Seizure Disorders

Musupila.M
DCM,ADGM,Bsc CS(UNZA)
6 November 2019
 Seizures(Convulsions)
Definition

 A seizure(convulsion) is an abnormal
discharge of cortical neurons resulting
in alteration of motor, sensory, or
cognitive function
 Epilepsy

• Epilepsy is recurrent seizures un related to

fever or acute cerebral insult.

• Can be
• 1. Generalized seizures: whole cortex is
involved diffusely
• 2. Partial seizures: one area of the cortex
involved; may become generalized.
 Classification
• Generalized Seizures can be divided:
• Absence: Typical or complex
Brief lapse in awareness without impairment
afterward

• Myoclonic -Brief, repetitive, symmetric muscle contractions e.g.

juvenile myoclonic epilepsy, infantile spasms

• Tonic -Sustained muscle contraction

• Clonic-Rhythmic jerking

• Tonic- clonic

• Atonic -Abrupt loss of muscle tone

 Classification cont…
• Partial seizures can be:
• 1.Simple partial( remain conscious)
Motor, sensory, autonomic, psychic

• 2.Complex partial ( impaired consciousness)

simple partial extended
Initial complex partial e.g. temporal lobe
epilepsy.

• 3.Partial with secondary generalization

 Investigating Epilepsy
• Take full history and clinical examination including
developmental check.
• For first convulsion investigate only if less than 6
months old or unwell child or findings on
examination.
Investigations:
• EEG
• Blood: glucose, metabolic screen, congenital
infection,
• Skull Xray, CT scan, MRI
 Common seizure types
 Absence seizures
 1.Typical presents with loss of awareness, no motor
activity, eyelid fluttering.
No postictal phase
Last < 30 seconds
 2.Complex presents with motor component (
myotonic movements, loss of body tone)
 EEG shows typical 3/sec generalised spikes and
waves.
 Treatment: Ethosuximide, Sodium valpraote,
Lamotrigine(Lamictal)
 Generalised tonic-clonic
seizures
• May be idiopathic or induced by infections, stress,
or drugs. An aura suggest a focal origin
• Features:
• Tonic phase; sudden loss of consciouness, tonic
contraction, apnoea, cyanosis,eyes roll backwards.
• Clonic phase; rhythmic contractions of all muscle
groups, tongue biting, sphincter control lost.
• Postictal: semiconscoius for about 30 minutes to 2
hours
 Febrile convulsions
Brief, generalized, tonic-clonic convulsion
associated with a febrile illness
• Usually occur while febrile
• Rarely focal
• Rarely recurrent
• Usually normal neurologic examination
• Children aged 6months to 5 years
• Last less than 15 minutes
 Management of Febril
Convulsions
• Treatment
• Admit
• Fever control
• Parental advice on fever control and
management of fit
• Rectal diazepam if seizure occur
 Management of febrile convulsions
cont..

Investigations

• Depend on the clinical examination

looking for the source of infection.
• Urine mcs
• Mps
 Complex Febrile Convulsions
• Complex type:
• < 6months or > 5 years
• Focal
• last longer than 15 minutes
 Status Epilepticus
• Status epilepticus occurs when a fit
last more than 30 minutes
• This is an emergency requiring
urgent attention.
Treatment: Status Epilepticus

• Stabilize patient( airway, breathing,

circulation)
• Give oxygen
• Drug therapy.( diazepam, paraldehyde)
• If fitting continues paralyze and ventilate
 Non epileptic funny turns
Breath holding attacks.
• Occur between age of 6 months to 3years.
• Precipitated by fear, anger and pain.
• Starts with a cry then breath holding.
• Either becomes cyanosed or pale.
• May become unconscious, stiffens with clonic
movements, then limp with a rapid recovery.
 Benign Paroxysmal Vertigo
• Benign paroxysmal vertigo
• Occur in 1-3 years
• Sudden onset , unsteadness,horizontal
nystagmus, vomiting,pallor, remains
conscious.
• May last < 5 minutes
• Ear infection associated.
 Night Terrors

• Common in 18 months to 7 years

• Wake up from sleep screaming, thrashing,
tachycardia.
• Normal sleep afterwards.
• Syncope
• Postural
• Sensitive vago-cardiac reflex causing
bradycardia, collapse, pallor.
• Cardiac arrythmias e.g prolonged QT
syndrome
 Hysterical Fits
• Hysterical fits
 Therapy

 Treatment: sodium valproate,

carbamazepine, clobazam

 Simple partial seizures:

Usually are motor, involving asynchronous
tonic or clonic movements. Aura may occur
Therapy
Complex partial seizures:
Involve altered consciousness.
May follow a simple partial seizure
Temporal lobe epilepsy may produce
outburst of emotions.
Automatism are a common feature( lip
smacking, chewing, drooling)
Phenobarbital

• Effective for all types of  Dose

convulsions except absence › Load: 15 mg/kg IM or IV
 Can repeat 10 mg/kg after
• Rebound convulsions may 30 minutes if convulsions
occur on withdrawal continue
• Side effects › Maintenance: 2.5-5 mg/kg
IM or IV or oral OD
• Sedation
• Respiratory depression
• Behavioral disturbances
• Hyperkinesia
• Skin reactions
• Megaloblastic anemia
Carbamazepine
 Dose
• Effective for partial › Start: 10 mg/kg/day divided
convulsions BD (max 100mg BD)
• May actually make some › Increase: 100 mg/day each
generalized convulsions worse week until convulsions
• Side effects controlled
› Maintenance: 20 mg/kg/day
• Sedation
divided BD (max 400mg BD)
• Dizziness
• Diplopia
• Bone marrow suppression
• Skin reactions
• Hepatitis
• Gastrointestinal symptoms
Sodium valproate
• Effective for all types of  Dose
convulsions › Start: 10-15 mg/kg OD
• Side effects › Increase: 5-10
mg/kg/day each week
• Gastrointestinal until convulsions
symptoms controlled
• Hepatitis › Maintenance: 30
mg/kg/day divided BD
• Sedation
• Hyperactivity
• Pancreatitis
Phenytoin

• Effective for all types of • Dose

convulsions except absence • Load: 15-20 mg/kg PO or IV
• Can be given IV to stop status • Give dose over 30 minutes to
epilepticus, like diazepam or avoid cardiovascular collapse
phenobarbital • Flush with saline before and
after to avoid peripheral vein
• Must be given carefully! irritation
• Side effects • Maintenance: 5 mg/kg/day
• Nausea/ vomiting divided BD (max 150mg BD)
• Mental status changes
• Visual changes
• Hirsutism
• Gum hypertrophy
• Skin reactions
• Bone marrow suppression
• Hepatotoxicity
 Summary anticonvulsants

Anticonvulsant Target dosage Efficacy Side effects

(mg/kg/day) (Generalized/Partial)

Phenobarbital 5-10 G/P Cognition, sedation

Carbamazepine 10-20 P Sedation, ataxia,

diplopia, Stevens-
Johnson, bone marrow
supression,
hepatotoxicity
Sodium valproate 10-20 G/P Weight gain, alopecia,
hepatotoxicity,
pancreatitis
 END
Thank you