case presentation on generalized epileptic seizures in pediatrics
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This document summarizes a pediatric clerkship, including various cases seen (viral pyrexia, meningitis, asthma), monitoring parameters for pediatric vital signs and biomarkers, commonly used drug classes and examples, and a case presentation on generalized epileptic seizures in a 3-year old female patient. The case is diagnosed as cryptogenic epilepsy based on symptoms and EEG results. Standard therapy of antiepileptic drugs like carbamazepine, phenytoin, and sodium valproate is outlined. The patient's current therapy of phenytoin, midazolam, and sodium valproate is assessed, with goals of reducing seizure activity and preventing complications. Monitoring parameters and lifestyle modifications are recommended to manage the condition.
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case presentation on generalized epileptic seizures in pediatrics
- 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....😃😃