A seizure is a discrete event with various manifestations while epilepsy (seizure disorder) is defined as a condition with recurrent seizures.1–4 The well-known Mayo Clinic study looking at the incidence of epilepsy in their area from 1935 to 1967 reported an incidence of newly identified epilepsy as 36 to 48/100,000/y in the 10 to 19 year age cohort.5 Various studies note that epilepsy affects approximately 1% to 2% of the general population and approximately 25% of those with epilepsy are younger than 18 years.3,5–7 The prevalence is 3 to 5/1000 adolescents while research notes the annual incidence of a seizure disorder is 24.7/100,000 10- to 14-year-old and 18.6/100,000 15- to 19-year-old. Thus, there are many children and youth with epilepsy who may be involved in sports.
Epilepsy may develop de novo in childhood at any time; thus, in adolescence, it may be a carryover from childhood or begin anytime in the adolescent years. Table 10-1 identifies various causes for epilepsy, but most cases are idiopathic in children and also in adolescents beginning younger than 16 years. As youths get older than 16 years of age, the possibility of a space-occupying lesion increases. Evaluation can also identify seizures because of head trauma, drug abuse, cerebrovascular accidents, central nervous system infections, pseudoseizures, cancer or adverse effects of cancer treatment, syncopal complications, sleep deprivation, hyponatremia, and others (Table 10-1).3,8 Juvenile myoclonic epilepsy and juvenile absence epilepsy are examples of epilepsy that begin in the adolescent years.9,10
Table 10-1. Evaluation of Seizures in Adolescents* ||Download (.pdf)
Table 10-1. Evaluation of Seizures in Adolescents*
Possible Precipitating Factors Idiopathic Seizures
- Infectious: Bacterial viral meningitis, encephalitis; systemic infection with fever, sepsis
- Congenital defects: AV malformations, porencephaly
- Trauma neoplasms: CNS primary, metastatic
- Neurocutaneous syndromes: Sturge-Weber, tuberous sclerosis, neurofibromatosis
- Metabolic: Hypoglycemia, hypoparathyroidism, hypocalcemia, hyponatremia, hypernatremia, hypomagnesemia, hypophosphatemia, inborn errors of metabolism
- Vasculitis cerebrovascular accident: Ruptured aneurysm (congenital, mycotic), AV malformation, thrombocytopenia
- Drug related: Withdrawal from anticonvulsant drugs, withdrawal from CNS depressant addiction (including alcohol, cocaine), insulin overdose, phencyclidine overdose.
- Many drugs are reported (e.g., antidepressants, antihistamines, various antibiotics, and sympathomimietics).
- Hypertensive encephalopathy: Primary, renal, coarctation
- Others: Collagen vascular diseases (SLE), porphyrias, liver disease, renal failure, Gaucher's disease, juvenile huntington's disease, mitochondrial encephalomyopathy, shuddering attacks, pseudoseizures, syncope
Drugs (alcohol, phenothiazines, tricyclic antidepressants, antihistamines, others)
Hyperventilation (with absence types)
Photic stimuli (flashing or flickering light, television)
Olfactory or tactile stimuli
Ingestion of certain foods
Glucose (fasting and tolerance)
Toxic drug screen: Urine, serum, gastric
CT scan or MRI
Others: Blood culture, liver function testes, blood gases, serum anticonvulsant level, Wood's Lamp examination