Seizure

Question 1

When should seizure be treated immediately?

Answer 1

Child actively seizing with duration unknown or >5 mins
Known pathology (e.g. meningitis, hypoxic injury, trauma)
Cardio-respiratory compromise

Question 2

Red flags on seizure history

Answer 2

Head injury with delayed seizure
Developmental delay or regression
Headache prior to seizure
Bleeding disorder, anticoagulation therapy
Drug/alcohol use
Focal signs

Question 3

1st line treatment for seizures

Answer 3

Midazolam 0.15mg/kg (max 10mg) IM/IV or 0.3mg/kg (max 10mg) buccal/IN
Diazepam 0.3mg/kg IV/IO (do not give IM) or 0.5mg/kg PR

Question 4

2nd line treatment for seizures

Answer 4

Phenytoin 20mg/kg IV/IO
Levetiracetam 40mg/kg (max 3g) IV/IO
Phenobarbitone 20mg/kg (max 1g) IV/IO (commonly used in newborn seizures)

Question 5

3rd line treatment for seizures

Answer 5

RSI with propofol, thiopentone
Midazolam infusion
Ketamine
Pyridoxine

Question 6

When should imaging be considered?

Answer 6

Focal seizure
Patients requiring 3rd line agent
Children <6 months
Signs of elevated ICP
Bleeding disorder/coagulation
Child has not returned to baseline after post-ictal period and medication effect has passed

Question 7

Most common causes of afebrile seizures

Answer 7

Benign focal epilepsy of childhood (BFEC)

Idiopathic generalised epilepsy (IGE)