[The diagnostic and therapeutic management in the first cerebral attack in childhood]

Cerebral attacks are the most frequent neurological problem in childhood. The diagnostic and therapeutic management in the first cerebral attack belongs to subjects often discussed in literature but currently it arouses some controversies concerning especially the notions "cerebral attack", "unprovoked seizures" and also the fact when epilepsy should be diagnosed after the first or the second unprovoked attack of seizures and when to start its treatment. The author presents in detail the principles of the management of cerebral attack and its differentiation in children. In relation to the neurological examinations (EEG, cerebrospinal fluid analysis, neuroimaging examination), the author demonstrates both the indications for their performance as well as limitations due to frequently obtained negative results. Among cerebral attacks, after exclusion of symptomatic attacks and febrile seizures, the first epileptic seizure can be diagnosed in 50% of children. The treatment of epilepsy after the first epileptic seizure decreases effectively the number of seizures within the first three years. However, the percentage of children who achieved 3-5-year remission is in these patients similar to that in the group treated after 2 successive attacks of unprovoked seizures. EEG and neuroimaging examinations (cerebral MR more beneficial than CT) belong to the diagnostic canon in the case of a cerebral attack. Changes in neurological examination and also the changes maintaining after focal attack, the age of children with cerebral attack up to 6 months and changes on EEG and in neuroimaging examinations increase the risk of another attack. The selection of the performed laboratory tests depends on an individual case and should be extended when symptomatic nature of cerebral attack is suspected (i.e. acute or chronic encephalopathies).