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Seizure

Seizure. Dr. Shreedhar Paudel May, 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

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Seizure

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  1. Seizure Dr. ShreedharPaudel May, 2009

  2. 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

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

  4. Seizure….. • APPROACH TO A SEIZURE PATIENT • 1.History • Onset • Progression • post- ictalphase • Perinatal and Developmental history • family history • 2.Physical examination • 3.Investigation: EEG, imaging, LP

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. Febrile Convulsion…. • Prognosis:- • Recurrence 30- 50 % • Recurrent complex seizures– prone to develop epilepsy

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