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<p>Due to their heterogeneous etiology and prognosis, afebrile seizures in childhood and adolescence require an individualized diagnostic and therapeutic approach. They can be the expression of an acute systemic or cerebral disorder (acute symptomatic seizure, ASA), a&#xa0;single seizure event without an acute cause (unprovoked seizure), a&#xa0;first epileptic seizure in the context of a&#xa0;manifesting epilepsy or a&#xa0;nonepileptic paroxysmal event. Taking a&#xa0;structured history that focuses on risk factors, seizure semiology, potential triggers and previously unrecognized seizures is essential. A&#xa0;physical examination, including an inspection of the skin and a&#xa0;full neurological assessment, can also yield important additional findings. Laboratory tests and imaging should be used selectively; an electroencephalography (EEG) is particularly relevant for the diagnosis and prognosis after unprovoked seizures. The risk of recurrence is generally lower after ASA (&lt;20%) than after unprovoked seizures (30–50%). Early counselling and, when appropriate, referral to a&#xa0;specialized first seizure clinic are key components of management. The primary goals of the initial evaluation are to identify any acute, treatable causes or complications, assess the risk of epilepsy, recognize an underlying epilepsy syndrome, and either initiate timely prophylactic treatment with antiseizure medication (ASM) or provide a well-founded deferral.</p>

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Diagnose und Differenzialdiagnose erster afebriler Anfälle im Kindes- und Jugendalter

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月29日

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  • Florian Mayer,
  • Zielke Johannes

摘要

Due to their heterogeneous etiology and prognosis, afebrile seizures in childhood and adolescence require an individualized diagnostic and therapeutic approach. They can be the expression of an acute systemic or cerebral disorder (acute symptomatic seizure, ASA), a single seizure event without an acute cause (unprovoked seizure), a first epileptic seizure in the context of a manifesting epilepsy or a nonepileptic paroxysmal event. Taking a structured history that focuses on risk factors, seizure semiology, potential triggers and previously unrecognized seizures is essential. A physical examination, including an inspection of the skin and a full neurological assessment, can also yield important additional findings. Laboratory tests and imaging should be used selectively; an electroencephalography (EEG) is particularly relevant for the diagnosis and prognosis after unprovoked seizures. The risk of recurrence is generally lower after ASA (<20%) than after unprovoked seizures (30–50%). Early counselling and, when appropriate, referral to a specialized first seizure clinic are key components of management. The primary goals of the initial evaluation are to identify any acute, treatable causes or complications, assess the risk of epilepsy, recognize an underlying epilepsy syndrome, and either initiate timely prophylactic treatment with antiseizure medication (ASM) or provide a well-founded deferral.