Seizures are common in children and can be provoked by factors like fever or infection. They result from abnormal electrical activity in the brain. Partial seizures originate in one area of the brain while generalized seizures involve both hemispheres. Treatment involves identifying and treating the underlying cause, as well as using anticonvulsant medications. It is important to ensure safety during a seizure and provide supportive care afterwards.

1. MRS. AMITHA .R

2.  A seizure or convulsion; is a paroxysmal, transient
change in motor activity and/or behaviour that
results from abnormal electrical activity in the brain
 Most seizures in children are provoked by somatic
disorders originating outside the brain, such as high
fever, infection, head trauma, hypoxia, toxins, or
cardiac arrhythmias.
 Epilepsy is defined as recurrent, unprovoked seizures

3.  Convulsion are a series of forceful involuntary
contraction and relaxation of voluntary muscles
due to disturbance of brain functions.
 Convulsion are abnormal, involuntary,
paroxysmal, motor, sensory, autonomic or
sensorial changes resulting from abnormal
electrical discharges from the brain.

4.  Seizures are common in the pediatric age
group and occur in up to 10% of children
 Less than one third of seizures in children are
caused by epilepsy
 The incidence of childhood epilepsy is 1% to 2%

5.  Early neonatal period:
◦ Birth asphyxia
◦ Intraventricular hemorrhage
◦ Pyridoxine dependency,
hypoglycemia, hypocalcemia
or hyponatremia
◦ Inborn errors of metabolism.
 Late neonatal period:
◦ Kernicterus
◦ Infection, tetanus nepnatrum
◦ Inborn errors of metabolism
◦ Hypocalcemia,
hypomagnesemia and
hypoglycemia.
◦ Meningitis , septicemia
◦ Intrauterine infection

6.  Abrupt rise in temperature leading to febrile convulsion
 Infections of CNS
 Post vaccination encephalopathy
 Metabolic causes like dehydration, dyselectrolytemia,
alkalosis and hypokalemia.
 Brain lesions like neoplasms, brain abscess and
cysticercosis
 Drugs and poisons like lead encephalopathy
 Heat stroke

7.  A balance between excitation (excitatory neurotransmitteers;
glutamate, aspartate) and inhibition (inhibitory
neurotransmitters gama amino butyric acid (pyridoxine
dependency)) is essential for a normal brain function
 A seizure results when a sudden imbalance occurs between
the excitatory and inhibitory forces within the network of
cortical neurons infavore of a sudden-onset net excitation
(synchronous firing of many neurons at once)
 Symptoms and type of seizure will depend on affected area
of the cortical network

8. Partial
seizure
Simple partial
Complex
partial
Generalized
Absence seizure
Tonic-clonic
seizure

9. 1. Partial seizure:
partial seizure begin focally and result from abnormal
electrical discharges from a small portion of brain.
Symptoms will vary according to where the seizure
occurs
• In the frontal lobe; speech, twisting, turning,
pedaling
• In the temporal lobe, a feeling of fear, odd feelings
• In the parietal lobe, a numbness or tingling
• And in the occipital lobe, visual disturbance or
hallucinations

10.  Simple partial seizure;
◦ A partial seizures without dyscognitive features
◦ Usually the event is remembered in detail
 Complex partial seizure;
◦ With dyscognitive features
◦ There is loss or changes in consciousness,
awareness and responsiveness
◦ Patient may have staring and automatism
◦ Typically frontal/temporal lobe onset

11.  When focal seizures spread to involve the
whole brain and produce a generalized
seizure, they are said to have secondarily
generalized.
 Such spread is classically described as
progression from face to arm to leg
(Jacksonian march)

12.  Originate within and propagate throughout
both hemispheres
 Include loss of consciousness (LOC)
 May include tonic-clonic, atonia or myoclonic
jerking
 Widespread cellular, biochemical or structural
abnormalities

13.  Primary generalized seizure;
◦ starts from the both hemispheres at the same time
(starts on both sides)
 Secondary generalized seizure;
◦ starts from one hemisphere then moves on to the
other hemisphere (ends up on both sides)

14.  The clinical hallmark is a brief (< 15 seconds) disturbance of
brain function oss of environmental awareness, which may be
accompanied by automatism eg; eye fluttering, fumbling with the
fingers, lip smacking
 Can be caused by a complex partial seizure
 They usually begin between 6-12 years
 Neurologic examination and brain imaging are normal. The
characteristic EEG patterns consist of generalized 3-Hz spike-
and-wave activity
 Can be provoked by hyperventilation or strobe light stimulation

15.  Typically the seizure begins abruptly, consciousness and control
of posture are lost, child loses consciousness followed by
 The initial phase tonic: which consists of stiffening and upward
deviation of the eyes and pallor or cyanosis, Pooling of
secretions, pupillary dilation, diaphoresis, and hypertension are
common
 The next phase Clonic: which include jerking movements are
produced by as a result of contraction and relaxation of the
muscles. And it last for 30 seconds to 30 minutes.
 In the postictal phase: the child might be hypotonic. Irritability,
poor coordination slurred speech and headache, vital
disturbance are common.

16.  Myoclonic epilepsy;
◦ Sudden repeated contraction of the muscles of head, extremities
◦ It may occur in young children or even adolescents.
◦ Occur when the child is drowsy & falling asleep or just waking up.
◦ usually is associated with multiple seizure types not all myoclonus are
epileptic in nature
 Akinetic seizures (drop attack); (occurs in2 to 5 year)
◦ Sudden loss of muscle tone with head dropping forward for a few seconds.
◦ The child loses consciousness and falls. Later on amnesia follows.
◦ Child appears frozen in a position
◦ typically brief (lasting 1 to 2 sec), are quite disabling because of a sudden
loss of postural tone, resulting in falls and injuries.

17.  History
 EEG :
◦ Abnormal electric activity, in some cases it may show area in
brain where seizures start.
 Neuro diagnostic test are:
◦ Roentgenogram
◦ Computer Axial tomography
◦ Positron emission tomography
◦ MRI
 Miscellaneous test
◦ Blood chemistry
◦ Blood sugar
◦ Complete blood count
◦ Kidney and liver function test
◦ Lumbar puncture

18.  Simple partial or complex partial seizure
◦ Carbamazepine , phenobarbitone , phenytoin and
primidone
 Generalized tonic clonic seizure:
◦ Sodium valproate, Carbamazepine, phenobarbitone
, phenytoin
 Generalized absence seizure:
◦ Ethosuximide and valproic acid
 Myoclonic seizure:
◦ Clonazepam or valproic acid

19.  Anticonvulsant – phenobarbitone
◦ Initial dose of 20mg/kg, slow IV over 10 minutes
◦ If no response two additional doses of 10mg/kg,
slow IV over 15minutes.
◦ If convulsion are still not controlled
 Phenytoin 20mg/kg, slow IV over 20 minutes

20.  Surgical removal tumors, hematomas,
malformation , scars etc
 Corpus callostomy

21.  Assist the child to a lying position
 Take off eye glasses, loosen the tight clothes
 Remove dangerous objects from the vicinity
of the child
 Maintain airway and adequate oxygenation
must be ensure
 Administer the medication on time
 Do not restrain the child
 Do not force anything into the child’s mouth
during convulsion

22.  Complete bed rest
 Suction the air way
 Turn the face to one side , avoid aspiration
 Observe the child until fully conscious
 Treat the injury
 Monitor vital signs, if needed give CPR
 Provide oral fluids or IV fluids
 Provide non- stimulating, calm and quit environment
 Do not live the child alone
 Maintain intake output chart