The document discusses febrile convulsions and epilepsy in children. It defines febrile convulsions as seizures accompanied by a fever in the absence of infection, affecting 3% of children. Febrile convulsions are usually generalized tonic-clonic and related to a rapid rise in fever. Investigations are needed to exclude central nervous system infections. Epilepsy is defined as recurrent unprovoked seizures and affects 1 in 200 children. An underlying etiology is important to identify, and an electroencephalogram may be indicated if epilepsy is suspected. Parents, teachers, and children need guidance on management to avoid injury and reassurance, as both conditions generally have a good prognosis.

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2. Contents
 What is a seizure?
 Seizure types
 Etiology of seizures
 Febrile convulsions
 Epilepsies of childhood
 Epilepsy syndromes
 Status epilepticus
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3. What is a Seizure ?
 Paroxysmal, involuntary & sudden
disturbance of neurological function caused
by an abnormal or excessive neuronal
discharge.
 With or without LOC.
 If manifests as motor act – “convulsions”
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4. Seizures
Epileptic Non
epileptic
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5. Etiology of seizures
 Idiopathic (70-80%) – cause unknown but
presumed genetic
 Secondary
 Cerebral malformations
 Cerebral vascular occlusion
 Cerebral damage (ex; congenital infections,
hypoxic-ischaemic encephalopathy…)
Causes for Epileptic seizures
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6.  Cerebral tumour
 Neurodegenerative disorders
 Neurocutaneous syndromes
 Neurofibromatosis
 Tuberous sclerosis
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7. Causes for Non-epileptic seizures
 Febrile seizures
 Metabolic
 Hypoglycaemia
 Hypocalcaemia
 Hypomagnesaemia
 Hypo/hyper natraemia
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8.  Head trauma
 Meningitis/Encephalitis
 Poisons/Toxins
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10. Definition
 A seizure accompanied by a fever in the
absence of intracranial infection due to
bacterial meningitis or viral encephalitis.
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11. Incidence
 Affects 3% of children
 Positive family Hx in 10%-20%
 Autosomal dominant inheritance (thus family hx
important)
 Recurrent febrile seizures in 30%-40%
 1%-2% of subsequent epilepsy after a simple febrile
seizure
 4%-12% in complex febrile seizure
 Boys > Girls
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12. Diagnostic criteria
 Age
 6 months – 60 months (5yrs)
 Peak 14 – 24 months
 Temperature
 Usually >= 38C with rapidly rising temp.,
within 24hrs of onset of fever
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13.  Should not last >10min
 Generalized, not focal
 No residual weakness of limb or disability
except a brief period of drowsiness
 No evidence of CNS infections. (meningitis,
encephalitis, abscess….)
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14.  Extra cranial infection may be there. ( URTI,
tonsillitis, otitis media…)
 No Hx of previous afebrile seizure
 No acute systemic metabolic abnormality
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15. Classification
SIMPLE COMPLEX
Most common Uncommon
Lasts less than 15min Lasts more than 15min
One fit only in the same
illness
Recurring during same
illness within 24hrs
Generalized tonic-clonic Focal
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16. Risk factors for recurrent febrile
seizures
 Younger than 18 months (younger the child, higher
the risk...)
 Shorter duration of fever before the seizure
 Height of fever (lower the peak, higher the risk…)
 Positive family Hx
 Complex febrile seizure at onset
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17. Pathogenesis
 Not well known
 Due to temporary impairment of the
balance between convulsant and
anticonvulsant system of brain
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18.  Studies done in children suggest that the
cytokine network is activated and may
have a role in the pathogenesis of febrile
seizures
 Threshold level of anticonvulsant system in
these genetically predisposed children is
lower
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19. Other suggestions
 Endogenous pyrogens such as IL-1
increase neuronal excitability & cause
seizures
 Hyperthermia induced alkalosis
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20. Investigations
 Usually not needed in simple febrile
convulsion
 Complex form may need,
 Blood glucose, serum electrolytes
 LP and CSF analysis
 Neuro-imaging (CT, MRI)
 EEG
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21. Lumbar puncture is strongly
recommended ,
 Hx of irritability, reduced feeding or lethargy
 Clinical signs of meningitis/encephalitis
 Systemically ill
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22.  Prolonged post-ictal altered consciousness
 After a complex convulsion
 After pretreatment with antibiotics
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23. In these situations,
 LP must be undertaken to check for,
CSF
sugar
protein
organisms
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24. Neuroimaging is considered If,
 Micro/ macrocephaly
 Neurocutaneous syndrome
 Pre-existing neurological defect
 Recurrent complex febrile seizures
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25. EEG
 Not a guide for treatment
 Does not predict recurrence
 So not usually indicated
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26. Management
 Fever
 Find the cause (usually viral illness)
 Must exclude meningitis
○ Infection screen blood culture
urine culture
LP for CSF culture
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27.  Treating fever promote comfort.
 Not important in preventing seizures.
