The document discusses the differential diagnosis of paediatric seizures, distinguishing between epileptic and non-epileptic events. It specifically covers febrile convulsions, their epidemiology, signs, management strategies, and risks associated with recurrence and potential later epilepsy. Additional diagnostic investigations and reassurance for parents are highlighted, along with recommendations for care during convulsions.

1. Paediatric fits, faints, funny turns
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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
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