epilepsy is abnormal electric discharge from the brain cells leading to brain function defects

1. CLERKSHIP : 1
Department : Pediatrics
By : Mohammed Masiuddin
15ed1t0015

2. Cases in pediatrics
• viral pyrexia
• Generalized Epileptic seizures
• Lower Respiratory Tract Infection
• Asthama
• upper lobe consolidation.
• Meningitis
• vallecular cyst
• febrile illness with dengue ns1npositive with
thrombocytopenia
• Hie sequalae with microcephaly with global development
delay with acute GE with some dehydration

3. • Recurrent urinary tract infection
• FT/AGA/rr+/grunting
• Diarrheal Disease
• Bullous Impetigo
• Gastro enteritis with no dehydration
• Falciparum malaria
• Broncholitis

4. Monitoring parameters
• Pediatric vital signs, Biochemical and Hematology parameters change
throughout childhood.
• It gives idea about therapy management in prolonged treatment.
Vital signs
Parameters Age (2-5yrs) Age (5-12)
Heart rate
(b/m)
100-120 80-100
Systolic blood
pressure
(mm/hg)
80-90 90-110
Respiratory
rate(b/m)
25-30 16-25

5. COMMONLY USED DRUGS :
Class of drug Examples
Penicillin Antibiotics Ampicillin ,amoxicillin,amoxicillin
clavunate.
Cephalosporin antibiotics Cephalexin,cefotaxime,cefixime.
Macrolide antibiotics Azithromycin,clarithromycin
Acetaminophen Paracetamol
Anxiolytics Midazolam
Beta 2 agonist Salbutamol
Anti epileptic drugs Phenytoin,sodium valproate
Proton pump inhibitors Pantoprazole
Anti emetics Ondansetron
H2 receptor antagonist Ranitidine
Iron supplement Iron sulphate
Amino glycosides Amikacin

6. Case presentation on
Generalized epileptic form of
seizures.

7. Subjective Evidence :
A female patient of age 3 years
presented to the hospital with complains of seizures
of one episode, fisting of upper and lower limb ,
frothing and fall
H/O :
Frequent falls after prolonged standing.

8. Vital signs
• Afebrile
• Bp :80/60 mmhg
• Pr:107 b/m

9. Objective evidence
• Electroencephalogram report
Impression : abnormal sedated sleep EEG record,
signs of generalized epileptic activity.

10. ASSESSMENT
Diagnosis
• Based on subjective and objective evidence, final diagnosis
was found to be generalized tonic-clonic seizures
Etiology
• Cryptogenic epilepsy.
Assessment If Therapy Is Indicated
• Yes therapy is indicated to prevent further complications like
head trauma, cardiac arrhythmias and sudden death

11. Standard therapy for epilepsy
Type of seizure First line treatment Second line
Simple partial Carbamazepine Vigabatrin
Complex partial Phenytoin clobazam
Generalized tonic –
clonic
Valproate
Carbamazepine
Phenytoin
Lamotrigine
Vigabatrin
Clobazam
phenobarbital
Carbamazepine 10-20mg/kg/day q8-12hr not to exceed 35mg/kg/day
Vigabatrine : if less than 10 yrs of age then safety and efficacy not established,for 25-60kg
Pt 250mg po q12 hr initially then increase qweek to total maintenance dose of 1000mg q12hr
Phenytoin : 6months to 16 years : 5mg/kg/day in 2-3 divided doses
Clobazam : initially 5mg po od then after 1 week ,5mg po bd for patient having wt less
Than 30 kg
Valproate : 5mg/kg/day twice daily
Lamotrigine :0.6-1.2 mg/kg/day divided q 12 hr

12. Assessment of current therapy
Drug Category Dose Route &
Frequency
Inj
phenytoin
Anti
epileptic
25mg IV BD
Inj
midazolam
Anxeolytic 1cc IV SOS
Inj Sodium
valproate
Anti
epileptic
25mg Iv BD
Ors Electrolyte
replenisher
Sip Po

13. PLANNING
GOALS OF THERAPY
General Goals
• To improve quality of life.
• To reduce morbidity and mortality.
Patient Specific Goals
• To reduce seizures activity
• To prevent from further complications of head
trauma.

14. MONITORING PARAMETES
Therapeutic Monitoring
Electroencephalogram
Toxicity Monitoring
• Valproic acid may increase or decrease phenytoin levels through
plasma protein binding competetion
Points to patient
Disease: the condition is unpredictable and transcient in
nature but may be reduced with regular medication.
Drugs : syrup penobarbitone 2.5 ml/po/bd
zinc and gluconate syrup 0.5ml/po/od

15. LIFE STYLE MODIFICATIONS :
• The child should get plenty of sleep and maintain the regular schedule
• Children should not take bath alone.
• Patient should be made as comfortable as possible, preferably lying
down , cushoning the head and loosening any tight clothing or
neckwear
• During seizures patients should not be moved unless they are in a
dangerous place as at the top of the stairs or by the edge of water
• No attempt should be made to open the patients mouth or force
anything between the teeth, this usually results in damage and broken
teeth if any may be inhaled causing lung damage
• After seizures stops check the airway for any blockage.

16. THANK YOU....😃😃