The Child with Seizures

Question 1

What is the definition of a febrile seizure?

Answer 1

• Syndrome where a febrile (38+) child has a brief, generalised seizure in the absence of CNS infection or previous afebrile seizures
  
  • Can be simple (generalised) or complex (partial)

Question 2

How is a child with a febrile seizure managed?

Answer 2

• Exclude meningitis
  
  • LP/blood culture only if suspicious signs/symptoms (bulging, fontanelle, nuchal rigidity, < 12, focal seizure, pre-treatment with oral Abs)
• Reduce fever - not disease modifying, symptomatic only
  
  • Cool child e.g. remove excess clothing
  • Paracetamol
• Terminate prolonged seizures > 5mins
  
  • Diazepam

Question 3

What ongoing risks do children with febrile seizures have?

Answer 3

• 6 x increase in risk of epilepsy (3% will go on to develop)
• No increase in intellectual or developmental disability, neurological disorders or death

Question 4

What is the prognosis of childhood epilepsies in general?

Answer 4

• 50% favourable, 25% improve, 25% respond poorly to treatment

Question 5

What are some of the features of West syndrome?

Answer 5

• Epilepsy onset 3-8 months
• Nodding (head and shoulder hunching), salaam (hands together greeting pose) and lightning (leg flexion, knees to chest) can occur separately or together