Afebrile Seizures

Question 1

Causes

Answer 1

1. Hypoglycaemia
2. Epilepsy
3. Stroke, TBI, increased ICP or haemorrhage
4. Meningitis
5. Electrolyte disturbances - hypo-natraemia, -calcaemia or magnesemia.
6. Drug/toxin overdose

Question 2

Keep safe and observe

Answer 2

1. Stay - do not leave child unattended.
2. Time - duration of seizure.
3. Protect - monitor airway, provide padding, raise bedrails, remove hazardous items.
4. Observe - focal features?
5. Reassure - patient and family members.

Question 3

Active treatment - indications

Answer 3

1. Seizure > 5 min or duration unknown
2. Known pathology - e.g. meningitis, hypoxic injury, trauma.
3. Cardio-respiratory compromise

Question 4

Active treatment - procedure

Answer 4

0-5 min - continuous monitoring, O2T, venous access, BGL and 1st-line agent.
5-10min - repeat 1st-line agent.
10-15min - administer 2nd-line agent.
15-20min - administer alternative 2nd-line agent.
20+ min - seek senior assistance for RSI and 3rd line agent.

Question 5

Active treatment - agents

Answer 5

1st line - midazolam: 0.15mg/kg OR diazepam: 0.3mg/kg.
2nd line - levetiracetam: 40mg/kg OR phenytoin: 20mg/kg
3rd line - propofol.

Question 6

Post-seizure care

Answer 6

1. Recovery position
2. Monitor and maintain airway
3. Monitor for further seizure activity
4. Further investigations - BGL, VBGs/electrolytes and/or imaging (if < 6months, 2nd-3rd line agent, incomplete recovery)

Question 7

Patient education

Answer 7

1. Risk of recurrence
2. Seizure first aid and management plan
3. Advise to record future seizures
4. Written information
5. Resource contacts - e.g. Epilepsy foundation.
6. Emergency medications - e.g. buccal midazolam.