2. Learning outcome
Seizures in childhood
• Febrile seizure
• Unprovoked seizure
• Partial seizure
• Generalized seizure
• Mechanism of seizure
• Treatment of epilepsy
• Neonatal seizure
• Status epilepticus
• Conditions that mimics seizure
3. Seizure is a clinical event in which there is a sudden
disturbance of neurological function caused by an
abnormal or excessive neuronal discharge.
Febrile convulsion is a seizure associated with fever
in the absence of another cause and not due to
intracranial infection from meningitis or encephalitis
Epilepsy is recurrent seizures other than febrile
convulsions in the absence of an acute cerebral insult.
12. Approach to a child with seizure
• Pre ictal
– Any warning ? Abdomen
pain, fear, unpleasant
sensation
– Asleep or awake
– Trigger factor
– Any fever?
• Ictal
– Responding during spell vs
unconscious
– Does the child remember the spell
– Repetitive behaviours during spell
– Body movements – part or all
– Cyanosis
– Incontinence
– Duration
– Gaze deviation, eye rolling
History
13. • Post ictal
– Drowsy/ Confused/Tired
• Trauma
• Previous history of seizure, febrile seizure
• Development
• Current medications (buspirone)
• Family history of seizure/epilepsy
14. • Vitals, temperature
• Height, weight, head circ.
• CNS – signs of ICP, cranial nerves, motor, sensory,
cerebellar, reflexes,
• Signs of trauma
• Skin exam – neurocutaneous marker
• Sources of infection – ear, throat, abdomen,
respiratory
Physical examination
15. Blood investigation
– Complete blood count, blood sugar,
– Arterial blood gas
– Electrolyte
– Serum creatine kinase activity
– Serum prolactin : increase in generalized and complex
partial seizure. Not increase in absence and myoclonic
– Rise in ACTH and cortisol : post ictal phase
Investigation
Urine - urinalysis
16. Lumbar puncture and CSF culture
– Indication
– Suspicion of meningitis or encephalitis
– All HIV infected person
Electroencephalography (EEG)
– Diagnsosis and classified seizures
17. Neuroimaging
MRI and CT scan of brain
MRI FLAIR
PET AND SPECT
– Indication :
• fixed focal deficit,
• failure of seizure control with first line AED,
• worsening of seizure
19. Treatment
First step
– to ensure that the patient has a seizure disorder and not a
condition that mimics epilepsy
Second step
– Choosing an anticonvulsant
– Goals : to use only one drug with fewest possible side
effect
20.
21.
22.
23. Radical treatment In children with intractable seizures
• Ketogenic (fat based) diets . Its mechanism of action is poorly
understood.
• Vagal nerve stimulation, stimulation of a wire implanted
around the vagal nerve, may possibly be useful for focal
seizures; trials are being conducted.
• Surgery – temporal lobectomy for mesial temporal sclerosis but
other procedures include hemispherectomy or
hemispherotomy (does not involve hemisphere removal and
problems with shifts in space) and focal resections
24. • Febrile convulsion are common
• Recurrences likely
• No evidence of deaths
• If lasting >10min and not stopping
• Rectal diazepam
• Or immediately to the hospital
• Information and advise sheet
Advise and counselling
29. Summary
• Seizures are a behavioral change produced by an
abnormal hypersynchronous neuronal discharge
• In a febrile seizure – important to rule out CNS
infection
• In a first episode seizure – assess for traumatic
causes, CNS infections, hypoglycemia or electrolyte
abnormalities, toxic ingestions; among other causes
30. REFERENCES
• Nelson Textbook of Pediatrics, 1st Edition
• Ghai Essential Pediatrics, 8th Edition
• Illustrated textbook of paediatrics by Tom Lissauer
3rd Edition
• https://www.macpeds.com/documents/Approachto
Seizures.pdf
Hinweis der Redaktion
There is a broad differential diagnosis for children with paroxysmal disorders. Epilepsy is a clinical diagnosis based on the history from eyewitnesses and the child's own account. If available, videos of the seizures or suspected seizures can be of great help. The diagnostic question is whether the paroxysmal events are that of an epilepsy of childhood or one of the many conditions which mimic it (Fig. 27.1). The most common pitfall is that of a syncope leading to an anoxic (non-epileptic) tonic-clonic seizure.
The key to the diagnosis lies in a detailed history, which, together with clinical examination, will determine the need for an EEG or other investigations
Not all seizures require anti-epileptic drug therapy. This decision should be based on the seizure type, frequency and the social and educational consequences of the seizures against the possible unwanted effects of the drugs. Not all seizures require anti-epileptic drug therapy.
Choose the appropriate drug for the seizure. Inappropriate antiepileptics may be detrimental, e.g. carbamazepine can make absence and myoclonic seizures worse.
Monotherapy at the minimum dosage is the desired goal, although in practice several drugs may be required.
All anti-epileptic drugs (AEDs) have potential unwanted effects in which should be discussed
Patients with prolonged benzodiazepine, e.g. rectal diazepam or buccal midazolam.
Anti-epileptic drug therapy can usually be discontinued after 2 years free of seizures.
Surgery. Cessation of seizures and drug therapy may be achieved in some children whose clinical seizures are localised to a specific location in the brain as demonstrated on the EEG and functional imaging. The main procedure is temporal lobectomy for mesial temporal sclerosis but other procedures include hemispherectomy or hemispherotomy (does not involve hemisphere removal and problems with shifts in space) and focal resections. Detailed assessment is required to ensure that the benefits outweigh the risks.