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seizures_paed

paediatric seizures

patient information sheets

Mx of suspected seizure disorder

  1. is it really a seizure? most are secondary to syncope and are not primary seizure disorders, even if there is incontinence or “post-ictal” confusional state
  2. what type of seizure disroder is it? See below
  3. further Ix such as EEG, CT brain or MRI, consider home videos for difficult cases not witnessed by doctors
  4. counselling - prognosis, activity risk management, ? Genetic counselling
  5. anticonvulsant Rx - most probably as good as each other but need to assess adverse reaction profiles as this is what will generally limit success to only 50% for any one drug
  6. drug levels have limited utility, mainly for compliance assessment, and then perhaps only for phenobarb and phenytoin. Valproate levels do not reflect CNS levels. Assessing levels may do more harm than good!
  7. some may benefit from surgical Mx
  8. home Rx with buccal midazolam 0.3mg/kg in 5mg/5ml has risk of resp. depression in up to 5% and takes 8 min to work on average, so only use if over 6 months old, has history of prolonged seizures lasting more than 10minutes, lives a distance from medical help, and parents are capable of using it appropriately.
  9. 1-2% of those with severe poorly controlled seizures have sudden unexpected death (SUDEP) - mainly an issue in non-compliant adolescents

classification of paediatric epilepsy

clinical categories

  • genetic (60%) vs structural or symptomatic (40%)
  • focal (60%) vs general (40%)

genetic

  • JME - most common cause
  • Dravet syndrome
  • APNFLE
  • CAE
  • benign focal epilepsy of childhood
  • etc

structural/"symptomatic"

  • genetic or developmental - eg. Tuberous sclerosis
  • acquired
    • Hippocampal sclerosis
    • trauma
    • CNS infections
    • etc
  • cryptogenic - 30-40% of all paed epilepsies

aetiology of prolonged seizures in children:

  • epilepsy associated with 1st presentation, anticonvulsant withdrawal, intercurrent illness, esp. if fever.
  • CNS infection
  • metabolic disturbance (eg. hypoglycaemia, hyponatraemia, or hypocalcaemia)
  • trauma

Causes of paediatric seizures by age of onset:

First day of life:

  • hypoxia
  • drugs
  • trauma
  • infection - meningitis, TORCH
  • hyperglycaemia
  • hypoglycaemia
  • pyridoxine deficiency - Rx pyridoxine 100mg
  • biotinidase deficiency - typically hypotonic, pale with sparse hair. Rx oral biotin

Day 2-3 of life:

  • infection
  • drug withdrawal - cocaine
  • hypoglycaemia
  • hypocalcaemia
  • developmental malformation
  • intracranial haemorrhage
  • inborn error of metabolism
  • hyponatraemia or hypernatraemia
  • benign familial neonatal seizures - 15% will develop a seizure disorder

Day 4 to 6 months old:

  • infection
  • hypocalcaemia - esp. if preterm, small for age, diabetic mother, or Hx asphyxia; DiGeorge syndrome;
  • hyperphosphataemia
  • hypomagnesaemia
  • hyponatreamia
  • developmental malformation
  • drug withdrawal
  • inborn error of metabolism

6 months to 3 years:

  • birth injury
  • infection
  • toxin
  • trauma
  • metabolic disorder
  • cerebral degenerative disease

> 3 years:

  • febrile convulsion (until age 5yrs)
  • idiopathic
  • benign Rolandic - 3 to 13 yrs, >50% are nocturnal only, grow out of it, no Rx needed, often have tonic facial grimace resembling stroke
  • infection
  • trauma
  • cerebral degenerative disease
seizures_paed.txt · Last modified: 2014/04/23 06:06 by gary1