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2. Contents
 What is a seizure?
 Seizure types
 Etiology of seizures
 Febrile convulsions
 Epilepsies of childhood
 Epilepsy syndromes
 Status epilepticus
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3. What is a Seizure ?
 Paroxysmal, involuntary & sudden
disturbance of neurological function caused
by an abnormal or excessive neuronal
discharge.
 With or without LOC.
 If manifests as motor act – “convulsions”
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4. Seizures
Epileptic Non
epileptic
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5. Etiology of seizures
 Idiopathic (70-80%) – cause unknown but
presumed genetic
 Secondary
 Cerebral malformations
 Cerebral vascular occlusion
 Cerebral damage (ex; congenital infections,
hypoxic-ischaemic encephalopathy…)
Causes for Epileptic seizures
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6.  Cerebral tumour
 Neurodegenerative disorders
 Neurocutaneous syndromes
 Neurofibromatosis
 Tuberous sclerosis
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7. Causes for Non-epileptic seizures
 Febrile seizures
 Metabolic
 Hypoglycaemia
 Hypocalcaemia
 Hypomagnesaemia
 Hypo/hyper natraemia
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8.  Head trauma
 Meningitis/Encephalitis
 Poisons/Toxins
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10. Definition
 A seizure accompanied by a fever in the
absence of intracranial infection due to
bacterial meningitis or viral encephalitis.
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11. Incidence
 Affects 3% of children
 Positive family Hx in 10%-20%
 Autosomal dominant inheritance (thus family hx
important)
 Recurrent febrile seizures in 30%-40%
 1%-2% of subsequent epilepsy after a simple febrile
seizure
 4%-12% in complex febrile seizure
 Boys > Girls
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12. Diagnostic criteria
 Age
 6 months – 60 months (5yrs)
 Peak 14 – 24 months
 Temperature
 Usually >= 38C with rapidly rising temp.,
within 24hrs of onset of fever
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13.  Should not last >10min
 Generalized, not focal
 No residual weakness of limb or disability
except a brief period of drowsiness
 No evidence of CNS infections. (meningitis,
encephalitis, abscess….)
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14.  Extra cranial infection may be there. ( URTI,
tonsillitis, otitis media…)
 No Hx of previous afebrile seizure
 No acute systemic metabolic abnormality
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15. Classification
SIMPLE COMPLEX
Most common Uncommon
Lasts less than 15min Lasts more than 15min
One fit only in the same
illness
Recurring during same
illness within 24hrs
Generalized tonic-clonic Focal
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16. Risk factors for recurrent febrile
seizures
 Younger than 18 months (younger the child, higher
the risk...)
 Shorter duration of fever before the seizure
 Height of fever (lower the peak, higher the risk…)
 Positive family Hx
 Complex febrile seizure at onset
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17. Pathogenesis
 Not well known
 Due to temporary impairment of the
balance between convulsant and
anticonvulsant system of brain
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18.  Studies done in children suggest that the
cytokine network is activated and may
have a role in the pathogenesis of febrile
seizures
 Threshold level of anticonvulsant system in
these genetically predisposed children is
lower
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19. Other suggestions
 Endogenous pyrogens such as IL-1
increase neuronal excitability & cause
seizures
 Hyperthermia induced alkalosis
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20. Investigations
 Usually not needed in simple febrile
convulsion
 Complex form may need,
 Blood glucose, serum electrolytes
 LP and CSF analysis
 Neuro-imaging (CT, MRI)
 EEG
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21. Lumbar puncture is strongly
recommended ,
 Hx of irritability, reduced feeding or lethargy
 Clinical signs of meningitis/encephalitis
 Systemically ill
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22.  Prolonged post-ictal altered consciousness
 After a complex convulsion
 After pretreatment with antibiotics
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23. In these situations,
 LP must be undertaken to check for,
CSF
sugar
protein
organisms
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24. Neuroimaging is considered If,
 Micro/ macrocephaly
 Neurocutaneous syndrome
 Pre-existing neurological defect
 Recurrent complex febrile seizures
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25. EEG
 Not a guide for treatment
 Does not predict recurrence
 So not usually indicated
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26. Management
 Fever
 Find the cause (usually viral illness)
 Must exclude meningitis
○ Infection screen blood culture
urine culture
LP for CSF culture
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27.  Treating fever promote comfort.
 Not important in preventing seizures.
