Child with New Onset Convulsive Seizure

A first unprovoked convulsive seizure is a frequent neurological symptom in children. It is a common reason for pediatric emergency department visits and hospitalizations. Its presentation is often dramatic and is a major cause of anxiety and concern to parents and caregivers. The initial step is to distinguish the spell from other paroxysmal episodes that may mimic epileptic convulsive seizures like syncope, functional nonepileptic attacks, or functional seizures. It is important to determine if there are any provoking factors that may suggest an acute symptomatic etiology. An accurate history and comprehensive workup after a first unprovoked convulsive seizure is needed to determine the recurrence risk and the need to initiate antiseizure medication. Our review focuses on the differential diagnoses, evaluation, and management approach of first unprovoked convulsive seizure, also referred to as generalized tonic–clonic seizure.