.

(Seizures) 1


glutamate N-methyl-d-aspartic acid receptors 2
gamma-aminobutyric acid (GABA)
3
5
4

(Generalized seizures) (partial focal seizures)
1.

(convulsive or nonconvulsive) (postictal
state)
1.1. Absence seizures

( 15 )

1.2. Atonic seizures (muscle tone) (drop
attack)5
1.3. Tonic seizures
1.4. Myoclonic seizures

1.5. Clonic seizures
1.6. Generalized tonic-clonic seizures


2.


2.1. Simple partial seizures
2.2. Complex partial seizures
2.3. Partial seizures with secondary generalization

6-7
1.
1.1. (Infections) (meningoencephalitis), (brain
abscess), (parasites)
1.2. (Head trauma)

(child abuse) (epidural
hematoma), (subdural hematoma),
(posttraumatic seizures)
1.3. (intracerebral hemorrhage),
(cerebral embolism), (cerebral infarction),
(hypertensive encephalopathy)
1.4. (Tumor)
1.5. (Congenital abnormalities) (birth
asphyxia), (neurocutaneous syndromes)
2.
2.1. (Metabolic disorders) (hypoglycemia),
(hyponatremia), (hypernatremia),
(hypomagnesemia), 6 (pyridoxine deficiency)
2.2. (Intoxication) cyclic antidepressants, (lead),
cocaine, PCP, amphetamine, ASA, carbon monoxide, isoniazid, organophosphates, theophylline,
lidocaine, lindane
2.3. (Drug withdrawal) 48 . (anticonvulsants),
(alcohol)
 2.4. (Inborn errors of metabolism)
3. (Epilepsy)
2 (unprovoked seizures)

(neonates) (infants and toddlers) (children) (adolescents)

(Congenital brain (Accidental head injuries) (Accidental head injuries) (Accidental head injuries)
abnormalities)
(Brain (Brain (Brain
(Drug intoxication or tumor) tumor) tumor)
withdrawal)
(Epilepsy)
(Encephalitis) (Encephalitis) (Inborn error of
metabolism)

(Hypocalcemia) (Febrile seizure) (Hypertensive
encephalopathy)

(Hypoglycemia) (Hyponatremia) (Toxic ingestion)

(Hypomagnesemia) (Meningitis)

(Inborn error of (Nonaccidental head
metabolism) injury)

(Infarction) Shigella
(Shigella gastroenteritis)

(Intracranial hemorrhage) (Toxic ingestion)

(Meningitis)

(Nonaccidental brain
injury)


(Perinatal hypoxic brain

injury)
1:

1. (Seizure description)


1.1.
1.1.1.
(aura)

1.1.2. /
1.1.3.
1.1.4.
/ (incontinence)
1.1.5. (hemiparesis)
1.2.
1.2.1.
1.2.2.
1.2.3.
2. 3,7-8
2.1. ( 1) 6
5 (febrile seizures)
2.2.
2.2.1. (meningitis),
(encephalitis) (brain abscess)
2.2.2. (febrile seizures)
2.2.3.
(Seizure threshold) (epilepsy)
 2.3. (Associated symptoms)

2.4.

2.5.

2.5.1.
2.5.2.
2.5.3.
2.5.4.

2.5.5.
2.6.
2.7.

2.8.


2.9.

1.
1.1.
1.2. (Hypoxia)
1.3.
1.4. (Increased intracranial pressure)
2.
2.1. (Head circumferences)
(microcephaly) (macrocephaly)
2.2. (Fontanelle) (sunken anterior fontanelle)
(dehydration) (bulging anterior fontanelle)
(increased intracranial pressure)
2.3.

3.
 3.1.
3.2. (Neurocutaneous
syndromes) caf au lait spots, ash leaf spots, adenoma sebaceum7,9
4.

(pupils) (fundus)

(papilledema) (retinal hemorrhage)

(meningismus)

Todds paralysis 36 10
(stroke)

1. (Syncope)
(motor tone)
(aura)


vasovagal syncope
cardiogenic syncope prolonged QTc syndrome

-
-
-
2. (Breath-holding spells)
 (6-18 ) (emotional upset)

(cyanotic breath-holding spells)

40 11
3. (Night terrors)

12
4. (Acute dystonia)

(oculogyric crisis) (torticollis) (opisthotonos)
haloperidol metoclopramide 13
5. (Tics disorder)
14


6. Spasmus nutans
4 12 (head tilt) (head nodding)
(asymmetric nystagmus)
15-16
7. (chills)

8. Sandifers syndrome gastroesophageal reflux
tonic seizures 17

9. (Pseudoseizures)18
hysterical epilepsy,
hysterical seizures, psychogenic seizure, factitious seizures, functional seizures, conversion fits, pseudo-
attacks, paroxysmal somatoform disorder, pseudo-status epilepticus19
(cyanosis)

1. (First episode afebrile seizures)


(
)20 (dehydration)