 Physical methods
 Fanning
 Tepid sponging (now not recommended)
 Light clothing
 Drugs
 PCM
 ibuprofen
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28. Management at home
 Move danger away
 Left lateral position
 Do not try to stop fitting
 Do not put anything in mouth
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29.  Loosen clothing
 Wipe secretions from mouth
 No fluids or drugs orally
 Note the time
 Do not panic
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30. If seizure lasting >5-10 min,
 Seek medical advice
 Diazepam
 0.5mg/kg rectal
 Midazolam
 0.5mg/kg buccal
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31. Prognosis
 Generally excellent
 Risk of further febrile seizures – 30%
 Risk of epilepsy after single febrile seizure – 3%
 No increased risk of death
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32. Information for parents
 FC are common
 Recurrences likely
 Brain damage
 Later epilepsy
Very rare
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33.  No evidence of deaths
 What to do when fitting
 If lasting >10 min & not stopping
 Rectal diazepam
-OR-
 Take to the hospital
 Information & advice sheets
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35. Definition
 Chronic neurological disorder
characterized by recurrent unprovoked
seizures, associated with abnormal,
excessive or synchronous neuronal activity
in brain
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36. Pathogenesis
 Sudden, excessive, disorderly
discharging neurons
 Increased GLUTAMATE levels &
decreased GABA levels
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37. Classification
 Generalized
 Discharges from both hemispheres
○ Absence
○ Myoclonic
○ Tonic
○ Tonic-clonic
○ Atonic
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38.  Focal
 Arise from one or part of one hemisphere
○ Frontal seizures
○ Temporal lobe seizures
○ Occipital seizures
○ Parietal lobe seizures
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39. Generalized seizures
 There is,
 Always LOC
 No warning
 Symmetrical
 B/L synchronous discharge on EEG
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40. Absence
Transient LOC
Abrupt onset & termination
Typical(petit mal) or atypical
Often due to hyperventilation
Myoclonic
Brief, repetitive, jerky movements
Limbs, neck or trunk
Physiologically in hiccoughs
Tonic
Generalized increased tone
Tonic – clonic
Rhythmic contractions of muscle
groups
Become cyanosed
Jerking of limbs
Tongue biting & incontinence
Atonic
Combined with myoclonic jerk
Followed by transient loss of muscle
tone
Sudden fall or drop of head
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41. Focal seizures
 Begin in one hemisphere
 May herald by an aura
 May or may not have change in
consciousness
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43. Frontal
Motor phenomena
Temporal
Auditory or sensory (smell
or taste) phenomena
Occipital
Positive or negative visual
phenomena
Parietal
Contra lateral altered
sensation
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44. Diagnosis
 Primarily by detailed Hx
 Child & eye witnesses
 Video if available
 Skin markers of Neurocutaneous syn.
Or neurological abnormalities
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45. Investigations
 EEG
 Indicated whenever suspected
 To detect structural abnormalities
 Neuronal hyperexcitability
○ Sharp waves
○ Spike-wave complexes
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46.  Many children with epilepsy
 Many children never had epilepsy
Normal initial EEG
Abnormal initial EEG
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47. Additional techniques
 Sleep deprived record
 24h ambulatory EEG
 Video – telemetry
 Subdural electrodes (prior to surgery)
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48. Imaging studies
 Structural scans
 MRI
 CT brain
 Can identify
 Tumours
 Vascular lesions
 Sclerotic areas
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49.  Functional scans
 Structural lesions not always possible to see
 Can see areas of abnormal metabolism
 Suggestive of focal seizures
 Ex :- PET, SPECT
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51. West syndrome
 Age of onset 4-6 months
 Violent flexor spasms of head, trunk &
limbs
 Extension of arms
 “salaam spasms”
 EEG shows hypsarrhythmia
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53. Childhood absence epilepsy
 Age of onset 4-12 y
 Suddenly stop moving & stare
 Lasts only few seconds
 Has no recall
 May look puzzled
 Induced by hyperventilation
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55. Benign epilepsy with
centrotemporal spikes (BECTS)
 Age of onset 4-10 y
 Tonic clonic seizures in sleep
 Abnormal feelings in tongue & face
 Focal sharp waves in EEG
 Benign so important to recognize
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57.  A seizure lasting >30min or repeated
seizures for 30min without recovery of
consciousness in between
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58. Management
Diazepam 0.5mg/kg PR
Lorazepam 0.1mg/kg IV Midazolam 0.5mg/kg buccal
Check blood glucose
If <3mmol/L give IV glucose & recheck
Airway
Breathing Circulation
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59. Rapid-sequence induction with Thiopental
Mechanical ventilation Transfer to PICU
Phenytoin 18mg/kg IV over 20min or
Phenobarbital 15mg/kg if on oral phenytoin
Paraldehyde 0.4ml/kg PR
(If no response in 10min)
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60. Summary
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Febrile
convulsions
Affect 3% of children
Usually tonic-clonic with
rapid rise in fever
Must exclude CNS infection
Family advice about
management
Does not affect intellect
Reassure the parents
Epilepsy
Affects 1 in 200 children
Underlying etiology important
If suspected EEG is indicated
Need psychological help
Parents & teachers need to be
aware of the management
Avoid injurious situations

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