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Seizure Disorders in Children. Dr. Pushpa Raj Sharma FCPS Professor of Child Health Institute of Medicine. Definitions.

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seizure disorders in children

Seizure Disorders in Children

Dr. Pushpa Raj Sharma FCPS

Professor of Child Health

Institute of Medicine

definitions
Definitions
  • Seizure: A sudden, involuntary, time-limited alteration in behavior, motor activity, autonomic function, consciousness, or sensation, accompanied by an abnormal electrical discharge in the brain
definitions1
Definitions
  • Epilepsy: A condition in which an individual is predisposed to recurrent seizures because of a central nervous system disorderStatus Epilepticus: More than thirty minutes of continuous seizure activity, or recurrent seizures without intercurrent recovery of consciousness
introduction
Introduction
  • Convulsion associated with febrile disease
    • 2-4% of all children before the age of 5 years
  • Symptomatic seizures
    • 0.5-1%
  • Epilepsy:
    • Recurrent unprovoked seizures
      • First year of life:
        • 1,2/1 000
      • Childhood and adolescents:
        • 0,5-1/10000

Neurology Chapter of IAP

aetiology of epilepsy
Specific aetiology

Identifiable in only 30% of cases

Idiopathic 67.6%

Congenital 20%

Trauma

HIE

Congenital brain anomalies

Trauma 4.7%

Infection 4.0%

Vascular 1.5%

Neoplastic 1.5%

Degenerative 0.7%

Aetiology of Epilepsy

Neurology Chapter of IAP

seizure type
Seizure type

- Simple

(Normal consciousness)

- Complex

(Impaired consciousness)

Partial

(Only a portion

of the brain)

Generalized

(Both hemispheres are

involved)

Neurology Chapter of IAP

burden of the problem
Burden of the problem
  • Per 100,000 people, there will be:

86 seizures in the first year of life

62 seizures between 1 and 5 years

50 seizures between 5 and 9 years

39 seizures between 10 and 14 years

In over 65% of patients, epilepsy begins in childhood.

detailed history of the child with convulsion
DETAILED HISTORY OF THE CHILD WITH CONVULSION

• Mode of onset of convulsion, character, duration, any similar previous history (chronic/recurring).

• Triggering factors- fever, toxic substance or drug, metabolic dis- turbance.

•  Family history of convulsion, inborn error of metabolism.

• Peri-natal/Natal history-birth asphyxia, jaundice, birth trauma, central nervous system (CNS) infection e.g. meningitis, encephalitis etc.

• CNS status-cerebral palsy, mental retardation (learning difficulty), any post-convulsive state.

convulsion in infants and older children
CONVULSION IN INFANTS AND OLDER CHILDREN

A) Acute/Non-recurring    (i) with fever: febrile convulsion, infections e.g. meningitis    (ii) without fever: poisoning including medicinal overdose, metabolic disturbance

  • e.g. hypoglycaemia, hypocalcaemia and electrolyte imbalance, head injury, brain tumour, epilepsy.

B) Chronic/Recurring :    (i) with fever: recurrent febrile convulsion, recurrent meningitis.    (ii) without fever: epilepsy.

febrile seizures
Febrile seizures
  • Febrile convulsions, the most common seizure disorder during childhood
  • Age dependent and are rare before 9 mo and after 5 yr of age.
  • A strong family history of febrile convulsions.
  • Usually generalized, is tonic-clonic and lasts a few seconds to 10-min
  • Mapped the febrile seizure gene to chromosomes 19p and 8q13-21.
atypical febrile seizures
Atypical febrile seizures
  • The duration is longer than 15 min.
  • Repeated convulsions occur within the same day.
  • Focal seizure activity or focal findings are present during the postictal period.
treatment of febrile seizures
Treatment of febrile seizures
  • A careful search for the cause of the fever.
  • Use of antipyretics.
  • Reassurance of the parents.
  • Prolonged anticonvulsant prophylaxis for preventing recurrent febrile convulsions is controversial and no longer recommended.
  • Oral diazepam, 0.3 mg/kg q8h (1mg/kg/24hr), is administered for the duration of the illness (usually 2–3 days).
classification of epileptic seizures
Classification of Epileptic Seizures
  • Partial seizures:
    • Simple partial (consciousness retained)
      • Motor
      • Sensory
      • Autonomic
      • Psychic
    • Complex partial (consciousness impaired)
      • Simple partial, followed by impaired consciousness
      • Consciousness impaired at onset
    • Partial seizures with secondary generalization

Source: Nelson”s Textbook of Pediatrics, (17th ed.)

classification of epileptic seizures1
Classification of Epileptic Seizures
  • Generalized seizures
    • Absences
      • Typical
      • Atypical
    • Generalized tonic clonic
    • Tonic
    • Clonic
    • Myoclonic
    • Atonic
    • Infantile spasms
  • Unclassified seizures

Source: Nelson”s Textbook of Pediatrics, (17th ed.)

absence petit mal
Absence – Petit Mal
  • sudden cessation of motor activity or speech with a blank facial expression and flickering of the eyelids
  • more prevalent in girls
  • rarely persist longer than 30 sec
  • do not lose body tone
generalized tonic clonic grand mal
Generalized Tonic-clonic – Grand Mal
  • suddenly lose consciousness and in some cases emit a shrill, piercing cry
  • eyes roll back, their entire body musculature undergoes tonic contractions, and they rapidly become cyanotic in association with apnea
  • clonic phase of the seizure is heralded by rhythmic clonic contractions alternating with relaxation of all muscle group
mimicking seizures
Mimicking seizures
  • Benign paroxysmal vertigo
  • Night terrors
  • Breath-holding spells
  • Syncope
  • Paroxysmal kinesigenicChoreoathetosis
  • Shuddering attacks
  • Benign paroxysmal torticollis of infancy
  • Hereditary chin trembling
  • Narcolepsy
  • Rage attacks
  • Pseudo seizures
  • Masturbation
status epilepticus
Status Epilepticus
  • Three major subtypes:
    • prolonged febrile seizures
    • idiopathic status epilepticus
    • symptomatic status epilepticus
  • Higher mortality rate.
  • Severe anoxic encephalopathy in first few days of life.
  • History.
  • The relationship between the neurologic outcome and the duration of status epilepticus is unknown in children.
treatment of status epilepticus
Treatment of status epilepticus
  • Initial treatment:
    • assessment of the respiratory and cardiovascular systems;
    • A nasogastric tube insertion;
    • IV catheter;
    • a rapid infusion of 5 mL/kg of 10% dextrose;
    • blood is obtained for a CBC and for determination of electrolytes.
    • a physical and neurologic examination.

Source: Nelson”s Textbook of Pediatrics, (17th ed.)

treatment of status epilepticus1
Treatment of status epilepticus
  • Drugs:
    • should always be administered IV;
    • phenytoin forms a precipitate in glucose solutions;
    • have resuscitation equipment at the bedside;
    • A benzodiazepine (diazepam) may be used initially;
    • if the seizures persist, phenytoin is given immediately
    • The choices for further drug management include paraldehyde, a diazepam infusion, barbiturate coma, or general anesthesia.
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