Paediatric fits, faints, funny turns Differential diagnosis Epilepsy: • Defined as 2 unprovoked seizures at least 24 hours apart, or a tendency to seizures due to abnormal electrical activity. Non-epileptic seizures: • Febrile convulsions. • CNS infection. • Metabolic: ↓glucose, ↓/↑Na+, ↓Ca2+, ↓Mg2+. • Acute trauma. • Toxins Other 'funny turns', some of which may include convulsions but are not epilepsy: • Syncope • Reflex anoxic seizures: stimulus like pain, cold food, or fright → asystole → generalized tonic clonic seizure due to low brain O2. • Sleep myoclonus: a benign, random series of myoclonic movements during or just before/after sleep. Onset is usually in neonates and most resolve in infancy. • Migraine • Arrhythmia e.g. long QT. • Tics Psychological and emotional episodes: • Breath-holding attacks: crying then breath-holding in a toddler. May become cyanosed or have a short seizure. • Non-epileptic attack disorder. • Panic attacks.

1. Paediatric fits, faints, funny turns
Slide made with the
assistance of Medicos
PDF App:
https://bookapp.page.link
/slideshare

2. Differential diagnosis
Epilepsy:
 Defined as 2 unprovoked seizures at least 24 hours apart, or
a tendency to seizures due to abnormal electrical activity.
Non-epileptic seizures:
 Febrile convulsions.
 CNS infection.
 Metabolic: ↓glucose, ↓/↑Na+, ↓Ca2+, ↓Mg2+.
 Acute trauma.
 Toxins

3. Other 'funny turns'
Other 'funny turns', some of which may include convulsions but
are not epilepsy:
 Syncope
 Reflex anoxic seizures: stimulus like pain, cold food, or fright
→ asystole → generalized tonic clonic seizure due to low
brain O2.
 Sleep myoclonus: a benign, random series of myoclonic
movements during or just before/after sleep. Onset is usually
in neonates and most resolve in infancy.
 Migraine
 Arrhythmia e.g. long QT.
 Tics

4. Psychological and
emotional episodes:
 Breath-holding attacks: crying then breath-
holding in a toddler. May become cyanosed
or have a short seizure.
 Non-epileptic attack disorder.
 Panic attacks.

5. Investigations
ECG in all to rule out cardiac cause.
Other tests to consider:
 Acute: rule out CNS infection, glucose, U&E.
 EEG: generally just supports clinical diagnosis when epilepsy
is strongly suspected.
 More likely to do further tests if very young.
 Worry if no obvious infections signs to cause 'febrile'
convulsions e.g. no UTI or RTI.
 MRI if focal neurology or symptoms rapidly worsening,
suggesting ↑ICP
.

6. Febrile convulsions

7. Definition and epidemiology
 Tonic-clonic seizure as temperature rises rapidly.
 By definition, not due to CNS infection or in a
child
 Affects children 6 months to 6 years old.
 Often a genetic link, so check family history.

8. Signs and symptoms

9. Signs and symptoms
 Simple febrile convulsion: one off,
 Complex febrile convulsion: recurs in 24
hours or same illness, lasts >15 minutes,
or is focal.
 Signs of underlying infection.

10. Management
In a confirmed febrile convulsion, explain and
reassure parents:
 30% chance it will happen again, especially if they're
younger.
 If they are ill again keep them cool – unwrap, turn
heating down, but don't make them cold e.g. by
running a cold bath.
 Give paracetamol and ibuprofen as for any fever, to
relieve discomfort. However, there is no evidence that it
reduces the risk of convulsions.

11. Management
 Make sure they stay well hydrated.
 If convulsions happen again, put child in recovery
position on side and clear area. Remove dummy from
mouth.
 Only call ambulance if it's >5 minutes. Of course bring
them in if they're worried, they seem very sick, or they
see a non-blanching rash.
 Only provide PR diazepam if there are repeated
seizures >5 minutes in length.

12. Complications
 30% recur, especially younger.
 Confers small ↑risk of later epilepsy: 2.5% vs.
1.5% in kids without febrile seizures. Bigger
increase in risk if there is a complex seizure,
a family history of epilepsy, or other
neurological abnormalities.
 No evidence of ↑risk of death.

13. Thank you
Happy to share this slide with Medical student .
Find hundreds of books, slides, and articles for
free from the app. To download the app just visit
:https://bookapp.page.link/slideshare