CONVULSIVE DISORDERS

PRESENTERS:
KABWE
CHANDA
ELIAS
  DEFINITION OF TERMS ( convulsion, seizure)
 RISK FACTOR
 CAUSES OF SEIZURES / CONVULSIONS
 TYPES OF SEIZURES AND THEIR TREATMENT

CONTENTS  EPILEPSY
 STATUS EPILEPTICUS
 TREATMENT OF EPILEPSY AND STATUS EPILEPTICUS
 REFERENCES
  Convulsions: Excessive abnormal muscle contractions, usually
bilateral, that may be
sustained or interrupted (motor seizures) (nelson 2008)

What are?  Seizures: A seizure is a set of clinical symptoms associated with

abnormal electrical activity in neurons in the cortex of the
brain.
  MAJOR MINOR
- Age < 1 year - Family h/o of febrile seizures
- Family h/o of epilepsy
RISK - Prolonged fever
- Hyper pyrexia
- Complex febrile seizures
- Male gender
FACTORS - Infections - Electrolytes imbalance
 Acute/subacute
 Metabolic causes
 Hypoglycemia, hypo or hypernatremia, hypocalemia
 Intoxications/ toxins (lead)

 Infectious/Inflammatory
CAUSES OF  Meningitis, encephalitis, sepsis

SEIZURES  Post-infectious or autoimmune causes

 Fever*
 Trauma
 Vascular accidents
  Chronic/ Progressive
 Remote insults
 Perinatal asphyxia or vascular insult
 Past head injury
 Developmental brain abnormalities
 Agenesis of the corpus callosum, schizencephaly,
cortical dysplasia
CONT…….  Inborn errors of metabolism
 Storage disorders, amino acid disorders, organic
acid disorders
 Neurocutaneous disorders
 Cerebral degenerative diseases
TYPES OF
SEIZURES
 Precipitating factors
◦ Position, activity, intercurrent illness,
medications
Description of the episode
◦ Eye movements, body movements, one sided or
APPROACH both sides, loss of consciousness or alteration of
TO consciousness, incontinence, duration,
aftereffects
DIAGNOSIS Predisposing factors
◦ Past medical history, recent illness or
neurological symptoms, family history
 History
 Associated symptoms, intercurrent illness, recent
medications, exposures (drugs,toxins, pets), past
medical history ( birth history, developmental
history, family history)
Examination
 Fever or other abnormal vital signs
CONTI…..  Head size, skin abnormalities (hypo/hyperpigmented
areas) ,asymmetry of the face or the extremities,
enlarged organs, dysmorphic features
 Alteration of mental status, cranial nerve
abnormalities, motor tone or strength or reflex
changes, gait abnormalities,ataxia, sensory
abnormalities.
 FEBRILE CONVISION
Seizure in children between the age of 6 months and 5 years
TYPES OF in association with fever but without evidence of an
intracranial infection in a neurologically normal child
CONVULSIO  Rapidly rising temp more than 38 degrees celcius
NS OR  Average age of onset: 18 months to 22 months
SEIZURES  Boys more than girls
  Lab investigations, although routine, usually
unhelpful, in the evaluation of first time seizure
 CT is not warranted in the evaluation of simple
febrile convulsions but considered for complex
 Study of 71 patient with complex seizures
Investigation of  None had an intracranial condition requiring
febrile seizures treatment

 Routine EEG is seldom necessary

 ??LP
 Simple febrile seizure probable not indicated
 Probable those with prolonged post-ictal phase
  Oxygen and supportive care, tepid sponging
 Diazepam iv 0.2 to 0.3 mg /kg slowly or rectal 0.5mg /kg
Treatment of  Antipyretics
febrile Paracetamol 10 to 15mg //kg/dose TDS or QID

