1. Seizures in Children Dr Penny Mancais Consultant Paediatrician
Dorset County Hospital
Foundation trust

2. To be Covered Terminology History taking Prognosis of Seizures
Fits, faints and funny turns
When to refer
Pragmatic advice in Epilepsy

3. ANY SUDDEN ATTACK FROM WHATEVER CAUSE.
Definition of Seizure
ANY SUDDEN ATTACK FROM WHATEVER CAUSE.
Many manifestations determined by site of origin.
Many causes:
Non Epileptic (reflex anoxic ,fainting, Tics ,migraines, night terrors )
Epileptic
altered consciousness,involuntary movement,changes in behaviour etc.
Convulsion/fit also used but best avoided.
Epileptic seizure implies attack has occurred of epileptic activity in the brain
Febrile seizue between 3/12-6years with fever but no intracranial infection or defined cause. No definition of fever but temp at least 37.8 (NIH in America)

4. Definition of Epileptic Seizure
Manifestation of Epileptic (excessive) usually self limited activity of neurons in the brain
ILAE
Only use seizure or epileptic seizure. Febrile seizure causes an epileptic seizure but child does not have epilepsy
Epilepsy involves recurrent epileptic activity and is unprovoked ie no fever or no glucose.

5. Prognosis of seizures 1% afebrile seizure 3% febrile seizure
50% will have a recurrence
3% febrile seizure
Risk of recurrence %
Risk of Epilepsy following simple %
Risk of Epilepsy following complex %
Risk of Epilepsy following complex/FH 30%
Complex is >15mins,focal multiple in 24hrs.

6. Taking the History Diagnosis is in the History
No Ix to confirm epilepsy
RELIANT ON HISTORY
True for faints, night terrors EEG does not diagnose.
1\3rd patients misdiagnosed around the country including centres of excellence in Zurich.
As Gps do not need to diagnose epilpepsy but a clear history will help you decide?night terror, reflex anoxic seizure or unexplained.

7. What to ask Eye witness account Role play Avoid interpretations
Time line
Use counting
Home videoing
Pick up the phone speak to person who saw it. Takes time need to allow 15mins for a good detailed account
Time line-onset,freq,when they occur, initial features,following duration

8. Features that may occur in Seizures
Sudden fall
Jerking limbs
Blank stare
Urinary incontinence
Funny smell
Feeling of fear
Facial flushing
Seeing coloured spots
vomiting
Racing heart
Tingling sensations
Headache
Generalised stiffening
Floppiness
Ringing noises
Hiccups
Sudden loss of vision
Epilepsy or otherwise.
50% of children have faints sitting down
Jerks and wetting can occur in faints
Recovery can be quick in all epileptic and non epileptic seizures
? Confused order I n which things happy is important

9. Fits Faints and funny turns
Collapsing with convulsions
Drop attacks
Stiffening attacks
During sleep
Epileptic and non epileptic causes of both
Syncope ,RAS, psychogenic or GTCS
Astatic epilepsy, vertigo, cataplexy, episodic ataxia
Psychogenic self gratification tonic seizures
Epilepsy,night terrors, night mares, myoclonus

10. Fits faints and funny turns
Appendix f of the NICE guideline
History differential diagnosis in different age groups.

11. When to refer Any child with ‘unexplained seizure’ (NICE)
<1years discuss ?admit
NO investigations
Advise home videoing, diary monitoring
All children with a diagnosis of epilepsy should have a named paediatrician.
Pick up phone discuss with COW or send urgent fax. Do not feel we can do within 2 weeks at present.
NO investigations EEG can be abnormal in those without epilepsy and noraml in those with.
No blodd tests (obviously glusoes if child having a seizure)

12. Pragmatic advice in Epilepsy
Will my child die?
Risk from fit is negligible
SUDEP 1:200 (poor control,teenagers,male)
Accidents
NO climbing/harness, swimming 1:1, shower
Alcohol (1=3 on anticonvulsants)
Recreational drugs (increase risk of seizure)
Most seizures last less than 2 mins if >5mins less likely to stop.Rectal diazepam for frequent or prolonged febrile convulsions.
Buccal midazolam for epilpetics
NO climbing with out harness for any form of seizure.
SUDEP no risk in idiopathic generalised epilepsy)

13. Advice continued Contraception:
Higher doses of Oestrogen for enzyme inducing drugs plus barrier protection
Starting a family
Driving
Nocturnal seizures ok
Fit free 1yr on/off medication
DVLA latest advice
Pill and lamotrigine(need increased dose of lamotrigine
Mini pill no good
Many issues for women who are preganant ideally talk through before coming pregnant.

14. Medication Now 17 drugs available Aim to improve seizure control
Minimises effects on learning and behaviour
Blood tests not needed
Very little evidence causes long term prognosis or alters death
Only to see if in therapeutic range/compliant

15. Summary History, History, History
All children with unexplained seizure need referral
<1 pick up phone ? Admit
Web sites:
National Society for Epilepsy
Epilepsy action
The future-hospital guideline for management of first seizure in secondary care
Bid for Epilepsy nurse partic the transition years.
Thank you questions