Seizure

• Seizre

  Most common pediatric neurologic disorder
• Seizure

  Caused by excessive and disorderly neuronal discharges in the brain
• Seizure

  Symptoms of an underlying disease process
• SEIZURE


  Caused by: Infectious, neurologic, metabolic, traumatic, or related to ingestion of toxins
• Children may have single seizure without the cause ever being known
• Alterations in Perception and Coordination

  • Abnormal electrical discharges
  • May arise from central areas in the brain that affect consciousness
  • May be restricted to one area of the cerebral cortex, producing manifestations characteristic of that particular anatomic focus
  • May begin in a localized area of the cortex and spread to other portions of the brain, and if sufficiently extensive, produce generalized seizure activity
• Physiologic stimuli


  Cellular dehydration, severe hypoglycemia, electrolyte imbalance, sleep deprivation, emotional stress, and endocrine changes
• patho seizure

  • Excessive excitation and loss of inhibition of a group of neurons in the CNS
  • Amplify electrical discharge of the neurons resulting to seizure
• Types of Seizure


  • Partial seizures
  • Generalized seizures
• Simple Partial Seizure with Motor signs

  • Aversive seizure eye and head turn away from the side
  • Rolandic (Sylvan) seizure tonic and clonic movements face,salivation, speech (most common during sleep)
  • Jacksonian march clonic beggining in the foot
• Complex Partial Seizure (Psychomotor seizures)

  • Period of altered behavior
  • Amnesia for event
  • Inability to respond to environment
  • Impaired consciousness during event
  • Drowsiness or sleep usually following seizure
  • Confusion and amnesia possibly prolonged
  • Complex sensory phenomena (aura)
• Simple Partial Seizure with Sensory signs

  • Numbness, tingling, prickling, paresthesia, or pain originating in one area (face or extremities) and spreading to other parts of the body
  • Visual sensations or formed images
  • Motor phenomena (posturing or hypertonia)
• Tonic-Clonic seizures


  • Tonic phase most common and dramatic, no warning, 10-20 seconds
  • Clonic phase 30 seconds to half hour or longer
• Complex Partial Seizure (Psychomotor seizures)


  • Stereotypic
  • Similar with each subsequent seizure
  • May suddenly cease activity, appear dazed, stare into space, become confused and apathetic, and become limp or stiff or display some form of posturing
  • May be confused
  • May perform purposeless, complicated activities in a repetitive manner (automatisms)
• Postictal stateGENERAL


  • Appears to relax
  • May remain semiconscious and difficult to arouse
  • May awaken in a few minutes
  • Remains confused for several hours
  • Poor coordination
  • Mild impairment of fine motor movements
  • May have visual and speech difficulties
  • May vomit or complain of severe headache
  • When left alone, usually sleeps for hours
  • On awakening, is fully conscious
  • Usually feels tired and complains of sore muscles and headache
  • No recollection of entire event
• Status epilepticusGENERAL


  • Series of seizures at intervals too brief to allow the child to regain consciousness between the time one event ends and the next begins
  • Requires emergency intervention
  • Can lead to exhaustion, respiratory failure, and death
• Absence seizure (Petit Mal or Lapses)Characterized GENERAL


  • Onset 4-12 years old
  • >boys than girls
  • Ceases at puberty usually
  • brief LOC
  • minim to no alteration in muscle tone
  • May go unrecognized due to little change in behavior
  • Abrupt onset; suddenly develops 20 or more attacks daily
  • Looks like daydreaming or inattentiveness
  • Events possibly precipitated by hyperventilation, hypoglycemia, stresses (emotional and physiologic), fatigue, or sleeplessness
• Absence seizure (Petit Mal or Lapses)GENNERAL


  • Brief loss of consciousness
  • Appear without warning or aura
  • Usually last about 5 to 10 seconds
  • Slight loss of muscle tone may cause child to drop objects
  • Ability to maintain postural control; seldom falls
  • Minor movements such as lip smacking, twitching of eyelids or face, or slight hand movements
  • Not accompanied by incontinence
  • Amnesia for episode
  • May need to reorient self to previous activity
• Atonic and Akinetic seizure (Drop Attacks) GENERAL

  • Characterized:
  • Onset 2 and 5 years old
  • Sudden, momentary loss of muscle tone and postural control
  • Events recurring frequently during the day, particularly in the morning hours and shortly after awakening
  • Manifested:
  • Loss of tone causing child to fall to the floor violently
  • Unable to break fall by putting out hand
  • May incur a serious injury to the face, head, or shoulder
  • Loss of consciousness only momentary
• Myoclonic seizureGENERAL


  Variety of seizure episodes

  Isolated as benign essential myoclonus

  
  

  • Sudden, brief contracture of a muscle or group of muscles
  • Occur singly or repetitively
  • No postictal state
  • May or may not be symmetric
  • May or may not include loss of consciousness
• Infantile spasmsUNCLASSIFIED


  • Possible series of sudden, brief, symmetric, muscular contractions
  • Head flexed, arms extended, and legs drawn up
  • Eyes sometimes rolling upward or inward
  • May be preceded or followed by a cry or giggling
  • May or may not include loss of consciousness
  • Sometimes flushing, pallor, or cyanosis
  • SIT BUT NO STAND=
  • Sudden dropping forward of the head and neck with trunk flexed forward and knees drawn up
  • Extensor spasms rather than flexion of arms, legs, and trunk, and head nodding
  • Lightning events involving a single, momentary, shock-like contraction of the entire body
• Febrile Seizure


  • Convulsions triggered by a rise in body temperature
  • Affects 2-5% of children between ages 6 months and 5 years
  • Peak incidence: 18 months of age
  • Twice as common in boys as in girls
  • Do not cause brain injury
  • Usually last less than 5 minutes
  • Do not occur frequently
  • Do not increase the risk of epilepsy
• Types of febrile seizure

  • Simple febrile seizure
  • Complex febrile seizure
• Simple febrile seizure


  • Occurs in ages between 6 months and 5 years
  • No preexisting neurologic abnormality
  • Consist of tonic-clonic seizure that occurs with a fever (>38°C)
  • Resolves within 15 minutes
  • Returns to alert mental status
  • No further seizure occurring within 24-hour period
  • Risk factors: viral infection, family history
• Complex febrile seizure


  • Occur in any age
  • With previous history of neurologic impairment
  • Prolonged seizure lasting more than 15 minutes
  • Can reoccur within 24-hours
  • Can result in neurologic deficits after the seizure
• Febrile seizure management


  1. Medications: Acetaminophen/ibuprofen, IV or rectal Diazepam

  2. Parental education and emotional support
• Tonic Manifestations:

  
  

  Eyes upward

  Immediate LOC

  Standing - Falling

  Stiffens

  Arms Flexed

  Legs, neck, and head extended

  Apneic-Cyanotic

  Increased Salivation And loss of swallowing reflex
• Clonic Manifestations:

  
  

  Violent Jerking of trunks and extremities

  Foaming

  Incontinence

  Longer intervals - Ceasing entirely