Seizures in Pediatrics: Initial Medical Evaluation and Evidence-Based Management

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.