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Definition
Sudden paroxysmal electrical discharge from the Central
nervous system resulting in involuntary, motor, sensory (or)
autonomic disturbances with (or) without alteration in
sensorium.
Seizure: the clinical manifestation of an abnormal and
excessive excitation and synchronization of a population of
cortical neurons
Epilepsy: two or more recurrent seizures unprovoked by
systemic or acute neurologic insults
Etiology
Etiology Contd..
METABOLIC CAUSES
Dehydration, dyselectrolytemia, acidosis, alkalosis, and
Hypoglycemia, Hyperglycemia, and inborn errors of
metabolism.
Etiology Contd..
MISCELLANOUS CAUSES
Anoxic / Hypoxic Ischemic Encephalopathy stage II,
Neonatal Seizures
In Neonates, incomplete myelination, lack of neurotransmitter, poor
spread of epileptiform discharge and lack of brain maturation result
in atypical and poorly organised seizures.
Observation of abnormal, repetitive attacks of movements,
postures or behaviors
Classification
subtle
tonic
clonic
myoclonic
autonomic
Evaluation for cause(s) of seizures
Confirmation/support by EEG
Etiology
Hypoxic ischemic encephalopathy, birth trauma
Intracranial Heamorrhage.
Metabolic Hypoglycemia, Hypocalcemia, Hypomagnesemia,
Hyponatremia
Pyridoxine dependency and deficiency
Inborn errors of metabolism - of aminoacids, carbohydrate,
organic acids and deficiency of enzymes (Urea cycle)
Structural malformations
Infections - Bacterial meningitis, intrauterine infections, brain
abscess, septicaemia
Drug withdrawal Sedatives, Anticonvulsants, narcotics
Genetic / Familial
Miscellaneous / Idiopathic
Febrile convulsions
Infantile spasms
Age dependent epileptic syndromes
Seizures due to other causes
Febrile Seizures
Definition - Convulsion associated with fever of extra cranial
origin in infant and children in the age group of 6 months to
5 years
Age dependent imbalance between the convulsant and
anti convulsant system in the brain.
More common in between 6 months & 5 years
Peaks in 14 18 months
90% occurs before 3 years
5% occurs < 6 months or > 4 years
Etiology
Bacteria
Shigella, salmonella, pnemococci
Genetics
Incidence
General
2 5 % children
More common in Japan 7 8%
Sex
more common in males than in females
Seasonal
Winter (RTI)
Summer (GIT infections)
15%
Focal or Unilateral
Last for > 15 mins
Postictal drowsiness / neurological deficit
Investigations
To find out the causes of
fever
CBC
Urine routine
Stool routine
Mx
Chest Skiagram
Blood culture
Peripheral smear
Blood sugar
Calcium
Magnesium
Electrolytes
Investigations Contd..
EEG
Not necessary in a case of 1st febrile seizures
Indication recurrent / atypical febrile seizures
1/3rd of cases show posterior slow wave activity
CT
MRI to rule out CNS infections
Criteria of Hospitalization
Age < 18 months
Child is ill looking
Complex seizures
Airway
Breathing
Circulation
Drugs Antipyretic
Tepid sponging
Diazepam 0.2 0.5 mg / kg / dose iv stat or rectal
Treatment Prophylaxis
Intermittent
Oral diazepam 0.2 0.4 mg /kg/dose, tds, for 3 days
Continuous
Treatment Prevention
Parent counseling parents more aware
During immunization give antipyretic if fever occurs
Risk factors
Recurrent febrile fits
Subsequent epilepsy
Prognosis
Excellent
Incidence of epilepsy in febrile seizures
With risk factor 9 %
without risk factor 1 %
Febrile Seizure
History duration of fever, &
seizures, description of episode,
family history
Normal - CSF
Abnormal CSF
Meningitis, Encephalitis
Contd..
Normal CSF
Assess Risk factors
Observe
Start Phenobarbitone
Side effects +
Sodium Valproate
Recurrence
No Side effects
Continue 2 seizure
free years
Early
Phenobarbitone
None
Observe
Partial Seizures
Simple
Complex
Secondary generalized
Phenytoin
Felbamate
Primidone
Gabapentin
Tiagabine
Lamotrigine
Topiramate
Levetiracetam
Valproate
Oxcarbazepine
Zonisamide
Phenobarbital
Clonazapam
Lamotrigine
Levetiracetam
Topiramate
Valproate
Zonisamide
Carbamazepine
Felbamate
Lamotrigine
Levetiracetam
Oxcarbazepine
Phenytoin
Topiramate
Valproate
Zonisamide
Discontinuing AEDs
Seizure freedom for 2 years
implies overall >60% chance of successful withdrawal in
some epilepsy syndromes
Favorable factors
Surgical Treatment
Potentially curative
Resection of epileptogenic region (focus) avoiding
significant new neurologic deficit
Palliative
Partial resection of epileptogenic region
Disconnection procedure to prevent seizure spread
corpus callosotomy
Multiple subpial transection
Syncope
Migraine
Cerebral ischemia
Movement disorder
Sleep disorder
Metabolic disturbance
Psychiatric disturbance
Breath-holding spells
Treatment
Time post onset
Treatment
Onset
2-3 min
4-5 min
7-8 min
Treatment Contd..
Time post onset
Treatment
10 min
Can repeat lorazepam or diazepam if
seizures ongoing
30-60 min
40 min
Refractory seizures
I.V. Valproic Acid -10-20mg/kg with N. saline over
3-5
Thiopentone* - 3-5mg/kg loading.
1mg/kg/hr infusion ,increased
Propofol* - 3-5mg/kg loading,
-5-10mg/kg/hr.
* Ventilation mandatory
Thank you