Seizures in Children PDF

iii congenital Neeroldial Gerthatic Here’s a comprehensive breakdown of the etiology, clinical presentation, management, and history/presenta...

iii congenital Neeroldial Gerthatic Here’s a comprehensive breakdown of the etiology, clinical presentation, management, and history/presentation of the common types of seizures in children: 1. Febrile Seizures Etiology Occurs with fever >38°C without CNS infection or underlying epilepsy. Peak age: 6 months to 5 years. Often triggered by rapid rise in temperature. Family history of febrile seizures or epilepsy increases risk. Clinical Presentation Simple febrile seizure: Generalized tonic-clonic seizure lasting 15 minutes), or multiple seizures within 24 hours. History and Examination Recent fever, often due to viral infections (e.g., influenza, HHV-6 causing roseola). No prior history of seizures. Developmental milestones are normal. Management Acute: Ensure airway patency, place the child in the recovery position. Antipyretics for comfort (e.g., paracetamol). No routine anticonvulsants for simple febrile seizures.  Prophylaxis: Rarely needed unless recurrent complex febrile seizures. 2. Neonatal Seizures Etiology Metabolic: Hypoglycemia, hypocalcemia, hyponatremia. Infections: Meningitis, TORCH infections. Birth trauma: Intracranial hemorrhage. Hypoxic-ischemic encephalopathy (HIE): Most common cause. Genetic conditions: Pyridoxine deficiency. Clinical Presentation Subtle signs: Eye deviation or blinking. Apnea episodes. Lip-smacking or sucking movements. Rhythmic limb jerking or tonic posturing. History and Examination Perinatal history: Birth asphyxia, maternal infections, or trauma. Poor feeding, lethargy, or irritability. Management Acute: Correct metabolic abnormalities. Treat infections (antibiotics/antivirals). Anticonvulsants: Phenobarbital is first-line. Monitor EEG and neuroimaging (cranial ultrasound, MRI). 3. Infantile Spasms (West Syndrome) Etiology Often associated with: Hypoxic-ischemic encephalopathy. Tuberous sclerosis complex. Genetic disorders (ARX gene mutations). CNS infections or metabolic disorders. Clinical Presentation Age: 3-12 months. Triad: 1. Infantile spasms: Sudden, symmetric flexor or extensor jerks of the head, trunk, and limbs. 2. Developmental regression. 3. EEG: Hypsarrhythmia (disorganized high-amplitude waves). History and Examination Delayed milestones. Episodes occur in clusters, often upon waking. Management First-line treatment: Adrenocorticotropic hormone (ACTH) or oral steroids (prednisolone). Vigabatrin (especially in tuberous sclerosis). Long-term: Manage developmental delay and address underlying cause. 4. Absence Seizures Etiology Typically idiopathic and genetically determined.  Seen in childhood absence epilepsy (4-10 years). Clinical Presentation Sudden episodes of staring with unresponsiveness lasting 5-15 seconds. Subtle automatisms: Lip-smacking, eye blinking. No postictal confusion. History and Examination Often triggered by hyperventilation. Normal development and neurological exam. Management First-line: Ethosuximide. Alternatives: Valproic acid or lamotrigine. 5. Tonic-Clonic Seizures Etiology Genetic epilepsy syndromes (e.g., Juvenile Myoclonic Epilepsy). Structural causes: Tumors, trauma, infections. Metabolic abnormalities. Clinical Presentation Tonic phase: Sudden stiffening of limbs. Clonic phase: Rhythmic jerking of limbs. Associated with loss of consciousness and postictal confusion. History and Examination Witnessed episodes of convulsions with tongue biting or urinary incontinence. Management Acute: Ensure airway, provide oxygen, and place the child in the recovery position.  Maintenance: Valproic acid, carbamazepine, or levetiracetam. 6. Atonic Seizures (Drop Attacks) Etiology Often seen in Lennox-Gastaut syndrome. Associated with developmental delay and diffuse brain abnormalities. Clinical Presentation Sudden loss of muscle tone → child collapses (“drop attack”). High risk of injury. History and Examination Frequent seizures with global developmental delay. Management Anti-epileptic drugs (AEDs): Valproic acid, lamotrigine, or rufinamide. Helmet: To prevent head injury during drop attacks. 