Understanding Seizures and Epilepsy

Seizures

• Involve abnormal electrical activity in the brain
• Diagnosed when two or more unprovoked seizures occur, separated by more than 24 hours
• Etiology can be secondary to triggers outside the brain, such as infection, fever, trauma, hypoxia, toxins, or cardiac arrhythmias
• Epilepsy is the cause triggers within the brain, leading to recurrent, unprovoked seizures
• Focal seizures involve one hemisphere, while generalized seizures involve the entire brain
• Generalized seizure types: absent, tonic/clonic, myoclonic, and atonic
• Pathophysiology involves disrupted electrical communication in the brain and an imbalance between excitatory and inhibitory mechanisms
• Diagnosis includes serum glucose, electrolytes, and calcium to rule out metabolic causes like hypoglycemia or hypocalcemia
• Lumbar puncture analyzes cerebrospinal fluid to rule out meningitis or encephalitis
• Skull X-rays evaluate for fracture or trauma
• CT and MRI identify abnormalities, intracranial bleeds and rule out tumors
• Electroencephalography (EEGs) may show findings for certain seizure types
• A normal EEG does not rule out epilepsy, as seizure activity is rarely present during testing; useful in evaluating seizure type and guiding medication selection
• Video EEGs capture the child's behavior with EEG changes for a more extended observation period
• Management involves seizure precautions like bed rails, oxygen, suction, and side-lying
• Medications: anticonvulsants (lorazepam, diazepam, Fosphenytoin), ketogenic diet, and vagal nerve stimulator implants
• Education focuses on safety, aspiration risk, intellectual disabilities, avoiding sports with head injury risk, driving restrictions (seizure-free for six months), and family support
• Complication: status epilepticus, characterized by prolonged or clustered seizures without consciousness recovery
• Status epilepticus treatment: basic life support and anticonvulsant administration

Hydrocephalus

• Characterized by the buildup of fluid in the brain's ventricles
• Results from an imbalance of CSF production, absorption, or drainage, increasing intracranial pressure
• Congenital risks: genetics, environmental factors during development, myelomeningocele, other neural tube defects, and intrauterine infections
• Acquired risks: injury, disease, infections, malformations (Chiari)
• Manifestations include irritability, lethargy, poor feeding, headaches in older children, vomiting, and changes in the level of conciousness
• Diagnosis involves skull X-rays, CT, and MRI
• Treatment: ventriculoperitoneal shunt, a catheter to redirect CSF to other body areas
• Shunt complications include infection, obstruction, and the need for revisions as the child grows
• Monitor for increased ICP and signs of infection
• Complications of hydrocephalus: increased risk of developmental disabilities, visual problems, and memory abnormalities

Meningitis

• Bacterial meningitis is often caused by Haemophilus influenzae type B, linked to unvaccinated children
• Involves inflammation, swelling, and exudates, leading to brain tissue damage due to secondary infections
• Secondary infections can develop from URI, contaminated LP, trauma, spina bifida, VP shunts, and cochlear implants
• Risks include structural defects in the brain or spinal column, lack of immunizations, and external introduction of bacteria via surgical procedures
• Manifestations include headache, fever/chills, vomiting, photophobia, stiff neck, rash, irritability, lethargy, seizures, weak cry, poor sucking/feeding, opisthotonic positioning, bulging fontanel, and positive Kernig or Brudzinski signs
• Diagnosis is via lumbar puncture, showing increased CSF, WBC/protein, low glucose, and possible blood culture-septicemia
• Management involves antibiotics after obtaining cultures, seizure precautions, reducing ICP, monitoring fluid status, reducing fever, and droplet isolation for 24 hours after antibiotics
• Complications include septicemia and death
• Aseptic/Viral Meningitis is the most common type in children younger than 5 years
• Manifestations are similar to bacterial meningitis but less severe
• Treatment is similar to bacterial meningitis, without antibiotics until labs confirm no bacteria

