Fits

Question 1

Immediate management of a seizure?

Answer 1

place child in recovery position
if seizure stops after 5 minutes keep in recovery position (risk of aspiration), give paracetamol for headache, perform 3 minute toolkit to assess for serious complications of a seizure and serious underlying causes

if seizure does not stop after 5 minutes need to start pathway for status i.e. midazolam or lorazepam

Question 2

Commonest causes of true seizures in children?

Answer 2

febrile convulsions
epileptic seizure in a child with diagnosed epilepsy

Question 3

Explain what reflex anoxic seizures are?

Answer 3

• Reflex anoxic seizures (RAS) occur mainly in young children, unexpected stimulus e.g. pain or shock or fright causes the heart and breathing to stop, often diagnosed as temper tantrums/ breath holding – these are completely harmless and children grow out of them

Question 4

If a child has a headache when wakes up from a fit?

Answer 4

this is good evidence it was a true seizure

Question 5

What is a common cause of seizures in infants underfeeding?

Answer 5

hypoglycaemia

Question 6

If a child has a focal seizure?

Answer 6

unusual if don’t have a diagnosis of epilepsy and if they present for first time with a focal seizure they likely need a brain CT to rule out structural causes

Question 7

Explain what a febrile convulsion is?

Answer 7

• Seizures accompanied by fever without any CNS infection which occurs in infants aged 6 months to 5 years
• Most are simple febrile seizures meaning they are generalized tonic clonic seizures lasting less than 15 minutes, that do not recur within 24 hours or with the same febrile illness with complete recovery in 1 hour
• Aetiology is not really known

Question 8

Risk factors for febrile convulsions?

Answer 8

• Genetic – if parents had febrile seizures child is more likely to get them
• Majority occur in 12 -18 months age range
• More likely with fevers that come on rapidly or very high fevers
• More likely in some specific infections and can also occur post vaccination

Question 9

Management of febrile convulsion?

Answer 9

• Place child in recovery position and time seizure
• Seizures > 5 minutes need medical management
• Should give child paracetamol when come round from seizure as likely to have headache
• Assess child using 3-minute toolkit
• Must exclude serious complications of seizures e.g. aspiration and serious causes of seizures and fever e.g. meningitis and encephalitis
• May need a LP to exclude meningitis

Question 10

Prognosis of febrile convulsion?

Answer 10

• Generally, do not recur beyond age 5
• 2-7% go on to develop epilepsy