Suspected Seizure Flashcards
What is status epilepticus?
Single seizure >5 mins or 2 more seizures within a 5 min period without person returning to normal between them (no refractory period).
What is the management of status epilepticus?
- ABC - airway adjunct, high flow O2, blood glucose
- 1st line: if still seizing after 5 mins - benzodiazepines (diazepam/lorazepam)
- Pre-hospital: can give diazepam rectally or buccal (oromucosal) midazolam (buccal midazolam is preferred) - rectal paraldehyde can be given but interacts with plastic so give it via glass syringe
- In hospital: IV lorazepam (may be repeated once after 10-20 mins)
- If still seizing (<10 mins) give 2nd line - phenytoin and phenobarbital infusion (paraldehyde PR 0.8ml/kg of the 50:50 mixture with oil, give while preparing or infusing phenytoin, use should not delay phenytoin)
- Reconfirm it is a seizure and get senior help, seek anaesthetic/ICU advice
- If no response within 45 mins of onset - induced coma via GA
- Shouldn’t give >3 doses of benzos - respiratory depression
What are differentials for seizures?
- Febrile seizure: triggered by high temperatures
- Encephalopathy: fluctuation of altered consciousness
- Encephalitis/meningitis
- Brain tumour: focal neurology present
- Epilepsy: need to have several seizures each on separate occasions
- Metabolic disorder: the younger the unconscious child, the higher the possibility of a metabolic cause for being persistently unconscious/encephalopathic or intractable seizures - FH of infant deaths
- Poisoning/intoxication
- Post-ictal: if the child wakes up and returns to normal self (usually within an hour of seizure)
- Sepsis/shock: illness prodrome
- Trauma/head injury
- HTN
- Hydrocephalus
What questions do you want to ask about prior to the seizure?
- Behavioural change
- Health that day
- Circumstances
- Time of episode
- Setting
- Activity at onset
- Warning: visual, hearing, fear, sweaty, lightheadedness
- Objective warning
- Triggers
- Time of last meal
What questions do you want to ask about during episode?
- Onset: sudden?
- Unresponsive, awareness
- Symmetrical
- Facial movement, eye movements
- Posturing, motor movements, clonic/myoclonic/spasm or tonic
- Breathing changes
- Incontinence
- Autonomic
- Visual disturbance
- Duration of seizure
What questions do you want to ask about post episode?
- Sleepy/disorientated
- N+V
- Amnesia for events
- Strange behaviour
- Weakness
- Injuries: tongue
- Time to recovery
What recent illness could correlate with a seizure?
- Fever
- Diarrhoea
- Wheeze/chest symptoms
- Weight loss
- Recent headaches
- Head injury/trauma
- Visual disturbances
- Vomiting or nausea/personality change
- Poor co-ordination
- New weakness
- Taken drug/substance
What is a simple febrile seizure?
- Short generalised seizure <5 mins - only 1 seizure
- Not recurring within 24hrs
- Occurring during a febrile episode and not acute disease on nervous system
- In a child aged 6 months to 5yrs, with no hx of neurological deficits
What is a complex febrile seizure (CFS)?
- Focal, generalised or prolonged seizure (>15 mins)
- Recurring >1 within 24hrs
- And/or associated with post-ictal neurological abnormalities - most commonly Todd’s palsy (usually localised to left/right side of body and usually subsides within 48hrs)
- If CFS lasts >30 mins or there are shorter serial seizure, without consciousness regained in between seizures, the disorder is called ‘febrile status epilepticus’
- Children have a slightly higher risk of developing epilepsy after complex febrile convulsions
What are indications for an urgent head CT or MRI?
- Encephalopathic or coma
- Suspected raised ICP
- Progressive neurological deficit
What are indications for an elective head MRI?
- In a child <2yrs at onset
- Hard focal neurological signs
- A focal epilepsy
- Associated significant learning difficulties
- Epilepsy resistant to full doses of 2 appropriate drugs
When would you do an EEG?
Urgent indications: - Suspected non-convulsive status - Non-traumatic encephalopathy - Coma of unknown cause Elective standard EEG: - Strong suspicion of epilepsy (to support classification) - Developmental or language regression - NOT generally after a first afebrile seizure or febrile seizures.
What is an epileptic seizure?
An epileptic seizure is a transient occurrence of signs +/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
What is epilepsy?
A disorder of the brain characterised by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure.
How is epilepsy defined?
A disease of the brain defined by ant of the following conditions:
- At least 2 unprovoked seizures occurring >24hrs apart
- One unprovoked seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after 2 unprovoked seizures, occurring over the next 10yrs
- Diagnosis of an epilepsy syndrome
