1. Seizure Dr. Shreedhar Paudel May, 2009

2. Seizure….. A seizure is a sudden disruption of the brain's normal electrical activity accompanied by altered consciousness and/or other neurological and behavioral manifestations – Characterized by paroxysmal, abnormal involuntary, motor, sensory and autonomic activity

3. Seizure….. Epilepsy is a condition characterized by recurrent seizures that may include repetitive muscle jerking called convulsions

4. Seizure….. APPROACH TO A SEIZURE PATIENT – 1.History Onset Progression post- ictal phase Perinatal and Developmental history family history – 2.Physical examination – 3.Investigation: EEG, imaging, LP

5. Seizure….. CAUSES OF CHILDHOOD CONVULSION – EARLY NEONATAL 1. Birth asphyxia 2. Intraventricular hemorrage 3. Inborn error of metabolism 4. Drug withdrawal – NEONATAL 1. Dyselectrolytemia 2. Developmental disorders 3. Infection 4. TORCH infection

6. Seizure….. CAUSES OF CHILDHOOD CONVULSION – FROM 1 MONTHS TO 3 YEARS 1. FEBRILE CONVULSION 2. INFECTION 3. METABOLIC DISTURBANCES 4. SPACE OCCUPYING LESION 5. EPILEPSY

7. Febrile Convulsion Commonest cause of seizure during early childhood Defn – seizure during fever occuring between 6 months to 5 years of age in the absence of neuroinfection Convulsions are not related to the degree of temperature rise but are frequent if temperature rises abruptly

8. Febrile Convulsion…. Types:- – Simple benign febrile convulsion Fits occur within 24 hrs of onset of fever Last < 10mins Single per febrile episode Family history of febrile convulsion – Atypical complex febrile seizures Family history of epilepsy and neurodevelopmental retardation

9. Febrile Convulsion…. Should be differentiated from meningitis or encephalitis which are also important causes of convulsions associated with fever LP done in – 1 st episode of febrile seizure – Infants (below 1 yr) EEG and neuroimaging – no role

10. Febrile Convulsion…. Treatment:- – Prompt reduction of temperature with Antipyretics or hydrotherapy – Supportive therapy Nursing in semi-prone position Adequate airway and oxygen – IV line To maintain hydration To give anticonvulsant medication To obtain blood specimen for investigations

11. Febrile Convulsion…. Treatment:- – Aspirin avoided – danger of development of Reye’s syndrome – Inj. diazepam(0.2- 0.3mg/kg/dose)maximum of 5 mg/dose → for control of seizures – Phenobarbitone – slower acting but more sustained action

12. Febrile Convulsion…. Febrile seizure prophylaxis:- – Intermittent prophylaxis During episodes of fever For first 3 days of fever (majority of cases occur within this period) Diazepam ( PO or rectal) Antipyretics, hydrotherapy, meticulous temperature recording – Continuous prophylaxis If failure of intermittent therapy Sodium valproate /phenobarbitone For 1-2 yrs or till 5 yrs of age whichever comes earlier

13. Febrile Convulsion…. Prognosis:- – Recurrence 30- 50 % – Recurrent complex seizures– prone to develop epilepsy