Seizure Disorders in Children - PowerPoint Presentation

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Seizure Disorders in Children

Dr. Pushpa Raj Sharma FCPS

Professor of Child Health

Institute of Medicine

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

Definitions

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

Neurology Chapter of IAP

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 aetiologyIdentifiable in only 30% of casesIdiopathic 67.6%Congenital 20%TraumaHIECongenital brain anomalies

Trauma 4.7%

Infection 4.0%

Vascular 1.5%

Neoplastic 1.5%

Degenerative 0.7%

Neurology Chapter of IAP

Seizure type

Partial

(Only a portionof the brain)

-

Simple(Normal consciousness)- Complex(Impaired consciousness)

Generalized

(Both hemispheres are

involved)

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

•

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

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 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

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

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

Partial seizures:Simple partial (consciousness retained)MotorSensoryAutonomicPsychicComplex partial (consciousness impaired)Simple partial, followed by impaired consciousnessConsciousness impaired at onsetPartial seizures with secondary generalization

Source: Nelson”s Textbook of Pediatrics, (17

th

ed.)

Simple partial - motor

Classification of Epileptic Seizures

Generalized seizuresAbsencesTypicalAtypicalGeneralized tonic clonicTonicClonicMyoclonicAtonicInfantile spasmsUnclassified 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

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

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

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

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.