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Fits, febrile convulsions, faints

Fits, febrile convulsions, faints. Dr Julia Thomson Medical students, Whipps X, 1 st April 2010. Objectives. Understand the definitions involved Understand some of the presenting features of fits and faints Understand how you might tell the difference between them. Overview.

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Fits, febrile convulsions, faints

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  1. Fits, febrile convulsions, faints Dr Julia Thomson Medical students, Whipps X, 1st April 2010

  2. Objectives • Understand the definitions involved • Understand some of the presenting features of fits and faints • Understand how you might tell the difference between them

  3. Overview • Background on afebrile fits • Background on febrile convulsions • Background on faints • Group task • Case presentations and discussion • Questions • Summary

  4. Fits - Epilepsy • Up to 5% of people will have at least one epileptic seizure in their life • But to be diagnosed as “having epilepsy”, the epileptic seizures must be RECURRENT • Many people with idiopathic epilepsy (ie. no underlying brain disorder) grow out of it • Classified as generalised or focal (partial) depending on whether it STARTS from both sides of the brain simultaneously or in one localised area • Many generalised seizure types recognised • Generalised tonic clonic (GTCS), tonic, myoclonic, atonic, absence • Up to 1/3 of children diagnosed with epilepsy do not have it • Exercise 1

  5. Febrile convulsions • “an event occurring in infancy or childhood, usually between 3 months and 5 years of age, associated with a fever but without evidence of intracranial infection or defined cause for the seizure” National Institute for Health, USA • Peak incidence 9 to 20 months, 3 to 4% of all children affected • No definition of fever, in practice ≥ 38oC • Family history likely. 25% risk for siblings • Most are generalised tonic-clonic seizures • Classified as simple or complex • SIMPLE: generalised, short, do not recur within 24 hours • COMPLEX: focal features, last > 10 minutes, recur within 24 hours • 30 – 40% risk of recurrence • Risk factors: < 18 months, Family History, low temperature, short duration of illness. • Risk of recurrence depends on how many risk factors present • 0 = 4%, 1 = 23%, 2 = 32%, 3 = 62%, 4 = 76% • Risk of developing epilepsy is six fold that of normal population (= 6 x 0.5%)

  6. Faints (paroxysmal non-epileptic disorders) • Faint = syncope. Caused by decrease in O2 supply to the brain. Loss of consciousness and postural tone may be followed by stiffening of body and brief jerking. • Reflex anoxic seizures • Breath holding attacks • Simple faints • Long QT disorders and other cardiac syncopes • Suffocation

  7. Other paroxysmal non-epileptic disorders • Behavioural events and psychological disorders • Daydreams and poor concentration • Self gratification/masturbation • Tics and stereotypies • Pseudoseizures • Derangements of sleep process • Nightmares • Night terrors • Cataplexy • Paroxysmal movement disorders • Benign neonatal sleep myoclonus • Dyskinesias • Paroxysmal ataxias

  8. Investigations • Biochemistry? • ECG? • EEG • MRI/CT? • Exercise 2

  9. Case presentations • What is the differential diagnosis? • What’s the most likely diagnosis? • Why? • Does the child need investigations and if so, what? • What is the prognosis?

  10. Questions?

  11. Summary • Definitions • Differences between epileptic seizures and paroxysmal non-epileptic disorders • Better understanding of how to tease out which the child is suffering from

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