Child Seizures Flashcards
Causes
A. Acute Seizure
- Febrile Seizure
- First epileptic fit.
- Symptomatic seizures
• CNS causes:
- Infection p meningitis, encephalitis, brain abscess.
- Irritation p brain edema
- Tumors of the brain
- Toxic p tetanus, drug (e.g aminophylline), lead encephalopathy
- Hemorrhage p trauma, hemorrhagic blood diseases.
- Hypoxia p hypoxic ischaemic encephalopathy.
- Hypertensive encephalopathy.
• Metabolic causes:
- Bilirubin encephalopathy
- Uremic encephalopathy
- Hepatic encephalopathy
- Hypo (glycemia, calcemia, magnesemia)
- Hypo or hypernatremia.
- Pyridoxine (B6 ) deficiency
- Inborn errors of metabolism
B. Recurrent Seizures
- Epilepsy
- Symptomatic seizures Tetany
- Degenerative brain diseases
- Chronic metabolic causes
- Inborn errors of metabolism
- Hepatic /Uremic encephalopathy
Febrile Seizures general
Definition: Seizures in age vulnerable children due to:
- Rapid rise of body temperature.
- Due to extra cranial causes (mostly viral) Incidence:
- Affect 4% of children.
- Family history in about 20 % of cases (genetic base do exist)
- Recurrent in 30-50% of cases specially in those with family history
Diagnostic criteria of febrile seizures
- Age: 6 - 60 months (convulsions below or above this age is not febrile)
- Fits occur within 8-12hrs from onset of fever.
- No evidence of CNS infection (e.g. meningitis), nor metabolic disease
- Evidence of extra cranial infection (e.g. tonsillitis, otitis media, roseola)
- Occur in the absence of a history of prior afebrile seizures
- Type of convulsions:
- 😭simple typical
- Generalized tonic-clonic.
- Last < 15 min.
- One fit only in the same illness.
When recurrent within24h ➡️ simple febrile seizure plus. - The commonest form
😭Complex - Focal
- Last > 15 min
- Recurring within 24 hr
- Uncommon.
Lumbar puncture to rule out meningitis in febrile seizures😱😱😱
Mandatory in
- Infants below 6 months presenting with fever and seizures
- Ill looking children
- Clinical suspicion of meningitis
Major risk factors predicting recurrence of febrile seizures:
- Age <1 yr
- Duration of fever < 24 hr
- Fever 38-39 °C
Febrile seizure tx
- Acute care of febrile seizure attack:
y Full history and thorough examination y Fever control by paracetamol and tepid sponges or cold bath.
y Fit lasting more than 5 minuets➡️ Diazepam, lorazepam, or midazolam
🧿🧿6 months-5 years: 0.2-0.5 mg IV initially, repeat every 2-5 minutes; do not exceed 5 mg;
y Investigate and treat the underlying cause
y Treatment of febrile status epilepticus
Epilepsy definition
• A brain disorder with predisposition to generate seizures with neurobiologic, cognitive, psychologic, and social consequences of this condition
• It is considered to be present when 2 or more unprovoked seizures occur in a time frame of longer than 24 hr
Or
At least 1 unprovoked epileptic seizure with enough EEG and clinical information to demonstrate recurrences
Epilepsy causes
- Idiopathic (Now termed genetic) in 80% of cases
- Organic (secondary) in less than 20% of cases
- Congenital cerebral malformation.
- Degenerative brain diseases.
- Post-traumatic, post-hemorrhagic, post-infection, post-toxic, post-anoxic
. Classification of seizes
A. Focal (partial) seizures
- Focal seizures without impairment of consciousness (Simple partial seizures)
- Focal seizures with impairment of consciousness (Complex partial seizures)
- Focal seizures with secondary generalization
• Benign childhood epilepsy with centrotemporal spikes (BECTS)
• Landau-Kleffner epileptic aphasia syndrome - Focal seizures epileptic syndromes:
B. Generalized seizures: The whole body is affected.
- Absence seizures(Petit mal)
A. Typical Absence seizures
B. Atypical absence seizures - Generalized motor seizures (Grand mal)
- Myoclonic epilepsies
- Infantile spasms
- Atonic or Astatic seizures
- Focal seizures without impairment
of consciousness (Simple partial seizures
No aura
Brief
-Motor (focal tonic, clonic or atonic) or sensory Often there is a motor (Jacksonian) march from face to arm to leg
-No automatism
DD: Tics: Unlike tics, motor seizures are not under partial voluntary control
- Focal seizures with impairment of
consciousness (Complex partial seizures)-
—Often preceded by aura (e.g. visual hallucinations)
- Last 1-2 min
- Only motor fits
- Automatism may occur ➡️ automatic semi purposeful movements of the mouth (oral, chewing) or of the extremities (manipulating the sheets, shuffling, walking).
Benign childhood epilepsy with centrotemporal spikes (BECTS)
- Starts during childhood (ages 3-10 yr) and is outgrown in adolescence
- The child typically wakes up at night owing to a focal (simple partial) seizure causing buccal and throat tingling and tonic or clonic contractions of one side of the face, with drooling and inability to speak but with preserved consciousness and comprehension
- EEG shows typical broad-based centrotemporal spikes that are markedly increased in frequency during drowsiness and sleep
- Drug of choice: Carbamazepine, oxcarbazepine
Landau-Kleffner epileptic aphasia syndrome
- Focal seizures + verbal auditory agnosia and loss of speech
- Drug of choice: Valproate
Typical Absence seizures
s Incidence: More in girls. Usually start at 5-8 yr of age. Description:
- Sudden cessation of all motor activities or speech with a blank facial expression; awareness of surroundings is cut off
- Accompanied by eye lid flutter or upward rolling of the eyes
- Last seconds; after seizure patient resume the pre seizure activity.
- Frequently recurrent; may occur countless daily
- No aura , loss of consciousness nor postictal phase
- 🤬EEG➡️ p typical 3 Hz spike–and–slow-wave discharges
- 😓Hyperventilation for 3-5 min can precipitate the seizures and the typical EEG discharges
Atypical absence seizures
- Absences associated with myoclonic components and tone changes of the head (head drop) and body
- Precipitated by drowsiness
- 🤬Usually accompanied by 1-2 Hz spike–and–slow-wave dischargesة
