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SEIZURES IN CHILDHOOD

Year 3 Batch 17
2013

definition
Sudden disturbance of neurological
function
Caused by abnormal or excessive
neuronal discharge

Epileptic
epileptic
Idiopathic
Secondary
Cerebral tumors
trauma
Neurodegenerative
Meningitis/enceph
Neurocutaneous syn
Poisons/toxins

Non
Febrile fits
Metabolic
Head

Secondary
Cerebral dysgenesis/malformation
Cerebral vascular occlusion
Cerebral damage eg congenital
intrauterine infection/HIE/IVH/ischaemia
Metabolic
Hypoglycemia/hypocalcemia/hypomagne
semia/ hypo & hypernatremia

SIMPLE FEBRILE SEIZURES


Occur with sudden/rapid rise of temp
In kids 6mths -6yrs
Strong genetic predisposition: 10% risk
if in
parents/sibs/relatives
Occurs on day 1, single (rarely twice)
brief/transient(not more than 10 mins)
Recurrence 30-40%

Simple febrile fits

Generalised, tonic- clonic, brief


No residual weakness/paralysis
No brain damage (EEG normal)
Intellectual performance normal
Normal risk for epilepsy (1-2%)

treatment
No specific treatment
Parents to be reassured & educated
on first aid management of seizure
Prevent rapid rise if possible ?sponging ?
antipyretics

*No role for antiepileptic drugs

Complex febrile fits

Focal
Prolonged
Repeated in same illness
Risk of epilepsy increased 4-12%

Epilepsy: definition

..chronic neurological disorder


..recurrent unprovoked seizures
...transient signs/symptoms
..which are always associated with
abnormal, excessive or synchronous
neuronal activity in the brain

EPILEPSY/SEIZURE
DISORDER
1) GENERALISED
Absence
Myoclonic
Tonic
Tonic-clonic
Atonic
2) FOCAL
Frontal
Temporal

Parietal
Occipital

diagnosis
A. Detailed history +/- video,
specific triggers, impairments
B. Examination: neurocutaneous
stigma
C. Investigations: EEG
ImagingCT,MRI,PET,SPECT
Metabolic screen
Genetic studies

management
1) counselling-disease,
triggers,compliance, monitoring
2) AED-generalised-valproate
-localisedcarbamazepine,lamotrigine
3) other options-ketogenic diet
-vagal nerve
stimulation
- surgery-lobectomy

complications
Status epilepticus:Seizure lasting 30mins or repeated
seizures for 30mins without recovery of
consciousness
Other problems : Side effects of drugs
AED drug levels
Rescue therapy
Prevention of injuries
Assoc learning disabilities

Conditions which mimic


epilepsy

Breath holding attacks


Reflex anoxic seizures
Syncope migraine
Benign paroxysmal vertigo
Others like cardiac arrhythmia, tics,
daydreaming, pseudoseizures,
movement disorders

Reference
Illustrated textbook of Pediatrics
Lissauer & Clayden 4th edition
Chapter 27 Page 472-478