• CVS— H.R , BP , Peripheral perfusion.
• RESPIRATORY : Cyanosis, Irregular breathing.
• CNS :
• Pupil . Fundus --Papilledema.
• Cranial Nerves.
• Sign of meningeal irritation.↑ ICP.
• Sensory , Motor system examination.
EEG : Support diagnosis.
Locate the epileptic focus.
• A normal EEG does not R/o epilepsy.
• Abnormal EEG always not indicates Epilepsy.
• If standard EEG normal --
• sleep/ sleep deprived EEG.
• 24 hrs Ambulatory EEG.
It is a record of the underlying neuronal activity of
• What are normal brain waves?
• β wave (fast ) >13Hz/sec --alert state.
• α wave (intermediate) 8—13Hz/sec –quite
• Theta wave (slow) 4—7 Hz/sec –drowsiness.
• δ wave (slower) <4Hz/sec –deep sleep.
• α Activity seen is normally seen in children.
• Depression of normal activity.
• Slow waves.
• Spikes & waves.
• Sharp waves.
DIFFERENTIAL DIAGNOSIS :
1.BREATH HOLDING SPELL :
• Age group — 6month — 2years.
- rarely upto 5 years.
• Precipitated by Fear , Frustration , Anger &
• Cry vigorously holds breath apnea
cyanosis LOC Convulsion.
• But in seizure , convulsion cyanosis.
2.REFLEX ANOXIC SEIZURE:
• Age group : Toddler.
• Precipitated by : Pain, Discomfort, Fright, cold
food , Head trauma.
• Severe pain stop breathing Hypoxia
Pale convulsion rapid recovery.
• This episode occurs due to cardiac asystole
from vagal inhibition.
• Preceeds by pallor , Nausia , Vomiting ,
Sweating , Blurring of vision ,Hypotension.
• POSITION : Prolonged standing.
• Precipitating Factor : Emotional upset , Pain , Anxiety.
• Duration : few min.
• Bradycardia , Hypotension, Clonic convulsion.
• H/o heart disease .
• Paroxysmal headache.
• Unsteadiness or Light headedness.
• Visual or Gastro intestinal disturbance.
5.BENIGN PAROXYSMAL VERTIGO :
• Recurrent attack of vertigo lasting for several
• Unsteadiness or even Falling.
• Occurs as a result of Viral Labyrinthitis.
6.CARDIAC ARRYTHMIA :
• Prolonged Q T Interval may some time cause
Collapse or Cardiac Syncope.
• Usually occurs after Exercise.
7. NIGHT TERROR.
8.NON EPILEPTIC ATTACK DISORDER:( NEAD)
2. Fabricated illness.– fabricated by parents.
3. Induced illness.- Induced by hypoglycemia or
Insulin over dose.
• PSEUDOSEIZURE :
• Incidence –5—10 %.
• Age – 10—12yr.
• Unresponsive to AED.
• Precipitating factor –Emotional upset.
• Tendency to occur in company.
• Never occur when the patient is alone.
• Poor psychosocial history.
• Confirm diagnosis before starting treatment.
• Explain to the parents about AED.
• Monotherapy at minimum dose should be attempted
first.( the single most effective drug should be started)
• If not control by monotherapy switch to poly therapy.
• Drug level may be measured routinely.
• Anti epileptic therapy can usually be discontinued after
• Anti epileptic therapy can be discontinued after 2 years
of Seizure free period over a period of 3—6 month.
• Indications of Polytherapy :
1. Worsening seizure.
2. Status epilepticus.
3. Non compliance.
4. Adverse effect.