Seizures, fits, funny turns, convulsions, attacks…  None of these really has a medical meaning.  Convulsion suggests rhythmic motor activity, but that’s about it.  The implication of most of these is that there is excessive abnormal, involuntary muscle contraction, usually bilateral.  But more broadly, some involuntary, usually sudden and self terminating episode of abnormal (or at least non-purposeful) activity and/or impaired awareness. Can be sustained or interrupted.

Nottingham RCPCH approved guideline distinguishes:

• Febrile?
• Already on anti-epileptic medication?  Consider checking levels, or at least storing sample.
• Predisposing conditions? eg neurodevelopmental problem, brain injury/surgery.
• Neonate or young infant? Some additional possibilities eg hypoxic ischaemic encephalopathy (HIE), Fifth day fits, drug withdrawal (neonatal abstinence syndrome), pyridoxine dependent epilepsy.

Most commonly Febrile convulsions ie age related, benign.  Beware complex (multiple seizures in same illness, focal features, prolonged >15 mins) and any abnormal findings eg neck stiffness, bulging fontanelle, prolonged illness, abnormal cognition before/after.

Important differentials are:

• meningitis
• encephalitis
• shaken baby (non-accidental injury)
• brain tumour/haemorrhage, hydrocephalus
• ingestion (deliberate or accidental)
• metabolic (low glucose, calcium/magnesium, low/high sodium)

May represent first evidence of epilepsy.