Seizures in Children

1
Seizures in Children

• Dr Penny Mancais
• Consultant Paediatrician
• Dorset County Hospital
• Foundation trust

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To be Covered

• Terminology
• History taking
• Prognosis of Seizures
• Fits, faints and funny turns
• When to refer
• Pragmatic advice in Epilepsy

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Definition of Seizure

• ANY SUDDEN ATTACK FROM WHATEVER CAUSE.
• Many manifestations determined by site of origin.
• Many causes
• Non Epileptic (reflex anoxic ,fainting, Tics
  ,migraines, night terrors )
• Epileptic

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Definition of Epileptic Seizure

• Manifestation of Epileptic (excessive) usually
  self limited activity of neurons in the brain
• ILAE

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Prognosis of seizures

• 1 afebrile seizure
• 50 will have a recurrence
• 3 febrile seizure
• Risk of recurrence
  35
• Risk of Epilepsy following simple 1
• Risk of Epilepsy following complex 6
• Risk of Epilepsy following complex/FH 30

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Taking the History

• Diagnosis is in the History
• No Ix to confirm epilepsy
• RELIANT ON HISTORY

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What to ask

• Eye witness account
• Role play
• Avoid interpretations
• Time line
• Use counting
• Home videoing

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Features that may occur in Seizures

• Sudden fall
• Jerking limbs
• Blank stare
• Urinary incontinence
• Funny smell
• Feeling of fear
• Facial flushing
• Seeing coloured spots
• vomiting

• Racing heart
• Tingling sensations
• Headache
• Generalised stiffening
• Floppiness
• Ringing noises
• Hiccups
• Sudden loss of vision

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Fits Faints and funny turns

• Collapsing with convulsions
• Drop attacks
• Stiffening attacks
• During sleep

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Fits faints and funny turns
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When to refer

• Any child with unexplained seizure (NICE)
• lt1years discuss ?admit
• NO investigations
• Advise home videoing, diary monitoring
• All children with a diagnosis of epilepsy should
  have a named paediatrician.

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Pragmatic advice in Epilepsy

• Will my child die?
• Risk from fit is negligible
• SUDEP 1200 (poor control,teenagers,male)
• Accidents
• NO climbing/harness, swimming 11, shower
• Alcohol (13 on anticonvulsants)
• Recreational drugs (increase risk of seizure)

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Advice continued

• Contraception
• Higher doses of Oestrogen for enzyme inducing
  drugs plus barrier protection
• Starting a family
• Driving
• Nocturnal seizures ok
• Fit free 1yr on/off medication
• DVLA latest advice

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Medication

• Now 17 drugs available
• Aim to improve seizure control
• Minimises effects on learning and behaviour
• Blood tests not needed

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Summary

• History, History, History
• All children with unexplained seizure need
  referral
• lt1 pick up phone ? Admit
• Web sites
• National Society for Epilepsy
• Epilepsy action