0071643192.pdf

PEDIATRICS

Pediatric Seizures

Seizures occur due to an involuntary discharge of cortical neurons. Types of

seizures are listed in Table 5.13. The diagnosis of epilepsy requires the child

to have >1 seizure. About 1% of children <20 years of age develop epilepsy.

SYMPTOMS/EXAM

■ May be postictal

■ May be incontinent or tongue biting

■ Examine closely for evidence of trauma, infection, or focal neurological

deficit.

DIAGNOSIS

■ Based on a detailed history of the event

■ Workup may include:

■ Serum glucose

■ Serum electrolytes (sodium, calcium, magnesium), CBC

■ Therapeutic drug levels if child is taking antiepileptic drugs

■ Lumbar puncture if concern for meningitis or subarachnoid bleed

■ Head CT if partial seizure, focal neurological deficit, or presence of

trauma

TREATMENT

Actively seizing:

■ Stabilize airway.

■ Lorazepam 0.05–0.1 mg/kg IV (max dose 2 mg)

■ Phenytoin (10–15 mg/kg IV) or phenobarbital (10–20 mg/kg IV) may be

necessary if seizures persist in spite of benzodiazepines.

■ Admission to hospital if first focal seizure or focal neurological deficit

■ Consider discharge to home if first generalized seizure (and normal ED

evaluation)

■ Follow-up with pediatrician and pediatric neurologist

■ If patient is discharged, the decision to start antiepileptic drugs should be

made in consultation with a pediatric neurologist.

TABLE 5.13. Classification of Pediatric Seizures

SEIZURETYPE CLINICALCHARACTERISTICS

Partial seizures (focal seizures)

Partial simple No loss of consciousness

Complex partial Loss of consciousness

Partial evolving to generalized Focal symptoms progressing to generalized seizure

Generalized seizures

Absence seizure Nonconvulsive, last <15 sec

Myoclonic Minor symmetric motor spasms

Tonic Increased tone

Clonic Rhythmic spasms

Tonic-clonic Alternating increased muscle tone with muscle spasm

Atonic Loss of muscle tone

Causes of Seizures

in Children—

TIMED IT

Trauma

Infection (meningitis)

Metabolic

(hypoglycemia,

hyponatremia,

hypernatremia,

hypocalcemia)

Epilepsy (medication

noncompliance

common)

Drugs (lead, cocaine,

aspirin, carbon

monoxide)

In-born errors of

metabolism

Tumor