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Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
Febrile seizures
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Febrile seizures

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  • 1. Seizures Prof.Dr.P.Soundararajan
  • 2. seizure is a transient occurrence of signs and symptoms resulting from abnormal excessive or synchronous neuronal activity in the brain.
  • 3. Febrile seizure; definition • Between 6m to 60months • Fever >38oc • no CNS infection, no metabolic imbalance • No prior febrile seizure
  • 4. SFS • GTC • <15mts • No >1 episode <24hrs • No postictal complications
  • 5. CFS • Focal • >1 episode in 24hrs • >15mts • Post ictal abnormality
  • 6. • 2-5% incident • SFS; No risk of complications • CFS; 2 fold increase in morbidity
  • 7. Cause • Autosomal dominant • Many genes, • sodium channel genes • generalized epilepsy with febrile seizures plus (GEFS+) • severe myoclonic epilepsy of infancy
  • 8. Recurrence • <1yr age • <24hr of fever • Family h/o febrile fit or epilepsy • CFS • Male • Low serum sodium
  • 9. RISK FACTOR RISK FOR SUBSEQUENT EPILEPSY Simple febrile seizure 1% Neurodevelopmental abnormalities 33% Focal complex febrile seizure 29% Family history of epilepsy 18% Fever <1 hr before febrile seizure 11% Complex febrile seizure, any type 6% Recurrent febrile seizures 4%
  • 10. Workup • Thorough history & examination • LP [assess sensorium] • Prior antibiotics?
  • 11. EEG • Normal CNS; no need • Doesn’t predict epilepsy • Spikes seen during drowsy • To do >2 weeks • To know type of epilepsy • 30mts wakefulness & sleep
  • 12. • Serum glucose • CT or MRI – Status epilepticus [hippocampal atrophy]
  • 13. Management • Counsel parent • Antipyretics • SFS; no drugs • CFS; Diazepam, lorazepam, midazolam • Rectal diazepam • Intranasal midazolam • Intermittent prophylaxis – Diazepam, phenobarbitone, clobazam • Iron deficiency?
  • 14. Status epilepticus • continuous seizure activity or recurrent seizure activity without regaining of consciousness lasting for >30 min. • impending status epilepticus ; seizures between 5 and 30 min. • Nonconvulsive status epilepticus • Refractory status epilepticus
  • 15. Causes • 30% 1st episode SFS • CNS infection • Trauma • CVA • Metabolic imbalance • Poisoning
  • 16. • Imbalance between excitation & inhibition • Increased excitability [glutamate, aspartate] • Decreased GABA mediated inhibition • Inadequate O2 supply • Hypoxia • Cerebral edema • Ca influx into neurons • Neuronal death
  • 17. Management • A B C • Detect underlying etiology • Electrolytes, BUN, glucose • CSF study • EEG • Imaging
  • 18. Drugs • IV lorazepam • midazolam • Fosphenytoin • Phenobarbitone • Valproate • propofol, thiopentol • Isoflorane • Induced acidosis.
  • 19. SE Protocol - 0 - 10 min • Verify and describe seizure • Airway - Positioning & suctioning • O2 through mask, Attach pulse oxymeter • NGT, BMV if needed • Start IV / IO - IV lorazepam 0.1 mg / kg (1st dose) • If no IV / IO, Midazolam IM 0.15 mg / kg • Monitor HR, RR, perfusion, BP, SaO2
  • 20. SE Protocol - 10 - 20 min • Check Glucose - Dextrostix, IV dextrose • Lab investigations • IV lorazepam 0.1mg / kg (2nd dose) • Monitor HR, RR, Perfusion, BP, SaO2 • BM ventilation if needed • IV Phenytoin 20 mg / kg over 20 min. (1st dose) • Fever reduction
  • 21. SE Protocol - 40 - 50 min • BM ventilation • IV Phenytoin 10 mg / kg (2nd dose) • If seizure still persists, IV Phenobarbitone 20mg / kg over 10 min. • Intubate prior to Phenobarbitone • Manage ICT • Consider IV Pyridoxine if > 3 yrs old
  • 22. SE Protocol - 60 min. Refractory Status Epilepticus • Admit in PICU • Involve Anesthetist / PICU team • Support circulation • Correct metabolic problems (Hypoglycemia, Hypocalcemia, Hypomagnesemia) • IV Midazolam infusion, Pentothal, IV Sodium valproate
  • 23. • IV Midazolam 0.15 mg / kg stat. dose Maintenance - 1 mcg / kg / min. • Raise / 1 mcg / kg / min. every 15 min. if seizure persists. Maximum 20 mcg / kg / min. • Higher the dose, need for ventilation • After control, same rate of infusion for 24 hours then taper by 1 mcg every 2 hours
  • 24. Approach to seizure • Assess CVS, RS status • Metabolic screen • Head examination • Eye ex • NCM • HSM • FND • EEG, imaging
  • 25. Thank you

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