21
(toxicology screen)
(neuroimaging) MRI CT MRI
CT

- (partial seizures)
-
-
- (focal deficit)
-





(lumbar puncture) (encephalitis)
(meningitis)
6
22 CT
-
-
- (increased intracranial pressure)
(electroencephalogram)





 -
-
-


23

2. (febrile seizures)
( 2-5%)
24
- (upper respiratory tract infection)
- (pharyngitis)
-
(otitis media)
- (pneumonia)
- (gastroenteritis)
- (urinary tract infection)
- (roseola)
-
2
1. Simple febrile seizures 25-26

- (generalized tonic-clonic seizures)
- 15
-
38
- 6 5
- 24 .
 simple febrile seizures American Academy of Pediatrics (AAP)
(
)



12
12-18 18
(neck stiffness), Kernig sign
Brudzinski sign

5 acetaminophen 15 ./
. ibuprofen 10 ./.
simple febrile seizures
diazepam
(ataxia), (lethargy), (irritability) 27
simple febrile seizures


2. Complex febrile seizures simple febrile seizures

- (focal seizures)
- 15
- 6 5
- 24 .
-
complex febrile seizures (diagnosis by
exclusion) ( )
28

 24

29

complex febrile seizures

3. (status epilepticus)

30 5 30-31
32-34
35-36
benzodiazepine diazepam


-
chin lift jaw thrust
- (nasal oral airway)

-
- (cannula) (face mask)
-
-
(increased intracranial pressure)

(airway compromised)
(respiratory failure) (apnea)

succinylcholine
vercuroneum


( )
37-38 60 .% D25W
2-4 ./. D10W 5 ./.
(blood gas) metabolic
respiratory acidosis

39-41
benzodiazepines GABA receptors
42 diazepam lorazepam lorazepam
benzodiazepines 43-44 diazepam
1-3 15-20 0.1-0.3
./. 0.5 ./. 0.25 ./. 20
. 5-10 benzodiazepine

benzodiazepine

benzodiazepines 2 refractory status

epilepticus benzodiazepines 2
(respiratory depression) 45
46 fosphenytoin/phenytoin phenobarbital
Phenytoin


20 ./. 1 ././ ( 50 ./)
47 phenytoin
phenytoin
normal saline

( 2-3 .)
fosphenytoin prodrug phenytoin phenytoin serum
phosphatases phenytoin equivalents (PE) phenytoin
prodrug 20 PE/. 3 PE/./ ( 150 PE/)
fosphenytoin


48 phenytoin49
 phenytoin phenobarbital
benzodiazepines benzodiazepines phenobarbital
GABA receptors
phenytoin phenobarbital
(long-acting) phenobarbital
- phenytoin
-
- 2
20 ./. 2 ././ ( 60 ./) phenobarbital
(cardiorespiratory depression)
benzodiazepines 50
phenytoin phenobarbital

Valproic acid valproic acid
20 40 ./. 5 ././
(metabolic disease)
(hepatic failure) ( )
Levetiracetam
(calcium-dependent neurotransmitter)
GABA receptors
51


( )

Propofol 52 1-2 ./.
2-10 ././. 53
metabolic acidosis
barbiturates pentobarbital ( 2-10 ./. 1 ././
.)
benzodiazepines midazolam 0.1 ././.
15 3 ././.
2




Drug Route Initial dose Repeat dose Maximum

Diazepam IV 0.1 0.3 mg/kg 0.1 0.3 mg/kg 10 mg
PR 0.5 mg/kg 0.5 mg/kg 20 mg
Phenytoin IV 15 20 mg/kg - -
Fosphenytoin IV, IM 15 20 PE/kg 5 10 PE/kg 30 PE/kg
Phenobarbital IV 15 20 mg/kg 5 10 mg/kg 40 mg/kg
Valproic acid IV 20 40 mg/kg 15 20 mg/kg 40 mg/kg
Levetiracetam IV 20 30 mg/kg - 3g
Pentobarbital IV 5 15 mg/kg 1 2 mg/kg 15 mg/kg
Profofol IV 0.5 2.0 mg/kg 0.5 1.0 mg/kg 5 mg/kg
Midazolam IV 0.1 0.2 mg/kg 0.1 0.2 mg/kg 10 mg
2:

4. (Neonatal seizures)
1
54
55 40
56

hypoxic-ischemic encephalopathy, ,
(congenital brain malformation),
(inborn errors of metabolism)


group
B strep herpes simplex virus (narcotics)



( cell count, protein, glucose, culture herpes PCR assay)

CT

(inborn errors of metabolism) lactate, ammonia, serum
amino urine organic acids 57-58
phenobarbital 20 ./.
5-10 ./. fosphenytoin 20 PE/.
lorazepam 0.1 ./.
refractory seizures midazolam
pyridoxine 100 .
pyridoxine dependency syndrome

5. (Epilepsy)

( )


-
-
-
-

(seizure threshold)

6. (Ventriculoperitoneal shunts)
 (shunt malfunction)
(CNS infection) VP shunt
series CT MRI

7.

(subdural hematoma)




2 shaken baby syndrome59

30-70%

(
) CT /

2
2 60

8. (Seizure-like events)

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