7. Myoclonic Seizures Etiology Often seen in Juvenile Myoclonic Epilepsy (JME). Triggered by sleep deprivation, stress, or flashing lights. Clinical Presentation Sudden, brief muscle jerks. No loss of consciousness. History and Examination Episodes occur in the morning after waking up. Management  First-line: Valproic acid. Alternatives: Levetiracetam or lamotrigine. Summary Table Seizure Type Age Group Clinical Presentation Management Febrile Seizures 6 months - 5 years Fever with tonic-clonic seizures Antipyretics; no anticonvulsants. Neonatal Seizures Birth - 28 days Subtle seizures (eye deviation) Treat underlying cause; phenobarbital. Infantile Spasms 3-12 months Flexor/extensor spasms; regression ACTH, steroids, vigabatrin. Absence Seizures 4-10 years Staring spells, eye blinking Ethosuximide. Tonic-Clonic Any age Stiffening → jerking, LOC Valproic acid, levetiracetam. Atonic Seizures 1-8 years Sudden loss of tone, drop attacks Valproic acid; protective helmet. Myoclonic Seizures Adolescence Sudden brief jerks; no LOC Valproic acid. Let me know if you’d like further clarification on any specific seizure type! Seizures in children can vary in presentation based on age, cause, and seizure type. They are broadly classified into focal and generalized seizures, along with specific pediatric conditions. Below is a detailed overview: 1. Focal (Partial) Seizures Origin: Begin in one specific part of the brain. Types: Focal aware seizures (simple partial): Child remains conscious; symptoms include twitching, sensory changes, or autonomic signs. Focal impaired awareness seizures (complex partial): Altered awareness with automatisms like lip-smacking, chewing, or fumbling. Common features: Symptoms depend on the brain area involved (e.g., motor, sensory, or autonomic signs).  May progress to focal to bilateral tonic-clonic seizures. 2. Generalized Seizures Origin: Involve both hemispheres of the brain from onset. Types: 1. Tonic-clonic seizures (grand mal): Phases: Tonic phase: Sudden stiffening of limbs. Clonic phase: Rhythmic jerking of limbs. Associated with loss of consciousness and postictal confusion. 2. Absence seizures (petit mal): Brief episodes (5-15 seconds) of staring, unresponsive to stimuli. Sudden onset and offset, often seen in school-aged children. May have eyelid fluttering or subtle automatisms. 3. Myoclonic seizures: Sudden, brief muscle jerks. No loss of consciousness. Seen in conditions like juvenile myoclonic epilepsy. 4. Atonic seizures (drop attacks): Sudden loss of muscle tone causing the child to collapse or drop objects. Often associated with severe epilepsy syndromes (e.g., Lennox-Gastaut syndrome). 5. Tonic seizures: Sustained muscle stiffness without a clonic (jerking) phase. Often occur during sleep and associated with epileptic encephalopathies. 6. Clonic seizures:  Repeated rhythmic jerking of limbs without a tonic phase. 3. Febrile Seizures Age: 6 months to 5 years. Association: Occur with a fever (typically >38°C) without CNS infection. Types: Simple febrile seizures: Generalized tonic-clonic, lasting 15 minutes), or occur multiple times within 24 hours. 4. Neonatal Seizures Age: Birth to 28 days of life. Features: Subtle presentation: Eye deviation, lip-smacking, apnea, or rhythmic movements of limbs. Causes: Hypoxic-ischemic encephalopathy, metabolic disturbances, infections, intracranial hemorrhage. 5. Epileptic Syndromes in Children West syndrome (Infantile Spasms): Age: 3-12 months. Features: Infantile spasms: Sudden flexor or extensor jerks of the neck, trunk, or limbs. Hypsarrhythmia: Abnormal EEG pattern. High risk of developmental delay. Lennox-Gastaut Syndrome:  Age: 1-8 years. Features: Multiple seizure types (tonic, atonic, atypical absence). Associated with intellectual disability. Benign Rolandic Epilepsy (BRE): Age: 3-13 years. Features: Focal seizures, often during sleep, involving face and mouth (drooling, twitching). Self-limiting with a good prognosis. Juvenile Myoclonic Epilepsy (JME): Age: Adolescence. Features: Myoclonic jerks, generalized tonic-clonic seizures, and absence seizures. Often triggered by sleep deprivation. 6. Status Epilepticus Definition: Seizures lasting >5 minutes or recurrent seizures without recovery of consciousness. Emergency: Requires immediate medical intervention to prevent brain injury. 7. Reflex Seizures Triggered by specific stimuli (e.g., flashing lights, reading, hot water). Summary Table: Seizure Type Key Features Focal seizures Start in one area; +/- awareness. Tonic-clonic Stiffening + jerking; loss of awareness. Absence Brief staring spells. Myoclonic Sudden muscle jerks. Atonic Sudden loss of tone (drop attacks). Febrile seizures Seizures with fever in children