Neurology Chapter of IAP Seizures in Childhood Neurology Chapter of IAP

Neurology Chapter of IAP Reference Paediatrics & Child health Coovadia and Wittenberg p.477-483 Lecture on AED Neurology Chapter of IAP

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

Neurology Chapter of IAP Aetiology of Epilepsy Specific aetiology Identifiable in only 30% of cases Idiopathic 67.6% Congenital 20% Trauma HIE Congenital brain anomalies Trauma 4.7% Infection 4.0% Vascular 1.5% Neoplastic 1.5% Degenerative 0.7% Neurology Chapter of IAP

Neurology Chapter of IAP Seizure type - Simple (Normal consciousness) - Complex (Impaired consciousness) Partial (Only a portion of the brain) Generalized (Both hemispheres are involved) Neurology Chapter of IAP

Epilepsy classification Clinical presentation is quite variable age of onset seizure type interictal condition EEG Outcome Evaluate the: the epileptic syndrome Possible aetiology The seizure type and syndrome type determine the Specific appropriate treatment Further evaluation Neurology Chapter of IAP

Neurology Chapter of IAP

Neurology Chapter of IAP

Main Periods according to Age Neonates Subtle, erratic, non-febrile Infancy and early childhood 3 months to 3 years Febrile seizures Infantile spasms Lennox Gastaut Myoclonic seizures Status epilepticus Partial complex Neurology Chapter of IAP

Main Periods according to Age Childhood to early adolescence Cryptogenic Absences Benign rolandic epilepsy Nine years to adulthood Primary generalized epilepsy Focal epilepsy with brain injury Neurology Chapter of IAP

Neurology Chapter of IAP Neonatal seizures Subtle seizures Deviation of the eyes Eyelids are flickering Swimming or pedaling movements Apnoeic spells Tonic Clonic Myoclonic Seldom tonic clonic seizures Neurology Chapter of IAP

Aetiology of neonatal seizures Perinatal: HIE ICH Metabolic Hypoglycemia, hypocalcemia hypomagnesemia Other Infections Structural abnormalities Drug withdrawal Neurology Chapter of IAP

Treatment of neonatal seizures Optimize ventilation, cardiac output, BP, glucose, electrolytes and pH. Treat the underlying disease Intravenous line is essential Treat the seizures promptly and vigorously Phenobarbitone Phenytoin Neurology Chapter of IAP

Non-epileptic paroxysmal events in childhood Syncope Breath-holding spells Pallid: Vagal asystole Cyanotic: Cerebra ischaemia due to a sudden rise in the intra-thoracic pressure impeding the venous return to the heart Night terrors Nightmares Masturbation Cardiac disorders Neurology Chapter of IAP

Non-epileptic paroxysmal events in childhood Complicated migraine Movement disorders Jitteriness Absence of abnormal gaze movements Provoked by passive flexion or extension Seizure jerks tend to be 2-3 Hz, clonus or jitteriness tend to be 5-6 Hz Normal EEG No increase in blood pressure or heart rate Neurology Chapter of IAP

Neurology Chapter of IAP Febrile seizures Definition: Seizure in children between the age of 6 months and 3-4(5) years in association with fever but without evidence of an intracranial infection Majority occurs before the age of 3 years Average age of onset: 18 months to 22 months Boys more than girls Neurology Chapter of IAP

Neurology Chapter of IAP Febrile seizures Recurrence 1/3 may have at least one recurrence The younger the age of onset the greater the risk of recurrence Risk of developing epilepsy 2% Risk increases with: Complex Abnormal neurological state Mesial temporal sclerosis Neurology Chapter of IAP

Management of febrile seizures Identify the underlying disease LP? CT or MRI is not warranted in the evaluation of febrile convulsions Routine EEG is seldom necessary Treatment: Long-term use of AED is not indicated Phenobarbitone Sodium valproate Rectal diazepam Antipyretics Neurology Chapter of IAP

Neurology Chapter of IAP Treatment of Epilepsy Drug treatment should be regular Simple as possible Minimum of side effects Monotherapy Changes should be made gradually High initial dosages increases side effects Rapid withdrawal carries the risk of provoking status Always calculate the dosage according to the weight Neurology Chapter of IAP

Neurology Chapter of IAP Treatment of Epilepsy Drugs commonly used Carbamazepine Sodium valproate ? Clonazepam ? Phenobarbitone ? Phenytoin Newer drugs Clobazam Oxcarbazepine Gabapentin Vigabatrin Lamotrigine NB. You are referred to the lecture on AED and the side effects should be studied! Neurology Chapter of IAP

Neurology Chapter of IAP Treatment of Epilepsy AED can cause convulsions Benzodiazepines can induce TC seizures in LGS Carbamazepine may exacerbate absence seizures What is used as first line treatment. Absence: Sodium valproate Focal and Generalized TC: Carbamazepine Neurology Chapter of IAP

Neurology Chapter of IAP

Neurology Chapter of IAP Status Epilpeticus Medical emergency Management Abort the seizures See figure 1 Resuscitate the brain ABC of resuscitation Cerebral oedema Mannitol Metabolic and biochemical abnormalities Hyperpyrexia Neurology Chapter of IAP

Neurology Chapter of IAP

Neurology Chapter of IAP Status epilepticus Treat the cause of the seizures ? LP CT/MRI Drug levels Toxic screen Neurology Chapter of IAP

Neurology Chapter of IAP Status epilepticus Correct the metabolic and systemic effects Drop in blood pressure Impaired brain perfusion  Liver enzymes Clotting defects Hyperkalaemia Hypoglycaemia Inappropriate ADH Renal failure Neurology Chapter of IAP