 Physical methods
 Fanning
 Tepid sponging (now not recommended)
 Light clothing
 Drugs
 PCM
 ibuprofen
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28. Management at home
 Move danger away
 Left lateral position
 Do not try to stop fitting
 Do not put anything in mouth
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29.  Loosen clothing
 Wipe secretions from mouth
 No fluids or drugs orally
 Note the time
 Do not panic
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30. If seizure lasting >5-10 min,
 Seek medical advice
 Diazepam
 0.5mg/kg rectal
 Midazolam
 0.5mg/kg buccal
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31. Prognosis
 Generally excellent
 Risk of further febrile seizures – 30%
 Risk of epilepsy after single febrile seizure – 3%
 No increased risk of death
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32. Information for parents
 FC are common
 Recurrences likely
 Brain damage
 Later epilepsy
Very rare
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33.  No evidence of deaths
 What to do when fitting
 If lasting >10 min & not stopping
 Rectal diazepam
-OR-
 Take to the hospital
 Information & advice sheets
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35. Definition
 Chronic neurological disorder
characterized by recurrent unprovoked
seizures, associated with abnormal,
excessive or synchronous neuronal activity
in brain
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36. Pathogenesis
 Sudden, excessive, disorderly
discharging neurons
 Increased GLUTAMATE levels &
decreased GABA levels
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37. Classification
 Generalized
 Discharges from both hemispheres
○ Absence
○ Myoclonic
○ Tonic
○ Tonic-clonic
○ Atonic
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38.  Focal
 Arise from one or part of one hemisphere
○ Frontal seizures
○ Temporal lobe seizures
○ Occipital seizures
○ Parietal lobe seizures
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39. Generalized seizures
 There is,
 Always LOC
 No warning
 Symmetrical
 B/L synchronous discharge on EEG
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40. Absence
Transient LOC
Abrupt onset & termination
Typical(petit mal) or atypical
Often due to hyperventilation
Myoclonic
Brief, repetitive, jerky movements
Limbs, neck or trunk
Physiologically in hiccoughs
Tonic
Generalized increased tone
Tonic – clonic
Rhythmic contractions of muscle
groups
Become cyanosed
Jerking of limbs
Tongue biting & incontinence
Atonic
Combined with myoclonic jerk
Followed by transient loss of muscle
tone
Sudden fall or drop of head
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41. Focal seizures
 Begin in one hemisphere
 May herald by an aura
 May or may not have change in
consciousness
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43. Frontal
Motor phenomena
Temporal
Auditory or sensory (smell
or taste) phenomena
Occipital
Positive or negative visual
phenomena
Parietal
Contra lateral altered
sensation
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44. Diagnosis
 Primarily by detailed Hx
 Child & eye witnesses
 Video if available
 Skin markers of Neurocutaneous syn.
Or neurological abnormalities
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45. Investigations
 EEG
 Indicated whenever suspected
 To detect structural abnormalities
 Neuronal hyperexcitability
○ Sharp waves
○ Spike-wave complexes
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46.  Many children with epilepsy
 Many children never had epilepsy
Normal initial EEG
Abnormal initial EEG
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47. Additional techniques
 Sleep deprived record
 24h ambulatory EEG
 Video – telemetry
 Subdural electrodes (prior to surgery)
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48. Imaging studies
 Structural scans
 MRI
 CT brain
 Can identify
 Tumours
 Vascular lesions
 Sclerotic areas
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49.  Functional scans
 Structural lesions not always possible to see
 Can see areas of abnormal metabolism
 Suggestive of focal seizures
 Ex :- PET, SPECT
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51. West syndrome
 Age of onset 4-6 months
 Violent flexor spasms of head, trunk &
limbs
 Extension of arms
 “salaam spasms”
 EEG shows hypsarrhythmia
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53. Childhood absence epilepsy
 Age of onset 4-12 y
 Suddenly stop moving & stare
 Lasts only few seconds
 Has no recall
 May look puzzled
 Induced by hyperventilation
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55. Benign epilepsy with
centrotemporal spikes (BECTS)
 Age of onset 4-10 y
 Tonic clonic seizures in sleep
 Abnormal feelings in tongue & face
 Focal sharp waves in EEG
 Benign so important to recognize
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57.  A seizure lasting >30min or repeated
seizures for 30min without recovery of
consciousness in between
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58. Management
Diazepam 0.5mg/kg PR
Lorazepam 0.1mg/kg IV Midazolam 0.5mg/kg buccal
Check blood glucose
If <3mmol/L give IV glucose & recheck
Airway
Breathing Circulation
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59. Rapid-sequence induction with Thiopental
Mechanical ventilation Transfer to PICU
Phenytoin 18mg/kg IV over 20min or
Phenobarbital 15mg/kg if on oral phenytoin
Paraldehyde 0.4ml/kg PR
(If no response in 10min)
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60. Summary
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Febrile
convulsions
Affect 3% of children
Usually tonic-clonic with
rapid rise in fever
Must exclude CNS infection
Family advice about
management
Does not affect intellect
Reassure the parents
Epilepsy
Affects 1 in 200 children
Underlying etiology important
If suspected EEG is indicated
Need psychological help
Parents & teachers need to be
aware of the management
Avoid injurious situations

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