2Aline Andressa Ferreira Schröder, 12Leocadia Felix de Araujo, 13Ana Clara Lobo Ribeiro, 9Joel Eloi Belo Junior, 3Douglas Hipolito Carvalho, 1Délio Tiago Martins Malaquias, 1Érica Miriam Fernandes Miranda Vão, 1Cristiana do Nascimento Oliveira Beloto, 1Samantha Regina Galo Sanches, 1Lucimara Pigaiani, 1Aline Cristina Couto da Silva, 1Wellington da Silva Pereira da Cunha, 1Suely Fernandes dos Santos, 3Jordana de Castro Kinner, 3Júlia Rossatto Mariani, 11Melissa Vieira de Oliveira, 4Isabelli Coreno Xavier, 4Thalita Pinheiro Morel Alineri, 5Rubens Rodrigues Tutela, 6Cristiano Bento Alvarenga, 7Nathalia de Castro Fraga, 8Lucas Pereira Sales Porto, 1,10*Thiago Augusto Rochetti Bezerra
1Medical student, Unaerp, Guarujá, Brazil
2Doctor of Medicine, PUC Goiás; Second-year Family and Community Medicine resident at HMDI, Brazil.
3Medical student, Nove de Julho University – São Bernardo do Campo, Brazil.
4Medical student, University of Western São Paulo (UNOESTE), Guarujá, Brazil.
5Medical student, São Judas University, Cubatão, Brazil.
6Medical student, Central University of Paraguay, Ciudad del Este, Paraguay.
7Doctor of Medicine, Nove de Julho University , São Bernardo do Campo, Brazil.
8Scholar in Biochemistry and Molecular Biology, The Pennsylvania State University, United States of America.
9Major Aviator of the Brazilian Air Force; Master’s degree in Human Operational Performance; Master’s degree in Intellectual Property and Technology Transfer for Innovation,
10Ph.D. of Medical Sciences, University of São Paulo, Brazil.
11Medical Student, Nove de Julho University – Vergueiro Campus, São Paulo, Brazil.
12Doctor of Medicine, Federal University of the Southern Border, Passo Fundo Campus, Rio Grande do Sul, Brazil.
13Medical Student, University of Rio Verde, Aparecida de Goiânia Campus, Goiás, Brazil.
ABSTRACT
Seizures in pediatrics are one of the most alarming and frequent neurological manifestations in childhood and have been the subject of intense research throughout medical history. Initially understood from an empirical and even mystical perspective, these seizures have been progressively clarified with advances in neuroscience, especially after the introduction of electroencephalography (EEG), which allowed for more accurate visualization of brain electrical activity. The transition to evidence-based practices has revolutionized the clinical management of these events, prioritizing a systematic, individualized, and safe approach. Initial medical evaluation has come to be considered the cornerstone of effective management, as highlighted by Da Silva et al. (2023) and Fonseca and Benavides (2022). In addition to a careful physical examination and detailed medical history, complementary tests, such as neuroimaging and continuous EEG, are essential, particularly in high-risk settings, such as in patients admitted to intensive care units. The importance of differentiating epileptic seizures from non-epileptic paroxysmal events has also been emphasized by authors such as Nickels (2020) and Glass (2017) as a strategy to avoid misdiagnosis and unnecessary treatment. In the therapeutic field, recent evidence supports the use of new antiepileptic drugs, such as levetiracetam, which has shown effective nd a favorable safety profile in studies with children (Arya, 2017; Pellock, 2016). However, the early initiation of pharmacotherapy after the first unprovoked seizure is still debated among experts, with authors such as Hirtz (2019) recommending caution, while others, such as Berg (2019), advocate early intervention in the presence of suggestive clinical and electroencephalographic findings. Systematic reviews play a crucial role in this scenario by synthesizing high-quality evidence and enabling the development of more robust guidelines. They also enable the identification of gaps in the literature and point to avenues for further investigation. The discussion among the main authors highlights both convergences—such as the defense of an individualized approach—and divergences, especially regarding the choice of initial treatment and the ideal time for intervention. Thus, the proposed systematic review contributes to consolidating current knowledge, improving clinical practice, and providing support for safer and more effective therapeutic decisions in the management of convulsive seizures in pediatrics.
KEYWORDS
Seizures, Pediatrics, Systematic review, Childhood epilepsy, Initial assessment, Evidence-based treatment.
REFERENCES
1) ABEND, N. S. et al. Electroencephalographic monitoring in the pediatric intensive care unit. Current Opinion in Pediatrics, v. 27, p. 592–600, 2015.
