Paediatrics

Question 1

What are the possible causes of seizures in a young child (e.g. 2.5 years)?

Answer 1

Epilepsy
CNS infection
Febrile convulsions
Metabolic causes (hypo-glycaemia, -calcaemia, -magnesaemia, or hypo- and hypernatraemia)
Cerebral hypoxia
Head trauma/NAI
Toxins/poisoning

Question 2

What is the occurrence and recurrence rate of febrile convulsions?

Answer 2

Febrile convulsions occur in 3% of children, between 6 months and 5 years. ~One-third of children will have further seizures.

Question 3

Do febrile convulsions increase the risk of developing epilepsy?

Answer 3

1-2% develop epilepsy, similar to risk for all children. No impact on intellectual performance either.
Complex febrile seizures (prolonged, focal or repeated) have an increased risk of 4-12% of subseqent epilepsy.

Question 4

What prophylactic medicine is offered for children prone to recurrent febrile convulsions?

Answer 4

None - side-effects out weigh potential benefits.

Parents may be given rectal diazepam to administer at home.

Question 5

What advice should be given to parents of a child who has suffered a febrile convulsion?

Answer 5

Give regular antipyretics e.g. paracetamol to reduce fever and use conservative measures such as removing excess clothing and tepid sponging to reduce the risk of febrile convulsions.

Question 6

What PMH should be enquired about for a child who has had a seizure?

Answer 6

Pregnancy and delivery: chance of perinatal hypoxia or maternal fever?
Developmental milestones
Previous fits
History of meningitis, encephalitis, head injury?

Question 7

What should be enquired about in the family history for a child who has had a seizure?

Answer 7

Is there any history of epilepsy, febrile convulsions, brain damage or neurological problems?