Seizure Disorder - Description
ICD-9-CM uses two general classifications for seizure disorders. Those in the 780 series are for convulsions, which may or may not be epileptic seizures, certain kinds of seizures (e.g, febrile seizures), or seizures not otherwise specified, whereas epilepsy and epileptic syndromes are coded for in the 345 group. Most require fourth and even fifth digits (see Seizures ICD9( 64 KB)).
Epilepsy: A condition in which an individual has recurrent, unprovoked seizures.
Status epilepticus: Traditionally, status epilepticus has been defined as more than thirty minutes of continuous seizure activity or recurrent seizures without intercurrent recovery of consciousness. Most seizures will stop on their own within five minutes of onset. A child with a seizure lasting 5 minutes or more will likely require medical intervention to stop it. [Jenssen: 2006] (See Status epilepticus).
See Related Issues below for information regarding assessment and treatment of specific seizure types and Infantile Spasms - old.
Seizure recurrence risk after a first afebrile, generalized, tonic-clonic seizure in a typically developing child is 25-50%:
- Age of the child and duration of the event do not affect the risk of recurrence.
- Half of recurrences will occur in the first 6 months following a first seizure, two thirds will occur within one year, and 90% or more within 2 years.
- The EEG is an important predictor of recurrence. If the EEG is normal, the 5-year recurrence risk is 25%.
- Occurrence of the seizure during sleep increases the recurrence risk to slightly.
- Children with intellectual disability, cerebral palsy, and/or a family history of epilepsy are more likely to develop epilepsy. Demographic information - seizures (Epilepsy Foundation of America)
- Seizure recurrence risk for children with an epilepsy syndrome:
- Depends on the epilepsy syndrome
- In general, idiopathic or genetically-determined epilepsy has the best prognosis.
- Up to 75% of children will experience a prolonged remission from seizures; this is not affected by the use of anti-epileptic drugs (AEDs).
- Likelihood for seizures to be controlled by medication:
- 50% of children with epilepsy will respond to the first medication
- 20-30 % of children will not respond completely, will require two medications for control, or will change medication before control is reached.
- 20-30% of patients will have intractable epilepsy that doesn't respond completely to multiple medications and/or other treatments such as the ketogenic diet, surgery, and the vagal nerve stimulator. Demographic information - seizures (Epilepsy Foundation of America)
- Likelihood for normal neuro-cognitive development depends on the epilepsy syndrome - see discussion of individual syndromes in the Seizure Disorder, Related Issues.
Neville BG, Chin RF, Scott RC.
Childhood convulsive status epilepticus: epidemiology, management and outcome.
Acta Neurol Scand Suppl. 2007;186:21-4. PubMed abstract
Hauser WA, Beghi E.
First seizure definitions and worldwide incidence and mortality.
Epilepsia. 2008;49 Suppl 1:8-12. PubMed abstract
Subcommittee on febrile seizures.
Neurodiagnostic evaluation of the child with a simple febrile seizure.
Pediatrics. 2011;127(2):389-94. PubMed abstract
|Content Last Updated:||6/2011|
The authors listed above are responsible for the overall Seizure Disorder Module. Authors contributing to individual pages in the module are listed on those pages.
Chan D, Phuah HK, Ng YL, Choong CT, Lim KW, Goh WH.
Pediatric epilepsy and first afebrile seizure in singapore: epidemiology and investigation yield at presentation.
J Child Neurol. 2010;25(10):1216-22. PubMed abstract
Deprez L, Jansen A, De Jonghe P.
Genetics of epilepsy syndromes starting in the first year of life.
Neurology. 2009;72(3):273-81. PubMed abstract
Jenssen S, Gracely EJ, Sperling MR.
How long do most seizures last? A systematic comparison of seizures recorded in the epilepsy monitoring unit.
Epilepsia. 2006;47(9):1499-503. PubMed abstract
Nunes ML, Geib LT.
Incidence of epilepsy and seizure disorders in childhood and association with social determinants: a birth cohort study.
J Pediatr (Rio J). 2011;87(1):50-6. PubMed abstract