This document provides definitions and terminology related to seizures in childhood. It discusses different types of seizures including neonatal seizures, febrile seizures, and unprovoked seizures. It describes mimickers of epilepsy such as breath holding attacks. Febrile seizures are defined as seizures associated with fever between 6-60 months of age without neurological infection. Management of febrile seizures involves treating the fever, ensuring adequate fluids, and using antipyretics. Long-term anticonvulsant prophylaxis is not usually recommended for febrile seizures due to side effects.
Headache in children -indexforpaediatrics.comdr-nagi
Headache is one of the commonest neurological symptoms in children and young people who are
referred to doctors. Headache refers to pain involving the orbits, forehead, scalp and temples but not
the face or neck. The primary headache includes chronic or recurrent headache and migraine. The
prevalence of chronic or recurrent headaches in children occur in 60-69% by the age of 7-9 years
and 75% by the age of 15 years. The prevalence of migraine in children is up to 28% of older
teenagers. The most serious cause of the secondary headache is brain tumor and the prevalence of
brain tumours in children is 3 per 100,000 per annum.
https://indexforpaediatrics.com
Headache in children -indexforpaediatrics.comdr-nagi
Headache is one of the commonest neurological symptoms in children and young people who are
referred to doctors. Headache refers to pain involving the orbits, forehead, scalp and temples but not
the face or neck. The primary headache includes chronic or recurrent headache and migraine. The
prevalence of chronic or recurrent headaches in children occur in 60-69% by the age of 7-9 years
and 75% by the age of 15 years. The prevalence of migraine in children is up to 28% of older
teenagers. The most serious cause of the secondary headache is brain tumor and the prevalence of
brain tumours in children is 3 per 100,000 per annum.
https://indexforpaediatrics.com
Not epileptic
•Wrong seizure type (semiology)
•Wrong epileptic syndrome
•Wrong interpretation of EEG and imaging
When to start a drug?
•Which drug and in what dose?
•When to change the drug?
•When (and how) to add a second drug (and which one)?
•When to stop the drug(s)?
•When to consider alternative therapies, including surgery?
Does it differ from adult stroke?
• Which neuroimaging?
• Which labs?
• If not a stroke, what could it be?
• Can we give rTPA?
• Will it reoccur?
• Do we need secondary prevention?
• What is the prognosis?
ATAXIA IN CHILDREN -CAUSES, MANAGEMENT, INVESTIGATIONS, TYPES, COMMONEST ATAXIA IN CHILDREN IN DETAIL, HOW WILL YOU FIND OUT THE CAUSE FOR ATAXIA IN CHILDREN FLOWCHART, DEFINITION, TREATMENT
This presentation looks at some of the common conditions that can present with hemiplegia. Stroke is the commonest, however, there are several other causes that need to be considered in a patient presenting with hemiplegia.
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.
Not epileptic
•Wrong seizure type (semiology)
•Wrong epileptic syndrome
•Wrong interpretation of EEG and imaging
When to start a drug?
•Which drug and in what dose?
•When to change the drug?
•When (and how) to add a second drug (and which one)?
•When to stop the drug(s)?
•When to consider alternative therapies, including surgery?
Does it differ from adult stroke?
• Which neuroimaging?
• Which labs?
• If not a stroke, what could it be?
• Can we give rTPA?
• Will it reoccur?
• Do we need secondary prevention?
• What is the prognosis?
ATAXIA IN CHILDREN -CAUSES, MANAGEMENT, INVESTIGATIONS, TYPES, COMMONEST ATAXIA IN CHILDREN IN DETAIL, HOW WILL YOU FIND OUT THE CAUSE FOR ATAXIA IN CHILDREN FLOWCHART, DEFINITION, TREATMENT
This presentation looks at some of the common conditions that can present with hemiplegia. Stroke is the commonest, however, there are several other causes that need to be considered in a patient presenting with hemiplegia.
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.
