fits, faints and funny turns

Question 1

what can cause convulsions in a child?

Answer 1

• head injury (trauma)
• febrile convulsions
• hypoglycaemia
• electrolyte imbalance
• drug ingestion (poison)
• epilepsy
• meningitis
• asphyxial injury

Question 2

what kind of questions would you want to ask in a convulsions history?

Answer 2

• have they bumped head?
• diabetic?
• any infection symptoms?
  have they ingested anything?
• how is their development?

Question 3

what age group does a febrile convulsion tend to occur in?

what infections are not included in the febrile convulsions seizure?

Answer 3

• 6 months to 5 years

- encephalitis/ meningitis

Question 4

what is a simple febrile seizure defined as?

what is a complex febrile seizure?

what is febrile status epilepticus?

Answer 4

• isolated, brief, generalised tonic/clonic seizure lasting <15 mins
• > 15 mins, focal features, repeat features with the same illness, or incomplete recovery from seizure after one hour
• duration >30 mins

Question 5

what is the risk of the child getting febrile seizures if 1st degree relative?

what are the common precipitants?

Answer 5

• 10%
• viral infection
• otitis media
• tonsillitis

Question 6

what will you do examination wise if someone comes in with a suspected febrile seizure?

blood tests?

Answer 6

• septic screen: urinalysis, NPA/ CXR, blood cultures, check for rashes, LP, ENT exam
• blood glucose, FBC, ESR, coagulation, U and Es.

Question 7

how would you advise parents on how to treat fever at home?

Answer 7

• remove excess clothing
• give fluids and antipyretics
• stay with the child and check for signs of infection
• call 999 if seizure lasts more than 5
• safety net: serious symptoms, lack of normal alertness, dehydration, fever >5 days then come in

Question 8

what would be the criteria for admission of a febrile convulsion?

Answer 8

• first episode
• diagnostic uncertainty
• complex febrile seizure
• <18 months
• pretreatment with abx

Question 9

if the convulsion is lasting more than 3-4 mins then what should you give?

Answer 9

• rectal diazepam/ buccal midazolam

Question 10

what is the prognosis of febrile convulsions?

Answer 10

• at no > risk of epilepsy unless complex seizure or FH of epilepsy
• 1/3rd of children experience a recurrence