Pediatric Seizure PDF
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Duhok College of Medicine
Khalaf Hussien Gargary
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Summary
This presentation details information on seizures in children. Covering different types, causes, and treatments. Includes key aspects for medical professionals. It is not a past paper.
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Seizures in Children Khalaf Hussien Gargary MD MBChB DCH CABP FAAP Professor of Pediatrics Consultant Pediatrician Learning Objectives Identify Identify different types of seizures in children Differentiate Differentiate the causes for seizures Recognize Recognize compo...
Seizures in Children Khalaf Hussien Gargary MD MBChB DCH CABP FAAP Professor of Pediatrics Consultant Pediatrician Learning Objectives Identify Identify different types of seizures in children Differentiate Differentiate the causes for seizures Recognize Recognize components of a seizure workup Discuss Discuss treatment for seizures in children Seizures Uncontrolled firing of nerves in the brain Generalized seizures Involves both cerebral hemispheres Focal seizures Involves one hemisphere Young infants Can be subtle Can look different Seizure Prevalence Can affect 1% of the population Febrile seizures Can affect 4-10% of the population 15% of children who have a first seizure will have another one in the next year Seizures are different depending on where they originate in the brain Alteration of vital signs and respiratory suppression are possible During a Seizure After a seizure there is a period of sleepiness (post-ictal period) Patients can develop transient paralysis (Todd’s paralysis) after a seizure Tonic-clonic (generalized) May be tonic or clonic Focal (one side of the body) Types of Myoclonic jerks Few to many short jerks in the body Seizures Atonic akinetic “drop spells” Absence No jerking; “staring spells” Seizure lasting for more than 30 minutes Status Epilepticus May result in death Infections Toxins Differential Traumatic/Vascular Diagnosis Idiopathic (Epilepsy) of Seizures Congenital Anomalies Genetic causes Metabolic causes Brain Abscess Encephalitis Meningitis Infectious Tuberculosis Viral illnesses HIV Causes Toxoplasmosis Birth injury Congenital Anomaly Neurologic Degenerative cerebellar disease Causes Hypoxic ischemic encephalopathy VP Shunt dysfunction Hypercarbia Hypocalcemia Hypoglycemia Metabolic Hyponatremia Causes Hypomagnesemia Inborn errors of metabolism Pyridoxine deficiency Cerebral contusion Traumatic causes Stroke Child abuse Cocaine, methamphetamine Lead poisoning Organophosphates Toxins Salicylates Sympathomimetics Tricyclic antidepressants Withdrawal from alcohol Brain tumors Neoplastic Metatstatic cancers Infantile spasms General myoclonic jerking of neck, trunks, limbs Begin around 3-7 months Associated with some genetic syndromes Typical EEG finding of “hypsarrhythmia” Bad prognosis: Death occurs within 3 years in 1/3 of children Profound cognitive effects Seizures are difficult to control Survivors may develop other types of seizures Simple partial seizures, often in face and hands EEG with Centrotemporal Benign spikes Rolandic Seizures happen during or Epilepsy around the time of sleep Almost always outgrown by adolescence Breath holding spells Syncope These look Panic attack like Tic disorders seizures, Benign myoclonus (in infants) but Dystonic reaction aren’t…. Pseudoseizures Night terrors EEG Seizure Electrolytes (to rule out workup--basic metabolic anomaly) CBC (to rule out infection) Necessary based on your assessment and physical exam Additional workup May need head CT or MRI Treatment: Febrile Seizures Loosen tight clothing Protect the person from injury If they have fallen, place something soft under their head Stay with them until they recover fully Call for medical care if seizure lasts more than 5 minutes Do not: Try to restrain the person Put anything between their teeth Move them, unless they are in danger Give them food to eat or drink Acute seizure control Medication side effects Valproic Acid and Phenobarbital Lamotrigine Phenytoin May cause fetal Long term effect Stevens-Johnson anomalies in pregnant decreased cognitive syndrome women ability Gum hyperplasia Need to check levels for adequate blood level Vagal Nerve Stimulator Non- pharmacologic Surgery seizure treatment Ketogenic Diet Occur in about 4% of children ages 6 – 60 months in association with a febrile illness Most common form of seizures and neurological disorder in children Febrile Seizures 30-40% will have at least one reoccurrence General population risk of epilepsy 0.5-1%, risk in patients with febrile seizures is 1-2%. Symmetric Febrile Seizures Lasts less than 15 minutes (most