Seizure disorder is one of the important topic in children and adult also. here i explained the seizure disorder in pediatrics, include all most content for nurses level
Dr Nivedita Bajaj - Basic Facts About Childhood EpilepsyNiveditabajaj
The basics Epilepsy by Dr Nivedita Bajaj , She is a Consultant Paediatrician working within NHS, currently employed by East and North Herts NHS Trust. Dr Bajaj has extensive experience in assessment and management of a wide range of neurodevelopmental conditions and neurodiabilities. She leads clinical autism service in her trust.
Visit - https://drniveditabajaj.blogspot.co.uk/
For more - https://www.nhs.uk/profiles/consultant/6068845
Read More - https://about.me/drniveditabajaj
THESE SLIDES ARE PREPAREED TO UNDERSTAND CHILD HEALTH DISORDERS IN EASY WAY Important links- NOTES- https://mynursingstudents.blogspot.com/ youtube channel https://www.youtube.com/c/MYSTUDENTSU... CHANEL PLAYLIST- ANATOMY AND PHYSIOLOGY-https://www.youtube.com/playlist?list=PL93S13oM2gAPM3VTGVUXIeswKJ3XGaD2p COMMUNITY HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPyslPNdIJoVjiXEDTVEDzs CHILD HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gANcslmv0DXg6BWmWN359Gvg FIRST AID- https://www.youtube.com/playlist?list=PL93S13oM2gAMvGqeqH2ZTklzFAZhOrvgP HCM- https://www.youtube.com/playlist?list=PL93S13oM2gAM7mZ1vZhQBHWbdLnLb-cH9 FUNDAMENTALS OF NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPFxu78NDLpGPaxEmK1fTao COMMUNICABLE DISEASES- https://www.youtube.com/playlist?list=PL93S13oM2gAOWo4IwNjLU_LCuhRN0ZLeb ENVIRONMENTAL HEALTH- https://www.youtube.com/playlist?list=PL93S13oM2gAPkI6LvfS8Zu1nm6mZi9FK6 MSN- https://www.youtube.com/playlist?list=PL93S13oM2gAOdyoHnDLAoR_o8M6ccqYBm HINDI ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAN4L-FJ3s_IEXgZCijGUA1A ENGLISH ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAMYv2a1hFcq4W1nBjTnRkHP facebook profile- https://www.facebook.com/suresh.kr.lrhs/ FACEBOOK PAGE- https://www.facebook.com/My-Student-S... facebook group NURSING NOTES- https://www.facebook.com/groups/24139... FOR MAKING EASY NOTES YOU CAN ALSO VISIT MY BLOG – BLOGGER- https://mynursingstudents.blogspot.com/ Instagram- https://www.instagram.com/mystudentsu... Twitter- https://twitter.com/student_system?s=08 #PEM, #HEALTH,#NEW,#BORN,#ASSESSMENT, #APPEARENCE,#PULSE,#GRIMACE,#REFLEX,#RESPIRATION,#RESUSCITATION,#NEWBORN,#BABY,#VIRGINIA, #CHILD, #OXYGEN,#CYANOSIS,#OPTICNERVE, #SARACHNA,#MYSTUDENTSUPPORTSYSTEM, #rashes,#nursingclasses, #communityhealthnursing,#ANM, #GNM, #BSCNURING,#NURSINGSTUDENTS, #WHO,#NURSINGINSTITUTION,#COLLEGEOFNURSING,#nursingofficer,#COMMUNITYHEALTHOFFICER
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Content
■ Definitions and Terminology
■ Neonatal Seizures
■ Mimickers of Epilepsy
■ Febrile Convulsions (Provoked Seizures)
■ Unprovoked Seizures
■ Seizure Classification
■ Emergency Management– Status Epilepticus
■ Mechanisms of Seizures
■ Pharmacology and Other Treatment Options
■ Take Home Message
History
Examination
Investigations
Management
Education
Follow-up
3. Terminology
■ Seizure
– A transient occurrence of signs and/or symptoms resulting
from abnormal excessive or synchronous neuronal activity in
the brain.
■ Acute symptomatic or provoked seizures
– occur secondary to an acute problem affecting brain
excitability, such as an electrolyte imbalance
■ Unprovoked seizure
– One that is not an acute symptomatic seizure.