2) ARYA, R.; SHARMA, S. Levetiracetam in pediatric epilepsy: A clinical review. Epilepsy Research, v. 134, p. 41–48, 2017.
3) BERG, A. T. et al. Recurrent seizures after the first unprovoked seizure in childhood. New England Journal of Medicine, v. 378, p. 133–141, 2019.
4) BERGIN, P. M. et al. Comparative efficacy of antiepileptic drugs in childhood epilepsy: A meta-analysis. Seizure, v. 23, n. 2, p. 85–92, 2014.
5) CAMFIELD, P. R.; CAMFIELD, C. S. Febrile seizures and genetic epilepsy with febrile seizures plus (GEFS+): Evolution over two decades. Seizure, v. 50, p. 135–140, 2017.
6) CASELLA, Erasmo Barbante; MÂNGIA, Cristina M. F. Approach to acute convulsive seizures and status epilepticus in children. Jornal de Pediatria (Rio J), v. 75, suppl. 2, p. s197–s206, 1999.
7) CROSS, H. J. et al. Pediatric epilepsy: A guide for multidisciplinary care. Lancet Neurology, v. 20, p. 525–538, 2021.
8) DA SILVA, Bruna Marisa Santos et al. Initial care for seizures in children. Revista Remecs – Revista Multidisciplinar de Estudos Científicos em Saúde, p. 67–67, 2023.
9) FERREIRA, Mariana Cunha et al. Febrile seizures in pediatrics: when to institute drug treatment? Cuadernos de Educación y Desarrollo, v. 16, n. 12 Special Edition, p. e6554–e6554, 2024.
10) FONSECA, André Luís Basso; BENAVIDES, Valeriane Maia Siravegna. Febrile seizures in children: a narrative review. Revista Eletrônica Acervo Médico, v. 3, p. e9780–e9780, 2022.
11) GLASS, H. C.; BONIFACIO, S. L. Neuroimaging in neonatal seizures. Journal of Pediatric Neurology, v. 15, n. 3, p. 123–132, 2017.
12) GLAUSER, T. A. et al. Evidence-based guideline update: Management of an initial unprovoked seizure in children. Neurology, v. 87, p. 178–185, 2016.
13) GUERRINI, R. Epileptic encephalopathies in children. Epilepsia, v. 60, n. 6, p. 43–52, 2019.
14) HAUSER, W. A. The prevalence and incidence of convulsive disorders in children. Epilepsia, v. 57, n. 4, p. 6–12, 2016.
15) HIRAI, Kaliny Mendes. Management of epileptic and convulsive seizures in childhood: an updated summary of clinical and organizational evidence. In: INNOVATIVE PRACTICES IN NURSING: COMPREHENSIVE AND HUMANIZED CARE. Curitiba: Editora Científica Digital, 2025. pp. 48–57.
16) HIRTZ, D. et al. Practice parameter: Treatment of the child with a first unprovoked seizure. Neurology, v. 92, p. 479–486, 2019.
17) HOLMES, G. L. Effect of seizures on the developing brain: Cellular and molecular mechanisms. Epilepsia, v. 58, n. 6, p. 51–58, 2017.
18) KWAN, P. et al. Definition of drug resistant epilepsy: Consensus proposal by the ILAE. Epilepsia, v. 62, n. 5, p. 964–973, 2021.
19) MCTAGUE, A.; CROSS, J. H. Treatment of epilepsy in childhood: Current evidence. Archives of Disease in Childhood, v. 105, p. 386–392, 2020.
20) NICKELS, K. C. Acute symptomatic seizures in children: Evaluation and management. Continuum (Minneap Minn), v. 26, n. 4, p. 1–10, 2020.
21) NICOLE-CARVALHO, Valentina; HENRIQUES-SOUZA, Adélia Maria de Miranda. Conduct in the first episode of a seizure. Jornal de Pediatria, v. 78, p. S14–S18, 2002.
22) NORDLI, D. R. Diagnosis and management of seizures in infants. Seminars in Pediatric Neurology, v. 25, p. 143–153, 2020.
23) PELLOCK, J. M. et al. Treatment of pediatric epilepsy: The new antiepileptic drugs. Pediatric Neurology, v. 62, p. 17–25, 2016.
24) RASPALL-CHAURE, M.; ALEGRET, M.; MACAYA, A. Epileptic syndromes in infancy and childhood. Revista de Neurología, v. 60, n. 1, p. 19–27, 2015.
25) SANKAR, R.; MURRAY, K. D. Molecular basis of epilepsy. Current Opinion in Pediatrics, v. 30, p. 727–734, 2018.
