26. Seizure Year 4 Paediatrics Notes OmpathStudy

26. Seizure Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / OTHER NOTES -- SEIZURE DISORDER Objectives:\n● To know that seizures (ZT’s) a symptom NOT a disease\n● To know clinical observation crucial for Dx, classification, and Rx.\n● R/O other paroxysmal, non-epileptic disorders.\n● To know acute management & prevention of recurrence.\n● To know thoughtful & rational patient work-up\n● To know optimum use of anti-epileptic drugs (AED’s)\n● To know comprehensive patient (not SZ’s) management. Sources: ​Dr.Albashiri’s slides and ​notes​, illustrator\n\nDefinitions:\n● Seizures​: are the clinical manifestation of aberrant, abnormal electrical activity in the\ncortical neurons.\n○ It is a symptom of cerebral pathology, not a disease \n● Epilepsy:​ ​is a chronic disorder characterized by the tendency for spontaneous, recurrent\nseizures and requires at least ​two ​un​provoked​ seizures to be considered as a\ndiagnosis.\n● Epileptic Syndrome:​ ​a complex of symptoms and signs that define a unique epilepsy\ncondition. ( e.g L.G.S ​Lennox-Gastaut syndrome​)\n● Epileptic Disorder:​ ​A chronic neurological condition characterized by recurrent epileptic\nseizures.\n● Non-epileptic seizures (NES):​ is a descriptive term for a group of disorders that refer to\nparoxysmal events that can be mistaken for epilepsy, but are not due to an epileptic\ndisorder. Epidemiology:\n● Seizure is the most common neurological disorders\n● Seizures occur in 3% to 5% of all children\n● Febrile seizures occur in 2% to 4% of the pediatric population.\n● Epilepsy occurs in approximately 1%. \n\nHistory Taking: Questions regarding the possible seizure can be divided into:\nPre-ictal Ictal Post-ictal \n● Was there any warning before ● Did any body ● How did the patient\nthe spell? If so, what was the movements occur? feel after the spell?\nwarning? ● Was there any ● Did the child seem\n● Did the child complain of perioral cyanosis? confused and tired\nabdominal discomfort, fear or ● Did the patient lose after the spell?\nany other unpleasant consciousness ● How long did it take for\nsensations before the spell? during the spell? the child to get back to\n● What was the child doing ● How long did the baseline condition?\nbefore the spell? spell last? ● Did the child suffer\n● Was the child asleep or ● How many from a headache after\nawake prior to the event? episodes? the spell?\n● Was the child sleep deprived ● How often do the ● Was there any\nprior to the spell? spells occur? weakness noticed?\n● Were there any triggers for\nthe spell?\n● Was the child well before the\nspell or was there a fever or\nillness? \nOther questions to ask:\n● Has the child ever had any seizures before?\n● Is there any history of febrile seizures?\n● Ask about past medical history\n● Pregnancy and birth history\n● Developmental history\n● Current medications\n● Is there any family history of seizures?\n\nPhysical Examination: A complete pediatric exam.\n● Pay attention to the following elements:\n○ Vitals, including temperature\n○ Height, weight and head circumference - plot on a growth chart to determine\npercentiles\n○ Developmental stage of child in gross motor, fine motor, language and social\ndomains\n● Signs of trauma.\n● Signs of increased intracranial pressure\n● Skin lesions may suggest a neurocutaneous disease\n● Special tests:\n○ Fundoscopy\n○ Neurologic exam: looking for focal deficits indicates symptomatic seizure. \n\nSeizure​ ​Categorization:\n★ After taking history and exam, you will be able to categorize the seizure which is\nimportant for determining treatment and prognosis. \nWe need to answer two main questions:\n1. Is the seizure focal or generalized?\n2. Is the seizure simple or complex? Is there impairment in consciousness? Classification of Epileptic Seizures:​old classification but we still use it very often\n1. Focal(partial) Seizures: ​NO​ loss of consciousness\na. Simple partial seizures (motor, sensory, hallucinations, autonomic psychic\nsymptoms)\nb. Complex Partial Seizures (​impaired​ consciousness)\nc. Partial seizures with secondary generalized.\n2. Generalized seizures: ​Complete​ ​LOSS​ of consciousness\na. Absence seizures ( typical and atypical)\nb. Myoclonic seizures\nc. Clonic Seizures\nd. Tonic seizures\ne. Tonic-clonic seizures\nf. Atonic seizures\n3. Unclassified seizures\n\n Auro with temporal lobe epilepsy, while\nfrontal lobe epilepsy\nnever have aura \n\nInternational classification of epilepsies,epileptic syndrome and related seizure disorders​New classification\n● Localization related​ (focal,local, partial )\n● Generalized epilepsies and syndromes\n● Undetermined epilepsies:\n○ With both generalized and focal seizure:\n■ Neonatal seizure\n■ Severe Myoclonic Epilepsy of Infancy (SMEI)\n■ Epilepsy with continuous Slow – wave during sleep\n■ Landau – Kleffner Syndrome (LKS)\n○ Without unequivocal generalized/focal features \n● Special syndromes:\n○ Conditions with epileptic seizure that do not require a