ASIM May p129-134

129 A n accurate diagnosis built on history, physical examination, and testing is the critical first step in successful management of epilepsy and isolated seizures in children. Determining the risk for recurrence is, of course, the paramount concern to both clinician and parents. In the United States, the estimates of recurrence risk range from 23% to 71%, with most of the variation in estimates attributable to study design and distribution of prognostic factors. In a recent large study, only one third (33%) of children with single unprovoked seizures had recurrences within 5 years. Thus, the early full evaluation of the seizure disorder often provides the evidence base to reassure parents. And for those children in whom recurrent events are deemed likely, classifying the epileptic complex by clinical, etiologic, and electroencephalographic (EEG) findings provides the necessary framework for ongoing evaluation and long-term treatment. Because an initial seizure can present in such varied settings, and because the majority of new-onset cases in children will actually yield no identifiable cause, no single diagnostic strategy will apply to evaluation of all children. This review will summarize a flexible and evolving diagnostic approach that is appropriate for the pediatric patient with presumptive epilepsy. An evaluation built on a basic history and a simple testing algorithm as described here should help neurologists avoid unnecessary tests while still constructing a full diagnosis of the syndrome that allows for accurate prognosis and successful therapeutic choices.