■ Reflex seizures
– A type of seizure precipitated by a sensory stimulus.
4. Terminology (Continued…)
■ Epilepsy
– A disorder of the brain characterized by an enduring
predisposition to generate seizures and by the
neurobiological, cognitive, psychological, and social
consequences of this condition.
■ Seizure disorder
– A general term that is usually used to include any one of
several disorders, including epilepsy, febrile seizures,
and, possibly, single seizures and symptomatic seizures
secondary to metabolic, infectious, or other aetiologies
(e.g., hypocalcaemia, meningitis).
5. Terminology (Continued…)
■ Epileptic syndrome
– A disorder that manifests as one or more specific seizure
types and has a specific age of onset and a specific
prognosis.
■ Epileptic encephalopathy
– An epilepsy syndrome in which there is a severe EEG
abnormality that is thought to result in cognitive and
other impairments.
■ Epileptic disease:
– A pathological condition with single specific well defined
aetiology which is associated with epilepsy (e.g.
6. Terminology (Continued…)
■ Benign epilepsy syndrome:
– A syndrome characterized by epileptic seizures that are
easily treated or require no treatment and remit without
sequelae.
■ Reflex epilepsy syndrome:
– A syndrome in which all epileptic seizures are
precipitated by sensory stimuli
■ Focal seizures and syndromes:
– Replaces the partial seizures and localization related
syndromes elaborate (terms of simple partial and
complex partial epileptic seizures are no longer
recommended).
7. Terminology (Continued…)
■ Idiopathic epilepsy syndrome:
– A syndrome that is only epilepsy. No structural brain
lesion or any other neurological signs.
■ Symptomatic epilepsy syndrome:
– Syndrome in which seizures are due to identifiable
structural lesion in brain.
■ Probably symptomatic epilepsy syndrome:
– Syndromes that are believed to be symptomatic but no
aetiology identified.
8. What is a seizure?
■ A seizure is the manifestation of an abnormal,
paroxysmal discharge of a group of cortical
neurons. This discharge may produce subjective
symptoms or objective signs.
■ The key features of a seizure
– Paroxysmal nature of the event.
– Associated abnormal movements / subtle
phenomena.
– Altered responsiveness or impairment of
9. What is a convulsion?
■ Predominantly, an uncontrollable &
involuntary contraction/relaxation or spasm
of a group or groups of muscles.
11. Neonatal Seizures
■ Seizures occurring in 1st month of life.
■ There are five main neonatal seizure types:
– Subtle
– Clonic
– Tonic
– Spasms
– Myoclonic
12. Neonatal Seizures (Continued…)
■ Seizures Versus Jitteriness
– Jitteriness can be defined as
■ Rapid motor activities, such as a tremor or shake
■ That can be ended by flexion or holding the limb
■ Unlike most seizures, is usually induced by a stimulus
– Seizures,
■ generally do not end with tactile or motor
suppression
■ Often involve eye deviation and autonomic changes
17. Mimickers of Epilepsy
■ Paroxysmal events, abnormal movements / subtle
phenomena and states of altered responsiveness
are common in infants and children.
■ Diagnosing epilepsy in a non epileptic is more
harmful than missing the diagnosis in an epileptic.
■ The most useful diagnostic tool is an accurate
history taken from an eyewitness and/or patient
22. Breath-holding Attacks
(Continued…)
■ Usually self limiting and no treatment is required.
■ Two types - blue and pallid.
■ Blue breath holding attacks
– Provoked by upsetting an infant.
– Episode starts with crying.
– Followed by breath holding and apnoea.
– Loss of consciousness may be associated with a few
clonic jerks and bradycardia.
– May occur repeatedly or sporadically.
– Usually occur after 6 months of age with a peak
23. Breath-holding Attacks
(Continued…)
■ Pallid breath holding attacks
– Provoked by upsetting an infant.
– Crying prior to episode may not be apparent.
– Become pale and bradycardic.
– Loss of consciousness may be associated with tonic
jerks.
– Usually occur after 6 months of age with a peak
incidence at 2 years.
26. Pseudo-seizures
■ Pseudo seizure is the second most common cause
of misdiagnosis.
