Seizures in Childhood PDF

Seizures in Childhood DR JACQUELINE GYAPOMAA ASIBEY Definition A seizure is a clinical event in which there is a sudden disturbance of neurological function caused by an abnormal or excessive neuronal discharge. (source-Lissauer textbook of paediatrics) Seizures usually manifest as alteration o...

Seizures in Childhood DR JACQUELINE GYAPOMAA ASIBEY Definition A seizure is a clinical event in which there is a sudden disturbance of neurological function caused by an abnormal or excessive neuronal discharge. (source-Lissauer textbook of paediatrics) Seizures usually manifest as alteration of behaviour or function e.g. tonic, clonic movements, starring, drop attacks, autonomic disturbance. Motor manifestation of seizure is convulsion Seizures may be epileptic or non-epileptic. Seizures could be febrile or afebrile epileptic or non-epileptic seizure- causes Epilepsy Idiopathic (70–80%) – cause unknown but presumed genetic Secondary – Cerebral dysgenesis/malformation – Cerebral vascular occlusion – Cerebral damage, e.g. congenital infection, hypoxic-ischaemic encephalopathy, intraventricular haemorrhage/ischaemia Cerebral tumour Neurodegenerative disorders Neurocutaneous syndromes (source-Lissauer textbook of paediatrics) epileptic or non-epileptic seizure- causes Non-epileptic Febrile seizures Metabolic – Hypoglycaemia – Hypocalcaemia/hypomagnesaemia – Hypo/hypernatraemia Head trauma Meningitis/encephalitis Poisons/toxins. (source-Lissauer textbook of paediatrics) Febrile Seizures These are seizures occurring in young children aged 6 months and 6 years. as a result of elevated body temperature in the absence of a pathology in the brain. Affects about 2-3% of young children, between the ages of 6 months and 6 years. (source-Lissauer textbook of paediatrics) Febrile seizures are usually brief, generalised tonic, clonic and occur in conjunction with a rapid rise in body temperature.  There is a genetic predisposition 25% cases have a positive family history. Febrile Seizures-causes Common causes of febrile Seizures include : Malaria(uncomplicated) URTI Pharyngo-tonsillitis Otitis media Bronchopneumonia UTI Measles There are 2 main forms of febrile seizures - Simple and Complex Febrile Seizures Simple Complex -Commoner form seen -Multiple attacks in 24 hr -Single attack in 24 hr period period -Seizures are focal -Seizures are generalised -Last for < 15 mins -Duration of sz > 15 mins. Recurrence occurs in about 30-40 % of cases after the first episode. Risk of recurrence increases with - i) Young age at first episode ii) Onset of seizure at lower body temperature iii)positive family history of febrile seizure iv) the shorter the duration of illness Febrile Seizures Simple febrile seizures do not cause brain damage. The child’s subsequent intellectual performance is the same as in children who do not experience a febrile seizure. There is a 1–2% chance of developing epilepsy, similar to the risk for all children. Increased risk of epilepsy(4–12% risk) is associated with: Complex febrile seizure Family history of epilepsy Abnormal neurological examination at time of febrile seizure  Management of Febrile Seizures 1. ABC of resuscitation Airway - Clear & Maintain airways Breathing - Ensure that patient is breathing or assist respiration if needed Circulation - Assess circulatory function 2. Check Blood Sugar, if , 30mins or repeated seizures, such that the child does not regain consciousness in between attacks of seizure. It is a medical emergency! Predisposing Factors include : - Sudden withdrawal of AED - Poor drug compliance - Fever - Infection May follow febrile or afebrile seizures. It is a life-threatening condition and may be complicated by severe hypoxia, brain damage or sudden death. Management of Status Epilepticus Step 1. ABC of Resuscitation. Give Oxygen. Check Blood sugar Step 2. Rectal / IV Diazepam. Secure IV access. If seizures continue after 10mins, Step 3 IV Phenobarbitone 15-20 mg/ kg over 10mins. If no response Step 4. IV Phenytoin 18-20mg/kg slowly over 20 mins. If no response Step 5. IV Midazolam 10-20 ug/ kg over 10mins. If no response Step 6. Induction of anaesthesia with sodium thiopentone. References Textbook of Paediatrics-Lissauer Lecture notes(Dr Ike Lagunju,Paediatric Neurologist,University College Hospital,Ibadan/West Africa College of Physicians-Nigeria) Thank you