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Cerebral Palsy - Increased Seizures

  • See also

    Cerebral Palsy - Common Emergency Presentations:

    Chest infection

    Afebrile Seizures


    • Children with cerebral palsy and known epilepsy may present with increased seizures or break-through seizures
    • Consider possible precipitants:
      • Intercurrent illness (viral illness, chest infection, UTI)
      • Changes in medications
      • Vomiting or diarrhoea causing reduced absorption 
      • Non-adherence with medication
      • CNS infection 
      • Shunt malfunction (many children with cerebral palsy have VP shunts)


    • Check blood glucose if presents with a seizure
    • Anticonvulsant levels may be useful in some situations
      • Phenytoin, phenobarbitone (see  Therapeutic Drug Monitoring - available on RCH Intranet only)
      • Carbamazepine or sodium valproate levels are not usually helpful
    • Consider LP, see Lumbar puncture, imaging, antibiotics flowchart
    • Assessment of conscious state and responsiveness may be difficult. Failure of improvement of conscious state post seizure or worsening conscious state requires re-evaluation and consideration of neuro-imaging.
    • Consider the possibility of non-convulsive status particularly in those with seizure disorders with multiple seizure types. This may require EEG confirmation
    • Check for regression (consider possible neurodegenerative disorder)


    • See Afebrile Seizures for management of acute fitting
    • Treat intercurrent illness as appropriate

    Adjustments to maintenance anti-convulsants should be discussed with the consultant responsible

  • Reference List

    1. Gabis, LV et al. Assessment of Abilities and Comorbidities in Children with Cerebral Palsy. Journal of Child Neurology. 2015. 30(12) p 1640-1645.
    2. Karim, T et al. Improving epilepsy control among children with cerebral palsy in rural Bangladesh: a prospective cohort-based study. BMJ Open. 2022. 12e052578. doi:10.1136/bmjopen-2021-052578
    3. Latzer, IT et al. Prediction of Drug-Resistant Epilepsy in Children with Cerebral Palsy. Journal of Child Neurology. 2020. 35(3), p187-194.
    4. NICE guideline [NG62]. Cerebral Palsy in under 25s: assessment and management. Retrieved from (viewed 07 Sept 2022).
    5. NICE guideline [NG217]. Epilepsies in children, young people and adults. 2022. Retrieved from (viewed 07 Sept 2022).
    6. Singhi, P et al. Epilepsy in Children with Cerebral Palsy. Journal of Child Neurology. 2003. 18(3), p175-179.
    7. Tsubouchi, Y et al. Long-term prognosis of epilepsy in patients with cerebral palsy. Developmental Medicine & Child Neurology. 2019. 61, p1067-1073. doi: 10.1111/dmcn.14188.