■ Pseudo seizures could occur when there is a history
of epilepsy / family history of epilepsy or even
concurrent with epilepsy.
■ The difficulty arises when epilepsy coexists.
28. Reflex Seizures (Stimulus-
Precipitated Seizures)
■ Many patients with epilepsy can identify
precipitating or provoking events that predispose
them to having a seizure.
■ There is another group of patients who have
seizures in response to a specifically identifiable
sensory stimulus or activity and are considered to
have reflex seizures.
■ Because no known reflex may be involved, more
appropriate terms may be sensory-precipitated or
29. Reflex Seizures (Stimulus-
Precipitated Seizures)
(Continued..)■ Stimuli may be
– external (light, patterns, music, brushing teeth)
– internal (math, reading, thinking, self-induced)
■ Reflex seizures may be
– generalized
– Partial
– non-convulsive
– Absence
– myoclonic
30. Reflex Seizures (Stimulus-
Precipitated Seizures)
(Continued..)
■ avoidance or modification of stimuli is the initial
approach.
■ Such activities may include
– wearing blue or polarized sunglasses
– avoiding high-contrast flashing-light video
games
– using a TV remote control or watching TV in a
well-lit room at a distance of > 8 feet
– covering one eye when in a provocative
36. Febrile Seizures
■ Febrile seizures are seizures that
– occur between the ages of 6 and 60 months (peak 12-18
months)
– with a temperature of 38°C (100.4°F) or higher
– that are not the result of CNS infection or any metabolic
imbalance
– occur in the absence of a history of prior afebrile
seizures.
37. Febrile Seizures (Continued…)
■ An epileptic seizure occurring in childhood,
– after age 1 month
– associated with a febrile illness
– not caused by an infection of the central nervous system
(CNS)
– without previous neonatal seizures or a previous
unprovoked seizure
– not meeting criteria for other acute symptomatic
38. Febrile Seizures (Continued…)
■ Simple febrile seizure
– is a primary generalized
– usually tonic-clonic
– attack associated with fever
– lasting for a maximum of 15 min
– not recurrent within a 24-hr period
39. Febrile Seizures (Continued…)
■ Complex febrile seizure
– is more prolonged (>15 min)
– and/or is focal
– and/or recurs within 24 hr
■ Febrile status epilepticus is a febrile seizure lasting
longer than 30 min.
40. Febrile Seizures (Continued…)
■ Most patients with simple febrile seizures
have a very short post-ictal state and usually
return to their baseline normal behaviour and
consciousness within minutes of the seizure.
41. Febrile Seizures (Continued…)
■ Febrile infection–related (or refractory ) epilepsy
(FIRES)
– is a very different disorder
– seen predominantly in older (>5 yr) usually male
children
– associated with an encephalitis-like illness
– but without an identifiable infectious agent
■ Children with FIRES were previously normal but
subsequently develop difficult-to-treat epilepsy.
42. Febrile Seizures (Continued…)
■ A few epilepsy syndromes typically start with febrile
seizures
■ These are,
– Generalized epilepsy with febrile seizures plus
(GEFS+)
■ Autosomal dominant syndrome
■ Onset is usually in early childhood, and remission is
usually in mid-childhood
■ Characterized by multiple febrile seizures and by
43. Febrile Seizures (Continued…)
– Severe myoclonic epilepsy of infancy (SMEI or
Dravet syndrome )
■ Most severe of the phenotypic spectrum of febrile
seizure–associated epilepsies.
■ Initially characterized by febrile and afebrile unilateral
clonic seizures that recur every 1 or 2 mo.
■ Seizures subsequently start to occur with lower fevers
and then without fever.
■ During the second year of life, myoclonus, atypical
absences, and focal seizures occur frequently and
developmental delay usually follows.
