1. Seizure Disorders in Children
By Paula Peterson, APRN, FNC, PNP
LPN2007, November/December 2007
2.0 ANCC/AACN contact hours
Online:
© 2007 by Lippincott Williams & Wilkins. All world rights reserved.

2. 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

3. Causes of Seizures brain injury trauma infection
metabolic and neurodegenerative diseases
cortical malformation

4. 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

5. Types of Partial Seizures
Simple - person remains alert
Complex - person experiences aura, with altered consciousness during seizure and confusion following the seizure

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. Diagnostic Tools
Electroencephalogram - to correlate with seizure activity and electrical discharges in the brain
Possibly a spinal tap for spinal fluid specimen

14. 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

15. Other Management Options
When medications have limited success:
ketogenic diet
vagal nerve stimulation
surgery

16. 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

17. 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

18. 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