Seizure disorders in children

Question 1

what are some causes of ‘non-epileptic seizures’?

Answer 1

febrile seizures
acute symptomatic seizures due to meningitis/trauma
convulsive syncope
breath-holding spells

Question 2

in what kind of seizure will consciousness be impaired?

Answer 2

ALWAYS in generalised seizures

or in focal seizures which become generalised

Question 3

what do we call seizures where you retain consciousness?

Answer 3

simple partial seizures (relate to focal seizures because generalised seizures are ALWAYS with impaired consciousness)

Question 4

ddx for seizure like activity?

Answer 4

syncope
breath-holding spells
sleep jerks (normal phenomenon)
parasomnias
migraines
movement disorders e.g. tics, stereotypy
psychogenic

Question 5

what is the difference between tremor and clonic jerking?

Answer 5

clonic jerking has a contraction and relaxation phase whereas a tremor doesn’t.

Question 6

if you ever have awareness of a seizure, it must be …..?

Answer 6

focal seizure or aura

Question 7

how can we provoke an absence seizure?

Answer 7

hyperventilation

Question 8

what is the classical definition of epilepsy in paediatrics?

Answer 8

recurrent (2 or more) unprovoked (afebrile), epileptic seizures

Question 9

what are the two categories of epilepsy which may indicate prognosis for the child?

Answer 9

genetic/idiopathic/primary- children with predisposition for epilepsy but normal neurology, may have a family history of seizures–> good prognosis

secondary/structural/metabolic- children have epilepsy from some structural/metabolic primary cause e.g. brain trauma, hypoglycaemia, intracerebral tumour etc

Question 10

what is the peak age for breath holding episodes?

Answer 10

1-2 year old toddlers

Question 11

febrile convulsions occur in –% of healthy children

Answer 11

3%

Question 12

what are some things you should tell a parent about what to do if their child has another febrile convulsion?

Answer 12

Tell them that they may notice their child LOC, become stiff, jerk, red or blue in the face. This may last for several minutes and they may be drowsy/irritable afterwards.

• Stay calm, time the episode, remove harmful objects, recovery position, don’t put anything in their mouth

IF:
>5 minutes, child does not wake up after convulsions stops, child has another convulsion within the same febrile illness, child looks really sick –> call ambulance

Question 13

what is the recurrence rate for febrile convulsions for a child?

Answer 13

Recurrence rate depends on the age of the child; the younger the child at the time of the initial convulsion, the greater the risk a further febrile convulsion (1 year old 50%; 2 years old 30%).