– Temporal lobe epilepsy secondary to mesial
temporal sclerosis
44. Febrile Seizures (Continued…)
■ Epidemiology
– Between 2% and 5% of neurologically healthy infants and
children experience at least one, usually simple, febrile
seizure
– Febrile seizures recur in,
■ approximately 30% of those experiencing a first
episode
■ in 50% after two or more episodes
■ in 50% of infants younger than 1 year of age at febrile
seizure onset
– Approximately 15% of children with epilepsy have had
febrile seizures
45. Febrile Seizures (Continued…)
■ Risk Factors for seizure recurrence
– Having no risk factors carries a recurrence risk
of approximately 12%; one risk factor, 25–50%;
– two risk factors, 50–59%; three or more risk
factors, 73–100%.
50. Febrile Seizures (Continued…)
■ Indications for admission to hospital after a febrile
seizure
– First febrile seizure.
– Age <18 months.
– Incomplete recovery after one hour.
– Any likelihood of CNS infection.
– A ‘complex’ febrile seizure.
– Fever has lasted more than 48 hours before
onset of seizures.
– Home circumstances inadequate/excessive
parental anxiety/parents’ inability to cope.
51. Febrile Seizures (Continued…)
■ Investigations
– Blood studies (SE, Ca2+, phosphorus, Mg2+,
FBC) are not routinely recommended in the
workup of a child with a first simple febrile
seizure.
– If clinically indicated (e.g., dehydration), SE
should be performed. A low sodium level is
associated with a higher risk of recurrence of the
febrile seizure within the following 24 hr.
– CBS should be done
52. Febrile Seizures (Continued…)
■ Investigations (Continued…)
– Lumbar puncture should be performed
■ for all infants younger than 6 months of age
■ if the child is ill-appearing
■ at any age if there are clinical signs or symptoms of
concern
■ is an option in children who have been pre-treated
with antibiotics
■ is an option in a child 6-12 months of age who is
deficient in Haemophilus influenzae type b and
Streptococcus pneumoniae immunizations or for
whom the immunization status is unknown
53. Febrile Seizures (Continued…)
■ Investigations (Continued…)
– EEG
■ If the child is presenting with the first simple febrile
seizure and is otherwise neurologically healthy, an
EEG need not be performed
■ An EEG would not predict the future recurrence of
febrile seizures or epilepsy
■ EEGs performed within 2 weeks of a febrile seizure
often have nonspecific slowing, usually posteriorly.
Thus if an EEG is indicated, it is delayed until or
repeated after more than 2 weeks have passed.
■ An EEG should generally be restricted to special cases
in which epilepsy is highly suspected
54. Febrile Seizures (Continued…)
■ Investigations (Continued…)
– A CT or MRI is not recommended in evaluating
the child after a first simple febrile seizure
– The workup of children with complex febrile
seizures needs to be individualized
56. Febrile Seizures (Continued…)
■ Management of Fever
– The fever should be treated to promote the
child’s comfort.
– An adequate fluid intake should be ensured to
prevent dehydration.
– Physical methods to reduce the body
temperature, such as fanning, and light clothing,
can be used
– Paracetamol and ibuprofen (if not suspecting
Dengue) are the recommended antipyretics.
– Should be prescribed in correct dose
57. Febrile Seizures (Continued…)
■ Management – Prophylaxis
– Long-term prophylaxis
■ Phenobarbitone - frequent and substantial side effects.
■ Sodium valproate - as effective as phenobarbitone, but may
produce fatal hepatic or pancreatic dysfunction in this age group.
– Intermittent prophylaxis
■ Oral or rectal diazepam
– As soon as the child starts fitting.
– Whenever the child is febrile and before the child starts fitting.
■ Oral clobazam
– Issues
■ recurrence is most likely when the fever has been present for less
than one hour.
■ Child will become drowsy – will affect clinical judgment
58. Febrile Seizures (Continued…)
■ Management – Evidence based Facts
Management of simple febrile seizures Sri Lanka Journal of Child
Health, 2017
Current Practice
Management of simple febrile seizures
Dr. Jithangi Wanigasinghe
Consultant Paediatric Neurologist
59. Febrile Seizures (Continued…)
■ Management – Follow up
– No need of routine follow up generally
– Specific cases should be assessed individually
and followed up as necessary
– If on long term prophylaxis – follow up to assess
drug side effects
60. Febrile Seizures (Continued…)
■ Immunisation Concerns…
– Children who have febrile convulsions before immunization
against diphtheria, pertussis and tetanus should be
immunized after their parents have been instructed about the
management of fever and the use of rectal diazepam or
consider acellular pertussis for future immunizations .