Spina Bifida

• Refers to neural tube disorders affecting the spinal cord
• Occulta is hidden and typically does not cause developmental or motor skill issues; typically requires no treatment
• Cystica involves maternal drug use (anticonvulsants), folic acid deficiencies, genetics, and malnutrition as risks
• Meningocele is less serious, involving meninges herniating through a vertebral defect with a normal spinal cord
• Meningocele can involve little to minor neurological deficits
• Surgical correction is a common treatment for Meningocele
• Myelomeningocele is more serious because the spinal cord ends at the defect point, causing paralysis below the defect
• Myelomeningocele is visible via ultrasound at birth
• Myelomeningocele complications: orthopedic deformities, bladder/bowel incontinence, hydrocephalus, and developmental delay
• Multiple surgeries are often needed for myelomeningocele
• Latex allergy is linked to fruits and vegetables like avocados, mangos, celery, and apples
• Frequent catheterizations may be needed for bowel/bladder incontinence
• Promote nutrition via NGT or side-lying pre-operatively, or infant laying prone on mother who is supine to breast feed
• Prevent infection: keep the sac moist and sterile, report leakage, position infant prone or side-lying, maintain temperature in warmer/isolette, avoid RECTAL TEMP, and keep clean of urine/stool
• Maintain skin integrity: meticulous skin care, synthetic sheepskin under the infant, monitor skin breakdown

Reye’s Syndrome

• A rare condition of unknown origin, leading to brain swelling, liver failure, and death within hours
• Risks: age under 15 years, viral infection, and use of salicylates or salicylate-containing products like aspirin
• Manifestations include severe, continuous vomiting without effort, changes in LOC, lethargy/irritability, confusion, and hyperreflexia
• Diagnosis: coagulation labs (monitor for bleeding), elevated LFTs and serum ammonia, and decreased glucose
• Management: focuses SUPPORT CARE, maintaining cerebral perfusion, monitoring/preventing ICP, and managing seizures and fluid status
• Education: avoid alka-seltzer and pepto-bismol during viral infections
• Complications: long-term neurological damage and death (through DIC)

Duchenne Muscular Dystrophy

• Inherited X-linked muscle wasting disease eventually involves muscle dystrophy
• Risks: Boys age 3-6 with family history
• Manifestations: include late starts in walking, large calves in toddlerhood, clumsiness, difficulty with stairs or running, Gower's sign, symmetrical weakness, and loss of ambulation ability
• Management: physical and occupational therapy for resources, mobility aids, braces, positioning, corticosteroids, calcium and vitamin D supplements, and antidepressants
• Beta Blockers and ACE Inhibitors decrease cardiac workload
• Maintain healthy weight (protein)
• Complications: include frequent systemic infections, learning and behavioral disorders, aspiration pneumonia, cardiac dysrhythmias, and respiratory failure

Cerebral Palsy

• Characterized by abnormal motor patterns and postures due to brain dysfunction
• Risks include brain anomalies, infections, head trauma, anoxic injury, and maternal factors (infections, trauma, nutritional deficits, and drug use)
• Manifestations: failure to meet milestones, persistent primitive reflexes, gagging/choking/poor suck, tongue thrust, abnormal posturing/rigidity, asymmetrical crawl, poor head control, hyperreflexia, vision/speech/hearing difficulties, toe walking, arching the back, seizures, and strabismus
• Diagnosis: metabolic and genetic testing, MRI, EEG, XR Skull, and US
• Management: PT/OT interventions
• Assistive devices and mobility aids are used
• Braces and splinting are used to reduce shortening of muscle fibers
• Medications: Baclofen, Dantrolene, and Diazepam reduce spasticity
• Anticholinergics decrease abnormal movement
• Scopolamine and glycopyrrolate decrease saliva and control drooling
• Botulinum toxin (botox) is used
• Complication: aspiration and potential for injury