Transcript Seizure Disorders in Children

SEIZURE DISORDERS IN
CHILDREN
Dr. Pushpa Raj Sharma FCPS
Professor of Child Health
Institute of Medicine
Definitions
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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
Definitions
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Epilepsy: A condition in which an individual is
predisposed to recurrent seizures because of a
central nervous system disorder
Status Epilepticus: More than thirty minutes of
continuous seizure activity, or recurrent seizures
without intercurrent recovery of consciousness
Introduction
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Convulsion associated with febrile disease
 2-4%
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of all children before the age of 5 years
Symptomatic seizures
 0.5-1%
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Epilepsy:
 Recurrent
 First

unprovoked seizures
year of life:
1,2/1 000
 Childhood
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and adolescents:
0,5-1/10000
Neurology Chapter of IAP
Aetiology of Epilepsy
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Specific aetiology
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 Identifiable
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in only
30% of cases
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Idiopathic
Congenital
67.6%
20%
 Trauma
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Trauma
Infection
Vascular
Neoplastic
Degenerative
 HIE
 Congenital
brain
anomalies
Neurology Chapter of IAP
4.7%
4.0%
1.5%
1.5%
0.7%
Seizure type
Partial
(Only a portion
of the brain)
- Simple
(Normal consciousness)
- Complex
(Impaired consciousness)
Generalized
(Both hemispheres are
involved)
Neurology Chapter of IAP
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.
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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
A) Acute/Non-recurring
(i) with fever: febrile convulsion, infections e.g. meningitis
(ii) without fever: poisoning including medicinal overdose,
metabolic disturbance
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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
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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
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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
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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
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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
Classification of Epileptic Seizures
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Generalized seizures
 Absences
 Typical
 Atypical
 Generalized
tonic clonic
 Tonic
 Clonic
 Myoclonic
 Atonic
 Infantile
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spasms
Unclassified seizures
Source: Nelson”s Textbook of Pediatrics, (17th ed.)
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
•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
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Benign paroxysmal vertigo
Night terrors
Breath-holding spells
Syncope
Paroxysmal kinesigenic Choreoathetosis
Shuddering attacks
Benign paroxysmal torticollis of infancy
Hereditary chin trembling
Narcolepsy
Rage attacks
Pseudo seizures
Masturbation
Status Epilepticus
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Three major subtypes:
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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
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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 epilepticus
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Drugs:
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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.