– Measles, mumps and rubella immunization should be given as
usual to children who have had febrile seizures, with advice
about the management of fever to the parents. Rectal
diazepam should be made available for use should a seizure
occurs.
– Febrile convulsions is not a contraindication.
– JE vaccine should be given only after fit free period of 1 year.
62. Unprovoked Seizures
What is epilepsy?
■ The clinical diagnosis of epilepsy usually requires
– the occurrence of at least one unprovoked epileptic
seizure
– with either,
■ a second such seizure
■ or enough EEG and clinical information to convincingly
demonstrate an enduring predisposition to develop recurrences.
■ For epidemiologic and clinical purposes, epilepsy is
considered present when
– two or more unprovoked seizures
– occur in a time frame of longer than 24 hr.
63. Epidemiology
■ Approximately 4–10% of children experience
at least one seizure (febrile or afebrile) in the
first 16 years of life
■ The cumulative lifetime incidence of epilepsy
is 3%
■ More than half of the disorders start in
childhood
64. ■ The ILAE Task Force on Classification has proposed a
multilevel framework for categorizing epilepsies
– Level 1: Determine if the event was an epileptic seizure
and, if so, characterize the seizure type or types based
on available clinical information as focal, generalized, or
unknown.
– Level 2: Determine the type of epilepsy the patient has
(focal, generalized, focal and generalized, or unknown).
– Level 3: Determine if the epilepsy fits into a particular
epilepsy syndrome
– Level 4: Establish a unifying diagnosis that takes into
account the epilepsy syndrome, underlying aetiologies,
65. ■ The aetiology for the epileptic seizures should be
considered at all levels of an epilepsy diagnosis as listed
above, etiologic categories:
– Genetic
– Structural
– Metabolic
– Immune
– Infectious
– Unknown
■ Comorbidities should be considered at all levels of an
epilepsy diagnosis. These can include.
– Developmental delay
– Psychiatric symptoms
– Behavioural issues
– Academic difficulties
– Movement abnormalities, and etc.
67. Evaluation (Continued…)
■ Immediate Assessment
– stabilization of the patient if the child presents during or
shortly after the seizure
– An assessment of the adequacy of
■ Airway
■ Ventilation
■ Cardiac function
– Measurement of
■ Temperature
■ Blood pressure
■ Glucose concentration
68. Evaluation (Continued…)
■ History
– Should search for potentially life-threatening causes of
seizures, such as,
■ Meningitis
■ Systemic sepsis
■ Unintentional or non-accidental intentional head trauma
■ Ingestion of drugs of abuse or accidental ingestion of drugs or
other toxins.
– Should aim to determine if the event was a seizure or not
– Whether the seizure has a focal onset or is generalized
69. Evaluation (Continued…)
■ History (Continued…)
– The duration of the seizure
– State of consciousness (retained or impaired)
– Whether an aura preceded the convulsion and
the behaviour the child was exhibiting
immediately preceding the seizure.
■ i.e. - Temporal lobe seizures may result in strange
warning feelings or aura with smell and taste
abnormalities and distortions of sound and shape.
70. Evaluation (Continued…)
■ History (Continued…)
– The posture of the patient
– Presence or absence and distribution of cyanosis
– Vocalizations
– Loss of sphincter control (more commonly of the
urinary bladder)
– Post-ictal state (including sleep, headache, and
hemiparesis)
The provider taking the history should ask specifically about each
of the above symptoms as appropriate because caretakers may
not spontaneously report them.
71. Evaluation (Continued…)
■ In addition to clarifying the seizure semiology, a detailed
history is crucial in identifying an underlying cause for the
seizure.
