1. Neurology Chapter of IAP
Seizures in Childhood
Neurology Chapter of IAP

2. Neurology Chapter of IAP
Reference
Paediatrics & Child health
Coovadia and Wittenberg p
Lecture on AED
Neurology Chapter of IAP

3. Neurology Chapter of IAP
Introduction
Convulsion associated with febrile disease
2-4% of all children before the age of 5 years
Symptomatic seizures
0.5-1%
Epilepsy:
Recurrent unprovoked seizures
First year of life:
1,2/1 000
Childhood and adolescents:
0,5-1/10000
Neurology Chapter of IAP

4. Neurology Chapter of IAP
Aetiology of Epilepsy
Specific aetiology
Identifiable in only 30% of cases
Idiopathic 67.6%
Congenital 20%
Trauma
HIE
Congenital brain anomalies
Trauma 4.7%
Infection 4.0%
Vascular 1.5%
Neoplastic 1.5%
Degenerative 0.7%
Neurology Chapter of IAP

5. Neurology Chapter of IAP
Seizure type
- Simple
(Normal consciousness)
- Complex
(Impaired consciousness)
Partial
(Only a portion
of the brain)
Generalized
(Both hemispheres are
involved)
Neurology Chapter of IAP

6. Epilepsy classification
Clinical presentation is quite variable
age of onset
seizure type
interictal condition
EEG
Outcome
Evaluate the:
the epileptic syndrome
Possible aetiology
The seizure type and syndrome type determine the
Specific appropriate treatment
Further evaluation
Neurology Chapter of IAP

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9. Main Periods according to Age
Neonates
Subtle, erratic, non-febrile
Infancy and early childhood
3 months to 3 years
Febrile seizures
Infantile spasms
Lennox Gastaut
Myoclonic seizures
Status epilepticus
Partial complex
Neurology Chapter of IAP

10. Main Periods according to Age
Childhood to early adolescence
Cryptogenic
Absences
Benign rolandic epilepsy
Nine years to adulthood
Primary generalized epilepsy
Focal epilepsy with brain injury
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11. Neurology Chapter of IAP
Neonatal seizures
Subtle seizures
Deviation of the eyes
Eyelids are flickering
Swimming or pedaling movements
Apnoeic spells
Tonic
Clonic
Myoclonic
Seldom tonic clonic seizures
Neurology Chapter of IAP

12. Aetiology of neonatal seizures
Perinatal:
HIE
ICH
Metabolic
Hypoglycemia, hypocalcemia
hypomagnesemia
Other
Infections
Structural abnormalities
Drug withdrawal
Neurology Chapter of IAP

13. Treatment of neonatal seizures
Optimize ventilation, cardiac output, BP, glucose, electrolytes and pH.
Treat the underlying disease
Intravenous line is essential
Treat the seizures promptly and vigorously
Phenobarbitone
Phenytoin
Neurology Chapter of IAP

14. Non-epileptic paroxysmal events in childhood
Syncope
Breath-holding spells
Pallid: Vagal asystole
Cyanotic: Cerebra ischaemia due to a sudden rise in the intra-thoracic pressure impeding the venous return to the heart
Night terrors
Nightmares
Masturbation
Cardiac disorders
Neurology Chapter of IAP

15. Non-epileptic paroxysmal events in childhood
Complicated migraine
Movement disorders
Jitteriness
Absence of abnormal gaze movements
Provoked by passive flexion or extension
Seizure jerks tend to be 2-3 Hz, clonus or jitteriness tend to be 5-6 Hz
Normal EEG
No increase in blood pressure or heart rate
Neurology Chapter of IAP

16. Neurology Chapter of IAP
Febrile seizures
Definition:
Seizure in children between the age of 6 months and 3-4(5) years in association with fever but without evidence of an intracranial infection
Majority occurs before the age of 3 years
Average age of onset: 18 months to 22 months
Boys more than girls
Neurology Chapter of IAP

17. Neurology Chapter of IAP
Febrile seizures
Recurrence
1/3 may have at least one recurrence
The younger the age of onset the greater the risk of recurrence
Risk of developing epilepsy 2%
Risk increases with:
Complex
Abnormal neurological state
Mesial temporal sclerosis
Neurology Chapter of IAP

18. Management of febrile seizures
Identify the underlying disease
LP?
CT or MRI is not warranted in the evaluation of febrile convulsions
Routine EEG is seldom necessary
Treatment:
Long-term use of AED is not indicated
Phenobarbitone
Sodium valproate
Rectal diazepam
Antipyretics
Neurology Chapter of IAP

19. Neurology Chapter of IAP
Treatment of Epilepsy
Drug treatment should be regular
Simple as possible
Minimum of side effects
Monotherapy
Changes should be made gradually
High initial dosages increases side effects
Rapid withdrawal carries the risk of provoking status
Always calculate the dosage according to the weight
Neurology Chapter of IAP

20. Neurology Chapter of IAP
Treatment of Epilepsy
Drugs commonly used
Carbamazepine
Sodium valproate
? Clonazepam
? Phenobarbitone
? Phenytoin
Newer drugs
Clobazam
Oxcarbazepine
Gabapentin
Vigabatrin
Lamotrigine
NB. You are referred to the lecture on AED and the side effects should be studied!
Neurology Chapter of IAP

21. Neurology Chapter of IAP
Treatment of Epilepsy
AED can cause convulsions
Benzodiazepines can induce TC seizures in LGS
Carbamazepine may exacerbate absence seizures
What is used as first line treatment.
Absence:
Sodium valproate
Focal and Generalized TC:
Carbamazepine
Neurology Chapter of IAP

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Status Epilpeticus
Medical emergency
Management
Abort the seizures
See figure 1
Resuscitate the brain
ABC of resuscitation
Cerebral oedema
Mannitol
Metabolic and biochemical abnormalities
Hyperpyrexia
Neurology Chapter of IAP

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25. Neurology Chapter of IAP
Status epilepticus
Treat the cause of the seizures
? LP
CT/MRI
Drug levels
Toxic screen
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Status epilepticus
Correct the metabolic and systemic effects
Drop in blood pressure
Impaired brain perfusion
 Liver enzymes
Clotting defects
Hyperkalaemia
Hypoglycaemia
Inappropriate ADH
Renal failure
Neurology Chapter of IAP