26) SHINNAR, S.; BERG, A. T. Does antiepileptic drug therapy prevent the development of epilepsy after febrile seizures? Epilepsia, v. 59, n. 5, p. 829–835, 2018.
27) SPECCHIO, N.; PARENTI, I.; FALCONE, M. Rare pediatric epilepsy syndromes: Clinical and therapeutic challenges. CNS Drugs, v. 36, n. 5, p. 421–433, 2022.
28) STREDNY, C. M. et al. EEG findings in neonatal seizures: A case-control study. Clinical Neurophysiology, v. 130, p. 678–684, 2019.
29) VERROTTI, A. et al. Cognitive and neuropsychological effects of antiepileptic drugs in children. Pharmacological Research, v. 107, p. 211–219, 2020.
30) WILMSHURST, J. M. et al. ILAE classification of epilepsies: Position paper of the ILAE Commission. Epilepsia, v. 56, n. 10, p. 1643–1657, 2015.
31) WIRRELL, E. C. Juvenile myoclonic epilepsy: Recognizing the signs in pediatric
ABSTRACT
Seizures in pediatrics are one of the most alarming and frequent neurological manifestations in childhood and have been the subject of intense research throughout medical history. Initially understood from an empirical and even mystical perspective, these seizures have been progressively clarified with advances in neuroscience, especially after the introduction of electroencephalography (EEG), which allowed for more accurate visualization of brain electrical activity. The transition to evidence-based practices has revolutionized the clinical management of these events, prioritizing a systematic, individualized, and safe approach. Initial medical evaluation has come to be considered the cornerstone of effective management, as highlighted by Da Silva et al. (2023) and Fonseca and Benavides (2022). In addition to a careful physical examination and detailed medical history, complementary tests, such as neuroimaging and continuous EEG, are essential, particularly in high-risk settings, such as in patients admitted to intensive care units. The importance of differentiating epileptic seizures from non-epileptic paroxysmal events has also been emphasized by authors such as Nickels (2020) and Glass (2017) as a strategy to avoid misdiagnosis and unnecessary treatment. In the therapeutic field, recent evidence supports the use of new antiepileptic drugs, such as levetiracetam, which has shown effective nd a favorable safety profile in studies with children (Arya, 2017; Pellock, 2016). However, the early initiation of pharmacotherapy after the first unprovoked seizure is still debated among experts, with authors such as Hirtz (2019) recommending caution, while others, such as Berg (2019), advocate early intervention in the presence of suggestive clinical and electroencephalographic findings. Systematic reviews play a crucial role in this scenario by synthesizing high-quality evidence and enabling the development of more robust guidelines. They also enable the identification of gaps in the literature and point to avenues for further investigation. The discussion among the main authors highlights both convergences—such as the defense of an individualized approach—and divergences, especially regarding the choice of initial treatment and the ideal time for intervention. Thus, the proposed systematic review contributes to consolidating current knowledge, improving clinical practice, and providing support for safer and more effective therapeutic decisions in the management of convulsive seizures in pediatrics.
KEYWORDS
Seizures, Pediatrics, Systematic review, Childhood epilepsy, Initial assessment, Evidence-based treatment.
REFERENCES
1) ABEND, N. S. et al. Electroencephalographic monitoring in the pediatric intensive care unit. Current Opinion in Pediatrics, v. 27, p. 592–600, 2015.
2) ARYA, R.; SHARMA, S. Levetiracetam in pediatric epilepsy: A clinical review. Epilepsy Research, v. 134, p. 41–48, 2017.
3) BERG, A. T. et al. Recurrent seizures after the first unprovoked seizure in childhood. New England Journal of Medicine, v. 378, p. 133–141, 2019.
4) BERGIN, P. M. et al. Comparative efficacy of antiepileptic drugs in childhood epilepsy: A meta-analysis. Seizure, v. 23, n. 2, p. 85–92, 2014.
5) CAMFIELD, P. R.; CAMFIELD, C. S. Febrile seizures and genetic epilepsy with febrile seizures plus (GEFS+): Evolution over two decades. Seizure, v. 50, p. 135–140, 2017.
6) CASELLA, Erasmo Barbante; MÂNGIA, Cristina M. F. Approach to acute convulsive seizures and status epilepticus in children. Jornal de Pediatria (Rio J), v. 75, suppl. 2, p. s197–s206, 1999.
7) CROSS, H. J. et al. Pediatric epilepsy: A guide for multidisciplinary care. Lancet Neurology, v. 20, p. 525–538, 2021.
