Seizures

January 2004
 Definitions
Seizures
 abnormal synchronized discharge of neurons

Epilepsy
 recurrent unprovoked seizures

Status Epilepticus
 Continuous generalized convulsions >5minutes
 Intermittent convulsions >15 minutes
 Continuous seizures on EEG >15 minutes
 Classifications
Partial (40%)

Febrile /
nonfebrile

Generalized (60%)
 Classification: Partial Seizures
Simple partial Sz Complex partial Sz
 Alert and oriented  Altered LOC

 Frequently preceeded by
(no change in LOC)
Aura (Déjà vu, dreamy state,
 Motor (jacksonian march) fear/anger, hallucinations)
 Sensory (hallucinations)  Can generalize GTC Sz.
 Autonomic (pallor, flush,  Automatisms (chewing,
diaphoresis) swallowing, drooling)
 Post – ictal state
 No post-ictal
depression
Partial Sz: Benign Rolandic epilepsy
 Central-temporal lobe epilepsy
 Most common partial Sz: 10-15% childhood Sz
 Onset 5-10 yrs and resolve by 15 yrs.
 Ipsilateral facial twitchingparalysis
Speech arrest and drooling
 Daytime: may generalised
During sleep: usually no generalisation
 Treatment: carbamezapine if necessary
 Generalized Seizures
1. Tonic-clonic (grand mal)
2. Absence (petit mal)
3. Myoclonic
4. Infantile spasms
5. Atonic
6. Tonic
 G-T-C Seizures
 Rhythmic stiffening and jerking involving trunk and
extremities

 Long post-ictal period

 Large differential diagnosis……see latter

 Treatment: acute (see latter)

chronic: carbamezapine, valproate,
dilantin, phenobarbital(<1yr)
 Absence Seizures
 Staring or brief lapse in conciousness
 no post-ictal depression
 Several seconds (1-15 seconds)
 may be frequent
 Autosomal dominant
 Can ellict by hyperventitation
 Characteristic EEG : 3 Hz/s spike waves
 Rx: ethosuximide, valproate (>2yrs)
 Myoclonic epilespy
 Sudden brief muscle jerks with loss of muscle
tone fall/slump forward
Types
 Benign myoclonus of infancy: clusters myoclonic mov’t of
neck, trunk extremities…..resolves by age 2
 Typical myoclonic epilepsy of childhood: dev’t
normal with uneventful PmHx. Onset(6 months-4 yrs). Most resolve,
but learning and behavioral difficulties. +ve FmHx.
 Complex myoclonic epilepsies: poor prognosis, GTC in
1st yr of life. Often perinatal insult (HIE, microcephaly). ¾ mental
retardadtion and behavioral problems.
 Juvenile Myoclonic epilepsy: onset 12-16yrs. Myoclonic jerks
on awakening, improves throughout day. Normal dev’t. Rx. Valproate
life long.
 Infantile Spasms
 symmetrical contractions of neck, trunk &
extremities
 Onset: 4-8 months
 Types: flexor, extensor, mixed
 Cryptogenic(20%): normal Hx, dev’t, P/E  good prognosis
Vs.
Symptomatic(80%): prenatal/perinatal/postnatal insult
95% dev’t delay
 Treatment: complicated, ACTH effective
 Generalized Seizures

Atonic: drop attacks

Tonic: stiffening only of limbs and

extremities.
 History
 Describe event (tone change, limb movements,
partial, generalized, drooling, eye deviation,
cyanosis, tongue biting, incontinence, post-ictal
depression)
 Onset (what was child doing), duration
 Fever, head trauma
 Inter current illness, sick contacts
 Previous occurences
 FmHx
 Differential Investigations
Structural
 Bleed (IVH, trauma, AVM,
shaken baby) Head U/S
 Neoplasms...esp if focal CT head, MRI

Infections
 Meningitis, Encephalitis CBC, Blood cultures
 Cerebral malaria LP
 Shigella (toxin) B/S

Metabolic
 lytes (Na, Mg, Ca, PO4, Glu)
Electrolytes
 Inborn areas of metabolism (AA
disorders, NH3, organic acid) Plasma amnio acids, Urine
organic acids, NH3

Drugs/toxins
 Sz medications?
Medication levels
 Acute management
 ABC’s
 Glucometer and blood work
 IV access
 Meds: Diazepam: 0.3mg/kg IV
0.5mg/kg rectal
Lorazepam: 0.1 mg/kg IV

 Trial of above meds 2X if not effective, load

with dilantin 20mg/kg or phenobarbital if <2yrs.