paediatric seizures

Question 1

Q1: 10 m.o. girl in A+E w generalised convulsion

BIBA 2 mins earlier although fit had been continuing for about 10 mins

had been unwell w a cold for some 12 h previously and was noted by mum to have a temp of 40˚C before the fit commenced

(a) what is the most likely dx?

Answer 1

febrile convulsion

Question 2

(b) what are your immediate actions before specific medication? suggest 4

Answer 2

1. call for senior help
2. A ⇒ protect airway
3. B ⇒ high-flow oxygen through trauma mask + pulse oximetry + auscultate for breath sounds
4. C ⇒ large bore IV access, fluid resuscitation, ABG, bloods (FBC, U+E, LFTs)
5. D ⇒ conscious level, check pupils
6. E ⇒ check for rash (e.g. petechial non-blanching), re-assess temperture
7. BM

^{n.b. for C, urinary catheter is a valid component but always done after seizure cessation}

Question 3

(c) you decide to stop the fit. how can this most appropriately be done?

Answer 3

benzodiazepines e.g. PR or IV diazepam or buccal midazolam or IV lorazepam

Question 4

(d) after successfully completing your initial treatment, you decide to control the child’s temperature. suggest 3 means of achieving this?

Answer 4

1. drugs (NSAIDs, paracetamol, aspirin)
2. stripping the child
3. removing blankets

Question 5

(e) the child’s mother later asks you if this episode means that her daugther should not have her next scheduled immunisations. is she eligible to have the immunisations under these circumstances?

Answer 5

yes, unless she is febrile or unwell at the time of vaccination

Question 6

(e) what 1 investigation would you consider essential in this girl?

Answer 6

urinalysis / urine culture to rule out UTI

Question 7

(f) when the child goes home, what 2 pieces of advice would you give to the parents about preventing another febrile convulsion?

Answer 7

1. ensure they have a thermometer so they can closely monitor child’s temperature when they are unwell
2. ensure they have a supply of paracetamol and ibuprofen in the home to give if the child is hot

Question 8

(e) what is the prognosis for this girl concerning liability to further convulsions?

Answer 8

• 33% of pts will have another febrile seizure, while 10-20% will have >=3 further episodes with most occuring within 2 years of the initial presentation
• there is also a 2-5% risk of developing epilepsy depending on type of febrile seizure (i.e. simple or complex)