8) DA SILVA, Bruna Marisa Santos et al. Initial care for seizures in children. Revista Remecs – Revista Multidisciplinar de Estudos Científicos em Saúde, p. 67–67, 2023.
9) FERREIRA, Mariana Cunha et al. Febrile seizures in pediatrics: when to institute drug treatment? Cuadernos de Educación y Desarrollo, v. 16, n. 12 Special Edition, p. e6554–e6554, 2024.
10) FONSECA, André Luís Basso; BENAVIDES, Valeriane Maia Siravegna. Febrile seizures in children: a narrative review. Revista Eletrônica Acervo Médico, v. 3, p. e9780–e9780, 2022.
11) GLASS, H. C.; BONIFACIO, S. L. Neuroimaging in neonatal seizures. Journal of Pediatric Neurology, v. 15, n. 3, p. 123–132, 2017.
12) GLAUSER, T. A. et al. Evidence-based guideline update: Management of an initial unprovoked seizure in children. Neurology, v. 87, p. 178–185, 2016.
13) GUERRINI, R. Epileptic encephalopathies in children. Epilepsia, v. 60, n. 6, p. 43–52, 2019.
14) HAUSER, W. A. The prevalence and incidence of convulsive disorders in children. Epilepsia, v. 57, n. 4, p. 6–12, 2016.
15) HIRAI, Kaliny Mendes. Management of epileptic and convulsive seizures in childhood: an updated summary of clinical and organizational evidence. In: INNOVATIVE PRACTICES IN NURSING: COMPREHENSIVE AND HUMANIZED CARE. Curitiba: Editora Científica Digital, 2025. pp. 48–57.
16) HIRTZ, D. et al. Practice parameter: Treatment of the child with a first unprovoked seizure. Neurology, v. 92, p. 479–486, 2019.
17) HOLMES, G. L. Effect of seizures on the developing brain: Cellular and molecular mechanisms. Epilepsia, v. 58, n. 6, p. 51–58, 2017.
18) KWAN, P. et al. Definition of drug resistant epilepsy: Consensus proposal by the ILAE. Epilepsia, v. 62, n. 5, p. 964–973, 2021.
19) MCTAGUE, A.; CROSS, J. H. Treatment of epilepsy in childhood: Current evidence. Archives of Disease in Childhood, v. 105, p. 386–392, 2020.
20) NICKELS, K. C. Acute symptomatic seizures in children: Evaluation and management. Continuum (Minneap Minn), v. 26, n. 4, p. 1–10, 2020.
21) NICOLE-CARVALHO, Valentina; HENRIQUES-SOUZA, Adélia Maria de Miranda. Conduct in the first episode of a seizure. Jornal de Pediatria, v. 78, p. S14–S18, 2002.
22) NORDLI, D. R. Diagnosis and management of seizures in infants. Seminars in Pediatric Neurology, v. 25, p. 143–153, 2020.
23) PELLOCK, J. M. et al. Treatment of pediatric epilepsy: The new antiepileptic drugs. Pediatric Neurology, v. 62, p. 17–25, 2016.
24) RASPALL-CHAURE, M.; ALEGRET, M.; MACAYA, A. Epileptic syndromes in infancy and childhood. Revista de Neurología, v. 60, n. 1, p. 19–27, 2015.
25) SANKAR, R.; MURRAY, K. D. Molecular basis of epilepsy. Current Opinion in Pediatrics, v. 30, p. 727–734, 2018.
26) SHINNAR, S.; BERG, A. T. Does antiepileptic drug therapy prevent the development of epilepsy after febrile seizures? Epilepsia, v. 59, n. 5, p. 829–835, 2018.
27) SPECCHIO, N.; PARENTI, I.; FALCONE, M. Rare pediatric epilepsy syndromes: Clinical and therapeutic challenges. CNS Drugs, v. 36, n. 5, p. 421–433, 2022.
28) STREDNY, C. M. et al. EEG findings in neonatal seizures: A case-control study. Clinical Neurophysiology, v. 130, p. 678–684, 2019.
29) VERROTTI, A. et al. Cognitive and neuropsychological effects of antiepileptic drugs in children. Pharmacological Research, v. 107, p. 211–219, 2020.
30) WILMSHURST, J. M. et al. ILAE classification of epilepsies: Position paper of the ILAE Commission. Epilepsia, v. 56, n. 10, p. 1643–1657, 2015.
31) WIRRELL, E. C. Juvenile myoclonic epilepsy: Recognizing the signs in pediatric
