Convulsions

Question 1

Sequence of events

Answer 1

Open question

Timeline

Question 2

Symptom analysis

Answer 2

Before

• Witness: what exactly happened
• Precipitating factors: what were they doing beforehand, were they scared or crying, did they fall or hit their head, have they been unwell recently
• Aura: any funny feelings or sensations before the event

During;

• Duration: how long
• LOC: fall to floor, hit head
• Seizure: describe it, any shaking, did whole body or only part of it jerk
• Tongue biting: front or side
• Incontinence: wet or soil themselves
• pallor/cyanosis: blue or pale during the episode

After;

• Postictal state: how were they immediately afterwards, do they remember it
• Previous episodes: has it happened before
• General health: how are they in general, growing and gaining weight, sleeping well

Question 3

Paediatric systems review

Answer 3

See previous slide

Constitutional- FWARJNL

Question 4

Patients perspective

Answer 4

Feelings and impact on life

ICE

Question 5

Background Information

Answer 5

PMH- cerebral palsy, tuberous sclerosis, previous meningitis
DH
FH- any conditions run in family, epilepsy or febrile convulsions?
SH- how are siblings, how is school?

Question 6

Febrile convulsions

Answer 6

6 months-5 years
High temp at time of seizure, usually due to common viral infection
Tonic (and or clonic) symmetrical generalised seizure usually lasting less than 5 minutes
No signs of CNS infection/focal neurology/ previous epilepsy diagnosis
NB- discharging ear requires immediate imaging and treatment

Question 7

Reflex anoxic seizure

Answer 7

Brief, spontaneous- triggered by fear, anxiety, or pain
Lasts lest than 1 minute
Suddenly pale and limp, losing conscious briefly
Involuntary tonic and or clonic movements of the limbs
May have urinary incontinence and feel groggy afterwards
No tongue biting

Question 8

Breath holding attack

Answer 8

Precipitated by emotions like anger
Crying episode, breath withhold, and pallor/cyanosis develops
Loss of consciousness may ensue, but recovery is quick

Question 9

Epilepsy

Answer 9

Partial seizure
Generalised seizure
many variants associated with childhood epilepsy

Question 10

Meningitis

Answer 10

Unwell and drowsy child prior to convulsions with pyrexia
Non blanching rash of meningococcal septicaemia may be present
Discharging ear- they could have intracranial complications (meningitis) of otitis media (don’t think it’s the fever that has caused it, there could be intracranial extension- discharging ear and seizure: scan immediately)

Question 11

Others

Answer 11

Tuberous sclerosis
Vasovagal syncope
BPV
Hypoglycaemic attack

Question 12

Investigations

Answer 12

Bedside- neuro exam, observations, ECG-arrhythmia
Bloods- blood cultures, FBC UE LFT glucose
Specialist- LP, EEG (during a seizure)