Seizure disorders in children
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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

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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%

Congenital20%

Trauma

HIE

Congenital brain anomalies

Trauma4.7%

Infection4.0%

Vascular1.5%

Neoplastic1.5%

Degenerative0.7%

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.)


Simple partial motor

Simple partial - motor


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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