– Personality changes or symptoms of increased
intracranial pressure - intracranial tumour
– Cognitive regression - Degenerative or metabolic
disease
– A history of prenatal or perinatal distress or of
developmental delay - Congenital or perinatal brain
dysfunction
– Acute to subacute personality changes, psychiatric
symptoms, and/or associated movement abnormalities -
Autoimmune aetiology
72. Evaluation (Continued…)
■ Examination
– A careful general and neurologic examination should be
performed.
– The examination should also be geared toward the
search for an organic cause.
– Localizing neurologic signs such as,
■ A subtle hemiparesis
■ Hyperreflexia
■ An equivocal or positive Babinski sign
might suggest a contralateral hemispheric structural
73. Evaluation (Continued…)
■ Examination (Continued…)
– A funduscopic exam should be performed to evaluate for
the presence of papilledema, optic neuritis, retinal
haemorrhages, etc.
– The child's head circumference, length, and weight are
plotted on a growth chart and compared with previous
measurements.
– The finding of unusual facial features or of associated
physical findings such as hepatosplenomegaly may point
to an storage disease or inborn error of metabolism
74. Evaluation (Continued…)
■ Examination (Continued…)
– The presence of a neurocutaneous disorder may be
indicated,
■ Vitiliginous ash leaf–type lesions - Adenoma sebaceum
■ Shagreen patches or retinal phakomas - Tuberous
sclerosis
■ Multiple café-au-lait spots - Neurofibromatosis
■ Nevus flammeus - Sturge-Weber syndrome
– Unilateral growth arrest of the thumbnail, hand, or
extremity in a child with a focal seizure disorder
suggests,
■ Arteriovenous malformation
75. Evaluation (Continued…)
■ Investigations
– Further laboratory testing, including
■ Serum electrolytes
■ A complete blood count
■ Urine toxicology tests
to be done considering the patient's clinical history and
examination.
– Electrocardiography (ECG) to rule out long QT or other
cardiac dysrhythmias
– A lumbar puncture is usually of limited value in the acute
workup unless the history or examination is suggestive
76. Evaluation (Continued…)
■ Investigations (Continued…)
– A routine EEG should be performed in all cases of a first
unprovoked non-febrile seizure to help predict the risk
of seizure recurrence.
– Emergent brain imaging with a head CT or brain MRI is
done
■ if the seizure was focal
■ if there are post-ictal focal deficits on neurologic exam
■ if the patient's status is not returning to baseline
■ in patients with trauma preceding the seizure
■ in patients with a high-risk medical history.
77. Evaluation (Continued…)
■ Investigations (Continued…)
– Functional imaging to detect areas of abnormal
(hypo / hyper) metabolism suggestive of seizure
foci.
– These include,
■ PET (positron emission tomography)
■ SPECT (single positron emission computed
tomography), which use isotopes and ligands,
injected and taken up by metabolically active cells.
78. Evaluation (Continued…)
■ Investigations (Continued…)
– Gene testing has been limited to patients,
■ Manifesting specific underlying malformational, metabolic,
or degenerative disorders
■ With severe epilepsy syndromes
■ With syndromes of Mendelian inheritance
– A full metabolic workup in,
■ Patients with drug-resistant epilepsy
■ Infants with new-onset epilepsy
■ Whom the initial testing did not reveal an underlying
aetiology
79. Seizure Classification (ILAE)
Epileptic Seizures
Generalized Onset Focal Onset Unknown Onset Unclassified
There is
not
enough
clinical
informati
on
Part of
one
cerebral
hemisph
ere
Synchronous
involvement
of all of
both
hemispheres
Clinical
characteristics are
unusual and a
determination of
onset cannot be
made despite an
adequate workup
81. Seizure Classification
(Continued…)■ Focal Onset seizures
– Frontal seizures
■ Involve the motor or premotor cortex
■ May lead to clonic movements, which may travel proximally
(Jacksonian march)
■ Asymmetrical tonic seizures can be seen
■ Atonic seizures may arise from mesial frontal discharge.
– Occipital seizures
■ Cause distortion of vision
– Parietal lobe seizures
■ Cause contralateral dysaesthesias (altered sensation)
82. Seizure Classification
(Continued…)
■ Focal Onset seizures (Continued…)
– Temporal lobe seizures
■ The most common
■ May result in strange warning feelings or aura with smell and
taste abnormalities and distortions of sound and shape.
