Transcript Seizure Disorders in Children

Seizure Disorders in
Children
By Paula Peterson, APRN, FNC, PNP
LPN2007, November/December 2007
2.0 ANCC/AACN contact hours
Online: www.nursingcenter.com
© 2007 by Lippincott Williams & Wilkins. All world rights reserved.
Seizures and Epilepsy

A seizure is defined as a transitory disturbance in
consciousness or in motor, sensory, or autonomic
function caused by uncontrolled electrical discharges in
the brain

Epilepsy refers to disorders characterized by recurrent
seizures rather than a single seizure
- Categorized by causes and types of seizures
Causes of Seizures

brain injury

trauma

infection

metabolic and neurodegenerative diseases

cortical malformation
Classification of Seizures

Symptomatic - symptom of underlying disease

Idiopathic - caused by genetically inherited trait

Cryptogenic - unknown cause

Partial - uncontrolled electrical activity in area of brain

Generalized - affects both hemispheres of brain at once
Types of Partial Seizures

Simple - person remains alert

Complex - person experiences aura, with altered
consciousness during seizure and confusion following
the seizure
More Seizure Types

Absence seizures - “staring episodes,” also called
petit mal seizures

Atonic seizures - sudden loss in muscle strength, often
resulting in a fall

Infantile spasms - brief flexion/extension of the upper
body, usually not seen after 18 to 24 months of age
More Seizure Types

Tonic seizures - usually occur during sleep involving
most of the brain, causing increased muscle tone

Clonic seizures - rhythmic jerking movements of the
entire body

Tonic-clonic seizures - also known as “grand mal”
seizures, whole-body jerking movements with loss of
bowel, bladder, and consciousness
Seizure Syndromes

Juvenile myoclonic epilepsy - inherited, myoclonic
seizures late in childhood, responds to medication but
rarely resolves

Benign rolandic epilepsy - common seizure syndrome
with good prognosis for the child to outgrow

Lennox-Gastaut syndrome - early childhood onset, no
cure, treated with medications
Causes of Lennox-Gastaut

brain malformations

perinatal asphyxia

severe head injury

central nervous system infection

inherited genetic or metabolic conditions

unknown in 30% to 35% of cases
Febrile Seizures

Brought on by fever in infants and children

Classified as typical or atypical

Typical febrile seizure- occurs in 2% to 5% of children
ages 6 months to 5 years of age, usually during first day
of acute infection
Atypical Febrile Seizure

Febrile seizure that recurs in a 24-hour period

Risk of epilepsy after is associated with risk factors for
seizure disorders

Often accompanied with Todd’s paralysis (transient
paralysis of a limb)
Diagnostic Tools

History and physical - emphasis on seizure event is
most valuable tool

Lab tests - complete blood cell count, metabolic panel

Brain imaging studies - Computed tomography scan,
magnetic resonance imaging
Diagnostic Tools

Electroencephalogram - to correlate with seizure
activity and electrical discharges in the brain

Possibly a spinal tap for spinal fluid specimen
Managing Seizure Disorders

Medication is mainstay

Goals:
- freedom from seizures and adverse events
- avoid drug interactions
- adherence to therapy
- minimal interference with daily life

Challenge to the health care provider is to meet these
goals with monotherapy
Other Management Options
When medications have limited success:

ketogenic diet

vagal nerve stimulation

surgery
Ketogenic Diet

rigid food plan

high fat, essential proteins, low carbohydrates

requires high level of family commitment

mixed results of decrease in seizures with medication

small number of children seizure-free
Vagal Nerve Stimulation

Surgical implantation (usually in patient’s neck) of a
device delivering electrical stimulation to the vagus nerve

Decrease in seizures reported with quicker recovery, not
seizure-free
Caring for Your Patient

Education of family and/or support system is key

Education about what to do during seizure

Education about medications and treatments

Referrals for family support