Medical Record Review
Lessons to Learn from the Treatment of Children Who Have Seizures
Editors: Lawrence F. Nazariam, MD.
Accompanying this issue of Pediatrics in Review is the American Board of Pediatrics' Guide for Record Review dealing with seizures. All general pediatricians eventually treat this chronic condition, and there are important lessons to be learned in the process.
In the sample record that follows, the initial observations of the patient's brief spells were made by the schoolteacher. Because a child spends so much time in school and is under the direct scrutiny of teachers, it is not surprising that subtle signs of illness first may be picked up in that setting. Interestingly, absence seizures are more likely to occur when the child is engaged in activities that are not particularly interesting to him or her, or do not demand his or her full attention. Certainly, a first generalized seizure, as well as any other kind of seizure, also may occur outside the home.
Because seizure activity often occurs away from home, parents and physicians may be dependent upon the observations of other people, including other children, teachers, coaches, or strangers who happen by. Consequently, the all-important description of the seizure activity may be severely distorted by the time the story gets to the pediatrician. It is critical that eyewitness accounts be gathered to get the full picture of the patient's illness; the extra effort needed to get a true account is well spent.
