Describes a particular type or types of seizures associated with typical EEG findings and patient characteristics , which is useful diagnostically, helps in choosing appropriate antiepileptic therapy, and allows for accurate prognostic statements to be made.
The typical seizure while the patient is awake is a focal one involving the face, pharynx and possibly the arm. The patient is conscious but unable to speak and may drool. Nocturnal seizures may be generalized with focal onset and pharyngeal muscle involvement where gagging is common.
Are common and may follow partial seizures or occur de novo. The presence of aura always indicate a focal onset of the seizure.
The patient suddenly loses consciousness, eyes roll back, and the entire body muscles undergo tonic contractions, apnea cause cyanosis. The clonic phase is heralded by rhythmic contractions alternating with relaxation of all muscle groups. The clonic phase slows towards the end of the seizures and the patient sigh as the seizure stops abruptly.
In the context of a febrile illness often an URT infection, roseola, or otitis media, the convulsion is associated with rapidly rising temperature usually develops when core temperature reaches 39ºC or greater. The classic seizure is brief generalized tonic - clonic lasting less than 5 minutes.
The child must be carefully examined for serious infection like meningitis and if any doubt exist lumbar puncture is indicated.
The risk of recurrence is 30%.
Treatment consist of fever control, careful search for the cause of fever. Oral diazepam at the onset of each febrile illness and for the duration of the illness is effective and safe in reducing recurrences.
Physical and neurological examination may provide a clue in patients with symptomatic epilepsy.
Electroencephalography (EEG): During a seizure the brain generates high voltage chaotic activity that peaks rapidly giving the appearance of Spikes or Sharp Waves . Between the clinical seizures shorter discharges may be recorded. Provocative modalities increases the chance of recording an abnormality, like photostimulation, hyperventilation, and recording during sleep.
Anticonvulsant therapy can control about 50% of patients. Adequate control is less likely when 1.seizures begin early in life. 2. occur frequently. 3. are of mixed type. 4. associated with mental retardation. 5. associated with abnormal neurological findings.
If the patient is seizure free for at least 2 years discontinuing medications should be considered.
A prolonged continuous seizure lasting more than 30 minutes or a series of seizures without return of consciousness for more than 30 minutes.
Prolonged febrile seizures is the most common form in children less than 3 years.
Withdrawal of antiepileptic drugs suddenly can result in status epilepticus.
Symptomatic status can be due to encephalitis, drug intoxication, electrolyte abnormalities, malformations of the brain, inborn errors of metabolism,brain tumor, encephalopathy, and intracranial hemorrhage.
A rapid physical and neurological assessment for evidence of trauma, papilledema, bulging fontanel, lateralizing neurological signs, manifestations of meningitis or sepsis, retinal hemorrhage, acidotic breathing, dehydration and pupil size.
A complete examination is done after seizure had been controlled.
Diazepam 0.2 – 0.3 mg./Kg. IV slowly is used initially followed by Phenobarbital 10 – 20 mg./Kg. loading dose.