Child with Seizure

Classification of seizure:
 Focal seizure
 Generalized seizure
 Febrile seizure
 Acute symptomatic seizure: usually secondary to brain pathology
 Unprovoked seizure
 Remote symptomatic seizure

Causes:
 Pregnancy - congenital problem
 Birth - trauma during birth
 After birth
o brain pathology (infection, tumor, trauma)
o metabolic (hypoglycemia, hypocalcemia, hypomagnesaemia,
hypo/hypernatremia)
o systemic infection (herpes simplex, TB, pneumococcus)
o systemic disease (bilirubin or hypertensive encephalopathy, vasculitis and
SLE)
 Idiopathic - most common in epilepsy

History Taking
 First episode or recurrent?
 Known case of epilepsy?
 Compliant to drugs?
 Dosage?
 Have underlying neurological disorder?
 Is the patient febrile?
 Detail history of the past seizures, past history of neurological disorder.
 Preictal  Condition of the child before seizure?
 aura or warning focal
 insult: hypocalcemia (feeding), ingestion of drugs,
head trauma
 Precipitation  sleep deprivation
 TV screen
 hyperventilation
 hypoxia
 Ictal phase  Onset, duration, frequency, nature, association with
drooling of saliva, lip smacking, chewing, swallowing,
up-rolling of eyeball, cyanosis, biting of tongue, urine,
bowel incontinence.
 Post-ictal  duration, deep sleep, drowsiness, headache, limb
phase pain, Todd's paralysis

** Todd's paralysis --> common syndrome associated with

weakness or paralysis in part or all of the body after a seizure. It
commonly affects one limb or half of the body.
  Meningitis - Older children - headache, photophobia, neck pain/stiffness.
Infant or younger children - fever, poor feeding, vomiting, irritability,
drowsiness, lethargy, LOC
 Encephalitis - fever, poor feeding, vomiting, irritability, drowsiness,
lethargy, LOC
 Septicemia - fever, rash, poor feeding, irritability.
 Birth History  maturity, congenital infection, hemorrhage, birth
trauma (obstructed, instrumental)
 Family History  epilepsy, febrile seizure, brain tumor
 Developmenta  Gross motor, Fine motor, Language and Social
l milestone domains

Physical Examination
 General appearance
o assess GCS, dysmorphism, any abnormal movement
 Vital signs
o temperature
 Height, weight, and head circumference
o plot on a growth chart to determine percentiles
 Signs of head trauma
o bruises, scar, bleeding
 Skin for neurocutaneous signs
o Neurofibromatosis - café au lait
o Meningococcal infection - purpuric rash
 CNS examination
o Signs of raised ICP
 Bulging anterior fontanelle
 Papilledema (fundoscopy)
 Hypertension
 Bradycardia
 Septicemia - cold clammy skin, prolong CRT, tachycardia, hypotension
 Developmental assessment
o gross motor, fine motor, language and social domains
o a delay indicates a cerebral insult