Seizures Flashcards
Definition of febrile convulsion. Why do children and not adults get them? What percentage of children get them?
Convulsion in child between 6 months and 6 years, who is currently febrile and has no history of previous afebrile seizure, current neurological condition or CNS infection.
Children’s CNS is immature and more susceptible to inflammatory insults, so higher chance of febrile seizure. 3% of kids get them
Difference between simple and complex febrile convulsion?
Simple - These are generalised, tonic-clonic seizures lasting less than 15 minutes that do not recur within the same febrile illness.
Complex - longer than 15 minutes, have focal features within seizure, reoccur within same febrile illness, or have incomplete recovery within 1 hour
What are the aims of management in a febrile convulsion?
Manage convulsion - DRSABCDE, supportive care for 5-10 minutes. After 10 minutes, secure IV access and give benzodiazepine
Ix and treat underlying illness once stable
Is there any role for paracetamol in a febrile convulsion?
No - does not reduce risk of future febrile convulsions.
What is the risk of recurrence of a febrile seizure in the future? How soon after the first febrile seizure do they usually get another (if they get one at all)?
Depends on age of child; if 1 year old, 50%. if 2 years old, 30%. Usually reoccurs in the next 6 months
Name 3 risk factors for epilepsy for a child whose had a febrile seizure. What’s the risk of developing epilepsy for a child with 0, 1 or 2 or more risk factors?
FHx of epilepsy, any neurodevelopmental problem, or an atypical febrile convulsion (focal or prolonged)
0 risk factors - 1% (same as general population)
1 - 2%
2 or more - 10%
What is the definition of an epileptic seizure?
Episodic neurological phenomena from abnormal, excessive hypersynchronous neuronal activity
Name 5 Ddx for an epileptic seizure in a child (i.e. secondary causes of a seizure)
Febrile convulsion Meningitis/CNS infection Syncope (breath-holding spell, long QT, vasovagal) Normal behaviour (sleep jerks) Hypoglycaemia coma Parasomnias Migraine Psychogenic
What is the main symptomatic difference between a generalised and focal seizure?
In generalised seizure, patient always loses consciousness (not always in focal)
What is the classical definition of childhood epilepsy?
Recurrent (> 1), unprovoked (afebrile) epileptic seizures
On what factors are epileptic syndromes characterised on?
Age, seizure type, EEG findings, prognosis
What are the 2 main classifications of etiologies of epilepsy? Which group has a better prognosis?
Genetic (idiopathic/primary) vs structural/metabolic (secondary/symptomatic)
Genetic carries a better prognosis - better response to therapy
Name 5 general causes of secondary (structural/metabolic) epilepsy in children
Developmental lesions Cerebrovascular events (stroke, HIE) Infection (meningitis, febrile status epilepticus) Neoplasia Metabolic disorders Chromosomal abnormalities Degeneration (Alpers syndrome)
What Ix are usually done for people with recurrent seizures?
EEG +/- video monitoring
MRI if suspect a secondary cause
Metabolic/genetic Ix if MRI is negative and still suspect it’s a secondary cause
What are the 3 main questions you’re trying to answer when confronted with a child with a seizure?
- Is this an epileptic seizure of a non-epileptic event?
- If it’s epileptic, is it focal or generalised?
- If it’s epilepsy, does it have a genetic or structural/metabolic cause?
