Seizure

Dr. Shreedhar PaudelMay, 2009

Seizure…..

• A seizure is a sudden disruption of the brain's normal electrical activity accompanied by altered consciousness and/or other neurological and behavioral manifestations– Characterized by paroxysmal, abnormal

involuntary, motor, sensory and autonomic activity

Seizure…..

• Epilepsy is a condition characterized by recurrent seizures that may include repetitive muscle jerking called convulsions

Seizure…..• APPROACH TO A SEIZURE PATIENT– 1.History

• Onset• Progression• post- ictal phase• Perinatal and Developmental history• family history

– 2.Physical examination

– 3.Investigation: EEG, imaging, LP

Seizure…..• CAUSES OF CHILDHOOD CONVULSION– EARLY NEONATAL• 1. Birth asphyxia• 2. Intraventricular hemorrage• 3. Inborn error of metabolism• 4. Drug withdrawal

– NEONATAL• 1. Dyselectrolytemia• 2. Developmental disorders• 3. Infection• 4. TORCH infection

Seizure…..

• CAUSES OF CHILDHOOD CONVULSION

– FROM 1 MONTHS TO 3 YEARS• 1. FEBRILE CONVULSION• 2. INFECTION• 3. METABOLIC DISTURBANCES• 4. SPACE OCCUPYING LESION• 5. EPILEPSY

Febrile Convulsion• Commonest cause of seizure during early

childhood

• Defn – seizure during fever occuring between 6 months to 5 years of age in the absence of neuroinfection

• Convulsions are not related to the degree of temperature rise but are frequent if temperature rises abruptly

Febrile Convulsion….• Types:-– Simple benign febrile convulsion• Fits occur within 24 hrs of onset of fever• Last < 10mins• Single per febrile episode• Family history of febrile convulsion

– Atypical complex febrile seizures• Family history of epilepsy and neurodevelopmental

retardation

Febrile Convulsion….• Should be differentiated from meningitis or

encephalitis which are also important causes of convulsions associated with fever

• LP done in – 1st episode of febrile seizure– Infants (below 1 yr)

• EEG and neuroimaging – no role

Febrile Convulsion….

• Treatment:-– Prompt reduction of temperature with • Antipyretics or hydrotherapy

– Supportive therapy• Nursing in semi-prone position• Adequate airway and oxygen

– IV line • To maintain hydration• To give anticonvulsant medication• To obtain blood specimen for investigations

Febrile Convulsion….

• Treatment:-– Aspirin avoided – danger of development of

Reye’s syndrome

– Inj. diazepam(0.2- 0.3mg/kg/dose)maximum of 5 mg/dose → for control of seizures

– Phenobarbitone – slower acting but more sustained action

Febrile Convulsion….• Febrile seizure prophylaxis:-– Intermittent prophylaxis• During episodes of fever• For first 3 days of fever (majority of cases occur within

this period)• Diazepam ( PO or rectal)• Antipyretics, hydrotherapy, meticulous temperature

recording

– Continuous prophylaxis• If failure of intermittent therapy• Sodium valproate /phenobarbitone• For 1-2 yrs or till 5 yrs of age whichever comes earlier

Febrile Convulsion….

• Prognosis:-– Recurrence 30- 50 %

– Recurrent complex seizures– prone to develop epilepsy