1 / 23

Pediatric Seizures

Learn about the evaluation, classification, diagnosis, and treatment of pediatric seizures, including febrile and partial seizures. Discover the frequency, history, triggers, and examination for accurate diagnosis and appropriate management. Explore information on generalized seizures and common types like absence and myoclonic epilepsy in children.

tonyk
Download Presentation

Pediatric Seizures

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pediatric Seizures An Overview

  2. Childhood Seizures • Evaluation • Classification • Diagnosis • Treatment • Mimics

  3. Evaluation • Frequency: 4-6/1,000 • History • Focal or Generalized • Duration, State of Consciousness, Triggers • Aura, Behavior, Posture, Post-ictal State • Examination • Vitals, HC, HSM, abnormal Neuro exam • Skin exam, Retinal exam, hyperventilation

  4. Classification-Febrile Seizures • 3-4% of population • Most common • Excellent prognosis • 9 months to 5 years; peak 14-18 months • Strong family history of febrile seizures • Rapid rising temp, >38 degrees Celsius • Generalized Tonic/Clonic; <10 minutes • If exam is normal, No further Work-up • Rectal Diazepam for recurrence

  5. Febrile Seizures (2) • Work up is necessary if: • More than one febrile seizure in 24 hours • Seizure last for more than 10 minutes • Focal seizure characteristics • Positive physical exam suggestive of infectious, structural, neurologic, congenital pathology

  6. Classification-Partial Seizures • Simple Partial Seizures • Maintained Consciousness • Motor activity: Versive Seizures • Sensory: aura • Autonomic • No automatisms, No tics (can be suppressed) • EEG: spikes, sharp waves in a unilateral or bilateral or multifocal pattern • Duration: 10-20 seconds

  7. Partial Seizures (2) • Complex Partial Seizures (impaired LOC) • Simple partial seizure followed by LOC • Consciousness impaired at onset of seizure • Aura: 1/3 of patients with PS • Automatisms: ¾ of patients with CPS • Following LOC into postictal phase, not recalled • Infant: alimentary; Child: gestural, unplanned

  8. PS (3): CPS (cont’d) • Spreading of discharge throughout brain can lead to secondary generalization (tonic-clonic) • EEG: Anterior temporal lobe sharp waves, focal spikes or multifocal spikes • Normal EEG in 20%; must use sleep deprived, prolonged techniques • Duration: 1-2 minutes • Needs CT or MRI to rule out structural causes

  9. PS (4): BPEC • Benign Partial Epilepsy with Centrotemporal Spikes (Rolandic Epilepsy) • Excellent Prognosis • Ages: 2 – 14; peak onset at 9 – 10 years old • Facial tonic-clonic symptoms • Normal exam, possible positive FamHx • One seizure: 20%; Repeated clusters: 25% • Occurs during sleep: 75% • EEG: repetitive spike in rolandic area, o/w nl.

  10. Classification: Generalized • Absence • Simple: Cessation of activity with blank facial expression, flickering of eyelids • Usually after age 5, F>M, hyperventilation • No aura, no postictal state, duration <30 seconds • 3/sec spike, generalized wave discharge • Complex: Associated motor symptoms • Myoclonic movements of face, fingers, extremities • May have loss of body tone • 2-2.5/sec spike and wave discharge

  11. Generalized (2) • Generalized Tonic Clonic • Focal Onset or De Novo • Aura can suggest origin • Tonic Contractions • LOC, eyes roll back, cyanosis, apnea • Clonic Contractions • Rhythmic contraction/relaxation, loss of sphincter • Post-ictal: 30 minutes to 2 hours • Truncal ataxia, hyperactive DTRs, Babinski’s • Vomiting, intense bifrontal headache

  12. Generalized (3); T/C (2) • Triggers • Low grade fever • Fatigue • Stress • Drugs: Methylphenidate, psychotropics, etc… • Duration: Few minutes • Idiopathic

  13. Generalized (4) • Myoclonic Epilepsies of Childhood • Repetitive seizures • Brief, symmetrical contractions • Loss of body tone—falling, slumping forward • Benign Myoclonus of Infancy • Myoclonic Epilepsy of Early Childhood • Complex Myoclonic Epilepsy • Juvenile Myoclonic Epilepsy

  14. Generalized (5); MEC (2) • Infancy • Neck, trunk, extremities • Normal EEG, Ends by 2 years, no meds • Early Childhood • 6 months – 4 years • Favorable outcome, 50% seizure free • MR, social problems in the minority • Positive EEG, possible genetic background • May have concurrent tonic/clonic or febrile seizures

  15. Generalized (6); MEC (3) • Complex • Poor prognosis • Focal or generalized seizures <1 year of age • History: hypoxic-ischemic encephalopathy, microcephaly • Positive EEG, less prominent FamHx • Refractory to meds • MR, behavioral problems in 75% • Lennox Gastaut syndrome

  16. Generalized (7); MEC (4) • Juvenile • Between ages 12 – 16 • 5% of all epilepsies • Initial: Morning myoclonic jerks • Later: Morning Generalized Tonic Clonic szs • Positive EEG: 4-6/sec irregular spike • Enhanced with photic stimulation • Normal exam, lifelong meds (Valproic Acid)

  17. Generalized (8) • Infantile Spasms • Between 4 – 8 months • Flexor, Extensor, or Mixed spasms • Cryptogenic: 10-20%, normal work-up • Good prognosis • Symptomatic: 80-90%, underlying pathology • Prenatal and Perinatal etiologies • MR 80-90% • Positive EEG: hypsarrhythmia pattern

  18. Diagnosis • Minimum • Blood glucose, calcium, mag, lytes, EEG • EEG techniques: 40% of EEGs are normal • Sleep deprived, prolonged (72 hrs), photic • CSF • Infectious etiology suspected • Radiologic: CT or MRI1 • Prolonged or intractable szs, neuro deficit, increased ICP • High risk: Predisposing factors, focal sz <33 months

  19. Treatment • Treat after the first uncomplicated seizure with a negative work up—80% will NOT have another seizure2 • Educate patient and family of possible long term use and side effects • May terminate meds after 2 seizure free years • Wean over 3-6 months due to possible recurrence or status.

  20. Treatment (2) • Carbamazepine or Tegretol • Gen T/C, partial; watch leukopenia, LFTs • Phenytoin or Dilantin • Gen T/C, partial; watch SJS, rashes, lupus-like • Phenobarbital • Gen T/C; watch behavioral changes • Sodium Valproate or Valproic Acid • Gen T/C, absence, myoclonic; watch LFTs, Reyes • ACTH • Infantile spasms; watch glucose, BP, lytes

  21. Treatment (3) • Ketogenic Diet • Increases GABA inhibition of seizure activity • Recalcitrant seizures • Complex myoclonic epilepsy • Fat diet, restriction of CHO and protein • Surgical Options • Vagal Nerve Stimulator3 • Ablation therapy • Intractable seizures

  22. Mimics • BPV • Night Terrors • Breath Holding Spells • Simple Syncope • Cough Syncope • Shuddering Attacks • Pseudoseizure • Benign Paroxysmal Torticollis of Infancy

  23. Bibliography • 1Sharma, et. al, “Role of Emergent Neuroimaging…,” Pediatrics, Vol 111, January, 2003. • 2Shinnar, et. al, “Risk of Seizure Recurrence…,” Pediatrics, Vol 98, August, 1996. • 3Parker, et. al, “VNS in Epileptic Encephalopathies,” Pediatrics, Vol 103, April, 1999.

More Related