16. Seizures in children

Question 1

what are seizures?

Answer 1

episodic neurological phenomena resulting from excessive hypersynchronous activity from neurons in cerebral cortex

Question 2

difference between generalised and focal seizures

Answer 2

Generalised
- tonic clonic (grand mal)
- absence (petit mal)
- myoclonic 
- tonic
- atonic (drop attacks)
- spasms
Focal seizures
- motor
-somatosensory
- visual/auditory
- autonomic
- dysphasic
- dyscognitive

Question 3

two broad groups of epilepsies based on etiology

Answer 3

• idiopathic

- symptomatic (underlying lesion/genetic/metabolic disorder)

Question 4

differential diagnoses of seizures

Answer 4

• normal - eg sleep jerks/inattention/day dreaming
• syncope - vasovagal, long QT
• parasomnias/sleep disturbances
• ‘migraine variants’
• movement disorders - tics, clonus, chorea, tremor
• behavioural and psych disturbances incl psychogenic

Question 5

History of possible seizure

Answer 5

• eye witness and pt account
• situation in which episodes occur
• hx of ‘minor’ events eg staring, little jerks
• perinatal and past med hx
• fam hx seizures, epilepsy, neuro disease
• dev hx

Question 6

examination seizure

Answer 6

• conscious state
• signs inc ICP
• signs meningism
• focal neuro signs
• dev signs
  dysmorphic features
  organomegaly

Question 7

Invx seizure

Answer 7

• biochem - glucose, electrolytes, Ca/Mg
• EEG
  MRI
  Metabolic and genetic invx
  video-EEG monitoring

Question 8

Tx of seizures and epilepsies

Answer 8

• counseling
• avoid precipitating factors = eg sleep deprivation, flashing lights
• lifestyle precautions/restrictions - driving, swimming etc
• antiepileptic drug if indicated
• tx for prolonged seizures, uncontrolled epilepsy