seizure among children is always difficult to differentiate It is always good to have basic knowledge about seizure in children if you are working in small KLinik kesihatan orr PPAT/RSAT.

2.  3rd Symptomology Based / Clinical Problem
Solving Session

3. Introduction
Definition
Learning outcomes
Review of literature
Contents
Discussion
Conclusion

4. 1. Plan a systemic diagnostic approching the neonates
and children seizures from history taking, physical
examination, and lab investigation
2. different of seizures and
non epileptic events
3. identify seizures based on
symptomology
4. causes of seizures
5. Counsel parents of child with
fibrile seizures
6. First aid management of fitting
child

5. A seizures or fits is a clinical events in which there is sudden
disturbance of neurological function in association with abnormal or
excessive neuronal discharge.
Epiliepsy is a chronic neurological disorder characterized by
recurrent unprovoked seizures with transient signs and symptoms
associated with abnormal, excessive neuronal activity in the brain
A fibrile conversion is a seizure accompanied by a fever in the
absence of intracranial infection due to bacterial meningitis or viral
encephalities.
Tom Lissauer & Graham Clayden, Illustrated Textbook Of Paediatrics, 2012, 4th Edition, Mosby Elsevier

6.  Physical examination:
 Vital sign including temperature
 Height, weight, head circumference
 Developmental stages
 Sign of trauma at head/ skin
 fundoscopy
 Important questions to ask from the parents/caregiver:
1. Video of the actual events (if any)
2. Note birth history
3. Developmental milestone
4. Family history of 3 generations
Paediatric Protocol 3rd edition by Hussain Imam bin Hj Muhammad Ismail, Ng Hoong Phak and
Terrence Thomas Page 208

7. Infants:
• Drowsiness
• Separated sutures on the skull
• Bulging of the soft spot on top
of the head (bulging fontanelle)
• Vomiting
Older children and adults:
• Behavior changes
• Decreased consciousness
• Headache and vomiting
• Neurological symptoms, including weakness, numbness, eye
movement problems and double vision

8.  Blood test – to rule out any metabolic
diseases
 Lumbar puncture- look for any meningeal
sign
 Imaging-
 CT scan:indicate any head trauma
 MRI: indicate any new or focal neurological
deficits, recurrent seizures

10.  A fibrile conversion is a seizure accompanied by a fever in the
absence of intracranial infection due to bacterial meningitis or
viral encephalities.
 Children between the age 3 months to 6 years of age.
(Paediatric Protocol 3rd edition by Hussain Imam bin Hj Muhammad Ismail,
Ng Hoong Phak and Terrence Thomas Page 214)
 Two classifications of febrile seizure:Simple febrile seizure Complex febrile seizure-
don’t cause brain damage, no risk
of subsequent epilepsy
focal, prolonged or repeated same
illness which has increase risk 4-
12% of subsequent epilepsy

11. Paediatric Protocol 3rd edition by Hussain Imam bin Hj Muhammad Ismail,
Ng Hoong Phak and Terrence Thomas Page 214

12. Paediatric Protocol 3rd edition by Hussain Imam bin Hj Muhammad
Ismail, Ng Hoong Phak and Terrence Thomas Page 214

13. Non epileptic events
syncope Breath holding attacks
Night terror Delirium
Migraine Day dreaming
Vertigo Pseudoseizures
Shuddering spells Sleep disorder

14. For most children, causes of seizures remain
unkown. In many cases, there are some family
history of seizures. The remaining causes are as
follow:
o Infection
o Head trauma
o Metabolic disorder
o Drugs medication
o Disorder of blood vessels

15. Illustrated Textbook of Paediatric 4th edition by Tom Lissauer and Graham Clayden
page 472

17. Illustrated Textbook of Paediatric 4th edition by Tom Lissauer and Graham
Clayden page 475

20.  Usually brief , generalized tonic-clonic
seizures occurring with rapid rise in fever.
 Symptoms:
1. Have fever higher than 38.0 °c
2. Shake or jerk the arms of both sides
3. Roll his eyes back in the head.
Illustrated Textbook of Paediatric 4th edition by Tom Lissauer and
Graham Clayden page 472

22.  the child cries out or groans loudly
 loses consciousnes & falls down
In the tonic phase, the child is rigid, her teeth clench, her lips may
turn blue because blood is being sent to protect her internal organs,
and saliva or foam may drip from her mouth; she may appear to
stop breathing because her muscles, including her breathing
muscles, are stiff
 HR&BP rise
 sweating
 Tremor
In the clonic phase, the child resumes shallow breathing; her arms
and legs jerk quickly and rhythmically; her pupils contract and dilate
 at the end of the clonic phase, the child relaxes and may lose
control of her bowel or bladder
 following the seizure, the child regains consciousness slowly and
may appear drowsy, confused, anxious, or depressed

23. Macleod’s Clinical Examination 12th edition by Graham Douglas, Fiona Nicol
and Colin Robertson Page 443

24. Illustrated Textbook of Paediatric 4th edition by Tom Lissauer
and Graham Clayden page 474

25. STATUS EPILEPTICUS
• Any seizure lasting >30 minutes
• Intermittent seizures, without regaining full
consciousness in between for >30 minutes
Paediatric Protocol 3rd edition by Hussain Imam bin Hj Muhammad
Ismail, Ng Hoong Phak and Terrence Thomas Page 204

26.  Visit pediatrician to conform the seizures
 Identify and treat any sources of fever
 Always place your child beside and monitor
 Give medication on time
 Pay attention to the details of the events
 Make sure child is up to date with
immunisation

27.  Educate and counsel on epilepsy
 Emphasize compliance if on antiepileptic drug
 Don’t stop medications by themselves. This may
precipitates breakthrough seizures
 Use a shower with bathroom door unlocked
 No cycling in traffics, climbing sports or swimming
alone
 Know emergency treatment for seizure
 Inform teachers and school about the condition
(Paediatric Protocol 3rd edition by Hussain Imam bin Hj Muhammad Ismail, Ng Hoong
Phak and Terrence Thomas Page 211)

28. First aid management
of fitting child

30. (Paediatric Protocol 3rd edition by Hussain Imam bin Hj Muhammad
Ismail, Ng Hoong Phak and Terrence Thomas Page 211)

31.  (Paediatric Protocol 3rd edition by Hussain Imam bin Hj Muhammad Ismail, Ng
Hoong Phak and Terrence Thomas Page 210)

32.  Treatment recommended for > 2 episodes
 Must recognize the type of seizure to choose
appropriate drug
 Add on 2nd drug if 1st drug failed
 Do combination therapy (2/max of drugs)
 TDM not routinely done unless there is drug
interaction is suspected
 Attempt slow withdrawal of medication over 3-6
months. If seizure recur, reverse last dose reduction
Paediatric Protocol 3rd edition by Hussain Imam bin Hj Muhammad Ismail, Ng Hoong Phak
and Terrence Thomas Page 208

33.  Many people with epilepsy lead productive
and outwardly normal lives. Medical and
research advances in the past two decades
have led to a better understanding of
epilepsy and seizures than ever before.
Advanced brain scans and other techniques
allow greater accuracy in diagnosing
epilepsy and determining when a patient
may be helped by surgery.
http://www.ninds.nih.gov/disorders/epilepsy/