Pediatrics [SEIZURES]

Introduction
“Seizures” is a major topic covered in the medicine videos. Kids Complex Simple
can have any kind of seizure - just like adults – but there are also Loss of consciousness No loss of consciousness
special seizures that affect children.
Generalized Partial
Total body Specific Symptoms
1) Absence
Kids who are suspected to have ADHD may have more than just Seizure Epilepsy
trouble paying attention. If the child has trouble paying attention Usually one-time event* Lifelong “focus” in brain
it might actually be hundreds of tiny seizures. These seizures are
complex because the child loses consciousness, but partial
because there are no external signs. He/she will see skip-phase
conversations, the teacher jumping from topic to topic, starting
and stopping sentences randomly as he/she comes in and out of
consciousness. Confirm the seizures with EEG and treat with
ethosuximide. This can easily be misdiagnosed as ADHD.

2) Febrile Seizures 5 “F”s of Simple Febrile Seizures

In young children, any febrile illness can cause a rapid spike in - Age Five months to Five years
body temperature. The rapid rise in temperature, not the high - First time seizure
fever, can cause a seizure. When the child seizes with a fever look - Occurs with a Fever
for the source and control the fever with Tylenol. Do NOT give - No Focal features
- Lasts less than Fifteen minutes
aspirin, ever, because of risk of Reye’s syndrome. If the source of
the seizure can’t be found on routine examination additional *If the 5 “F”s are fulfilled, it is a simple febrile seizure.
studies may be required (EEG / CT / LP). Most (98%) children Up to five % of children will have a simple febrile seizure
will NOT develop epilepsy. in their lifetime and family history of seizures increases
risk. Besides treating the cause of the fever, no further
3) West Syndrome (Infantile Spasm) workup or treatment is required.
If that young (< 6 months old) child has bilateral jerking of the
head or extremities but without fever, consider infantile spasms.
This syndrome is confirmed by interictal EEG showing
hypsarrhythmia. The spasms can be treated with ACTH but the
Pediatric Antiepileptic Drugs “Greatest Hits”
psychomotor retardation can’t be controlled; it’s associated
Lorazepam 1st treatment for status epilepticus
with mental retardation and a poor prognosis.
Phenytoin generalized complex seizures
Phenobarbital Partial seizures
4) Lennox-Gastaut Syndrome
Ethosuximide Absence seizures
Recurrent and difficult to treat seizures, usually presenting in
Carbamazepine Trigeminal neuralgia
boys between 2 and 6 years old. Interictal EEG shows slow Lamotrigine
spike-and-wave pattern. Also associated with psychomotor and Valproate
mental retardation. (Valproic acid)
Levetiracetam
5) Tuberous Sclerosis
Technically, this can be diagnosed at any age and seizures don’t
need to be present. But if a young (< 2 years old) child comes in
with afebrile seizures or a febrile seizure requires a CT, suspect
TS. The seizure and the ash leaf spots (enhanced by Wood’s
lamp) are enough to prompt a CT scan to reveal the tubers in the
brain. Prepare the child for mental retardation and sebaceous
adenomas.

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