Seizures in Children

Question 1

Describe a differential diagnosis for a child presenting with seizure

Answer 1

• Benign febrile seizure
• CNS (infection, tumour, trauma)
  
  • Idiopathic epilepsy and epileptic syndromes
• Metabolic causes (electrolytes)
• Drugs
• Seizure mimics (hypoglycaemia, breath holding spells, BPPV, syncope)

Question 2

What is the difference between a seizure and epilepsy?

Answer 2

• Seizure - episodic neurological phenomena resulting from abnormal, excessive, hypersynchronous activity from neurons in the cerebral cortex
• Epilepsy - neurological disorder in which there is a predisposition to seizures
  
  • Recurrent (>2), unprovoked (afebrile) seizures is another definition used

Question 3

When are children most likely to have a febrile seizure? What are the features of one?

Answer 3

• 6 months to 6 years
• Short (<5 min) tonic-clonic seizure with short post-ictal period
  
  • Associated fever or illness, family history
  • No history of non-febrile seizures or evidence of CNS infection

Question 4

How is a child with a febrile seizure managed?

Answer 4

• Exclude meningitis
• 2% chance only of progressing to epilepsy (1% in wider population)
• Antipyretics/fluids for comfort, treat underlying cause