed CNS infection or tumor or other known acute precipitating causes are excluded. We excluded neonatal seizures (≤28 days), first seizures lasting 30 minutes or more (status epilepticus), and febrile seizures, because these disorders are diagnostically and therapeutically different. The American Academy of Pediatrics has recently published recommendations for evaluation of children with a first simple febrile seizure.
    From the National Institute of Neurological Disorders and Stroke (Dr. Hirtz), National Institutes of Health, Bethesda, MD; Department

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