 Assess the cause of fever and treat appropriately

convulsion  Counsel parents
  a paroxysmal alteration in neurological function (i.e behavioral,
Neonatal motor or autonomic function)either or all three, occurring
within 28days of the new born.
seizures
  Subtle seizures
 Deviation of the eyes
 Eyelids are flickering
 Swimming or pedaling movements
 Apnoeic spells
 Drooling
TYPES OF  Sucking
NEONATAL  Abnormal cry

SEIZURES  Tonic
 Clonic
 Myoclonic
 Seldom tonic clonic seizures
  Perinatal:
 HIE

 Metabolic
 Hypoglycemia, hypocalcemia
 hypomagnesemia
 Other

CAUSES OF  Infections

NS  Structural abnormalities; malformation syndromes

 Genetic disorders
 Hemorrhage
  Optimize ventilation, cardiac output, BP, glucose, electrolytes
and pH.
 Treat the underlying disease
 Intravenous line is essential
TREATMENT  Treat the seizures promptly and vigorously
 Phenobarbitone
 Phenytoin
  Two or more unprovoked seizures that occur at interval greater
than 24 hours. (Unrelated to fever or acute cerebral)

EPILEPSY  It is a symptom complex arising from disordered brain that

maybe secondary to other pathological processes.
  Ease the patient to the floor or lowest positon if possible

APPROACH  Protect the head with a pad

TO SEIZURE  Loosen constrictive clothing

MANAGEME  Remove any objects that might injure the patient

 Place patient on the side
NT
  Correction of glucose, electrolyte, magnesium, and calcium
disturbances;
 control of blood pressure and oxygenation;

TREATMENT  administration of benzodiazepines and a series of routine

anticonvulsants.
 Treat infection
  Drugs commonly used  Newer drugs
 Clobazam
 Carbamazepine  Oxcarbazepine
 Sodium valproate  Gabapentin
 Vigabatrin
TREATMENT  Clonazepam
 Phenobarbitone
 Lamotrigine

 Phenytoin
  Antiepileptics can cause convulsions
 Benzodiazepines can induce Tonic Clonic seizures
 Carbamazepine may exacerbate absence seizures

 First line treatment.

CONTI……..  Absence:
 Sodium valproate
 Focal and Generalized TC:
 Carbamazepine
  status epilepticus in children refers to more than 5 minutes of
continuous seizure or 2 or more discrete seizures with
STATUS incomplete or without recovery of consciousness between the

EPILEPTICUS attacks.
  Types of status epilepticus;
1. Generalized convulsive status epilepticus include major
motor seizures and recurrent GTC convulsions

TYPES 2. Non convulsive status epilepticus include recurrent

nonconvulsive seizures, which include absence status,
partial complex status, and simple partial status)
  FBC, DC
 RBS
 Electrolytes, urea and Creatinine
 LFTs
INITIAL  Calcium, Magnesium, Phosphate
INVESTIGATIO  Lactate levels
NS  CSF studies
 CT scan
 EEG
  Give 10% dextrose 5ml/kg stat and then infusion over 4 to 6
hrs. (in case hypoglycemia caused seizures)
 Diazepam IV 0,2 to 0.4mg/kg stat. up to 2 dose. Lorazepam is
better. It does not depress respirations and is longer acting

TREATMENT  If seizures continue, Phenytoin IV loading dose of 15 to 20

mg/kg in 20mls saline. At a rate of 0.5 to 1mg/kg/min
 Phenobarbitone is next in line. IV 20mg/kg in 20mls saline at
a rate of 2mg/kg/min, then maintenance 5mg/kg OD or 2
divided doses
 IN  Propofol infusion 5-10 mg/kg/hr after bolus 2 mg/kg

PERSISTENT  Midazolam infusion 1 - 10 mcg/kg/min after bolus 0.15 mg/kg

STATUS  IV sodium Valproate

EPILEPTICUS
  General Peadiatrics protocols adopted from ADH, First edition
 Coovadias Peadiatrics and child health, 7th edition
 Nelsons book of paediatrics
REFERENCES  Medscape
THE END THANK YOU