Seizures Flashcards
What differentials should be considered in a child with a seizure?
Epilepsy Febrile convulsions Breath-holding attacks Reflex anoxic syncope Syncope (fainting) Benign paroxysmal vertigo Pseudo-seizures Migraine Others: Cardiac arrhythmias (long QT), Self-gratification, Tics, daydreaming, night terrors and Sandifer syndrome.
What are the most important questions to ask in the history of a child with a seizure?
What happened before seizure
What happened during seizure (e.g. tongue biting) and how long
What preceded the seizures – was there a post ictal state
How are epileptic seizures categorised
Generalised: involving the whole brain
Focal (partial epilepsy) – frontal, temporal occipital
Simple vs complex = reduced consciousness or not
What is west syndrome?
Infantile spasms (west syndrome) – 5 months clusters of head nodding and arm jerks every 3-30secs. Treat with prednisolone 1st line and vigabatrin 2nd line. Often associated with serious underlying condition – treat with ACTH/corticosteroids and vigabatrin, pyridoxine or ketogenic diet
What is lennox-gastaut syndrome?
Lennox-Gastaut syndrome – may be extension of infantile spasms, 1-5yrs, atypical absence with falls and jerks, majority have mental handicap.
What is benign rolandic epilpesy?
• Benign Rolandic epilepsy – more common in boys than girls, unilateral facial paraesthesia upon waking up
What is juvenile myoclonic epilepsy or Janz syndrome?
• Juvenile myoclonic epilepsy (Janz syndrome) – typically teen girls, infrequent generalised seizures in morning, daytime absence and sudden shock like myoclonic seizure – usually responds well to valproate
What is a tonic-clonic or grand mal seizure?
Tonic-Clonic (grand mal) – limbs stiffen then jerk forcefully with loss of consciousness. Treat with carbamazepine or sodium valproate
What are absence seizures or petit mal?
Absence seizures (petit mal) Common; starts at 4-7 years; resolves in adolescence. Brief episodes of unresponsiveness (no more than 10 seconds). Associated motor activity: repetitive purposeless movements of finger/mouth e.g. lip smacking (called automatisms); eye fluttering/flickering. Treat with ethosuximide then sodium valproate then lamotrigine and failing those 3 try combinations
What are myoclonic seizures?
Myoclonic seizures – child suddenly thrown to the ground – treated with valproate
How are partial seizures treated?
Partial seizures – treat with carbamazepine or lamotrigine
What causes epilepsy?
Often none is found but can be as a result of:
Infection
Hyponatraemia or another electrolyte imbalance
Hypoglycaemia
Any kind of cerebral trauma
How should a seizures be investigated?
Expert EEG MRI (CT in emergency situations) ECG U&E Glucose Temperature Lumbar puncture
How should seizures be managed in an emergency?
ABCDE and get help
Secure airway and give oxygen
Secure IV access
Check BP, pulse, glucose, Ca and Mg
Start a clock
Check temperature, if raised give rectal paracetamol
After 5 minutes if seizures continue give lorazepam IV or buccal midazolam
After 15 mins of seizures continue repeat dose of lorazepam or midazolam, prep phenytoin
After 20 mins give phenytoin or phenobarbital then call anaesthetist and prep for intubation
After 40 mins call PICU
How is epilepsy managed in the long term?
Prophylaxis with sodium valproate (generalised) or carbamazepine (partial)
Use one drug only and increase dose until fitting stops
Only start after 2nd seizure