■ Following spread to the pre-motor cortex
– Lip-smacking
– Plucking at one’s clothing
– Walking in a non-purposeful manner (automatisms)
can be seen
■ Déjà-vu and jamais-vu are described
■ Consciousness can be impaired and the length of event is longer
than a typical absence.
85. Epilepsy Syndromes
■ There are many Epilepsy Syndromes. Few from both Generalized and
Focal epilepsy syndromes are mentioned in brief.
EEG in a typical absence seizure in childhood
absence epilepsy. There is three per second spike
and wave discharge which is bilaterally synchronous
during, and sometimes between, attacks
90. Spike discharges from the left temporal lobe
(arrow) in a patient with complex partial seizures
caused by mesial temporal sclerosis
Left central-parietal spikes (arrow)
characteristic of benign partial epilepsy with
Centro-temporal spikes.
91. 1-2/sec inte-rictal slow spike waves in a patient
with Lennox-Gastaut syndrome
hypsarrhythmia with irregular multifocal
high-voltage spike-and-wave activity with a
chaotic high voltage slow background
93. Status Epilepticus
■ Status epilepticus (SE) is a medical emergency
■ The ILAE has refined the definition of SE to reflect
the time at
– which treatment should be initiated (t1)
– which continuous seizure activity leads to long-
term sequelae (t2) depending on the type of SE.
94. Status Epilepticus (Continued…)
■ For generalized tonic-clonic seizures, SE is defined
as
– continuous convulsive activity
– or recurrent generalized convulsive seizure
activity without regaining of consciousness (t1 =
5 min, t2 ≥ 30 min)
■ The definition for SE consisting of focal seizures
with impaired awareness (t1 = 10 min, t2 = 30 min)
■ Absence SE (t1 = 10-15 min, t2 = unknown)
99. Medications used in management of status epilepticus
(Continued…)
Status Epilepticus (Continued…)
100. Mechanisms of Seizures
1. Underlying aetiology
– Any pathology or pathologic process that can
disrupt neuronal function and connectivity and
that eventually leads to the second process -
epileptogenesis
■ i.e. - In some genetic epilepsies, a disorder in ion
channel function and/or structure is the underlying
aetiology that leads to an aberrant signal
transduction, which can cause seizures. These
mutations can involve
– Voltage-gated channels (Na+ , K+ , Ca2+ , Cl− ,
and HCN [hydrogen cyanide])
– Ligand-gated channels (nicotinic acetylcholine and
γ-aminobutyric acid A receptors [GABAA ])
101. 2. Epileptogenesis
– The mechanism through which the brain, or part of it,
turns epileptic
– large-scale molecular cell signalling pathways are
involved
3. Epileptic state of increased excitability
– In epileptogenic neurons, a dysregulation of
glutamatergic excitation versus GABAergic inhibition
occurs, which creates a seizure focus or network
4. Seizure-related neuronal injury
– For example, many patients show acute swelling in the
hippocampus or other regions after status epilepticus
and long-term hippocampal atrophy with sclerosis on
Mechanisms of Seizures
(Continued…)
103. Initiation of Anti-Epileptic Drugs
(AED)
■ In children, should be by a Paediatrician/ Paediatric
Neurologist.
■ Is generally not recommended after a first
unprovoked tonic-clonic seizure.
■ May be considered after a first unprovoked seizure
if,
– the individual has a neurological deficit
– a further seizure is unacceptable to the family
– brain imaging (where indicated) shows a
104. Choice of first AED depends on
■ The seizure type/ syndrome
■ The potential adverse effects
■ Co- morbidities
■ The availability and cost
105. Principles of AED Therapy
■ Should use monotherapy wherever possible
■ Unsuccessful initial therapy, try monotherapy with
another drug
■ If monotherapy in the maximum dose has failed, a
second drug should be started. The second drug
could be alternative first line.
■ If the second drug reduced the seizure frequency,
taper off the first and continue monotherapy with
the second.
■ If there is no improvement within a month, taper off
either the first or the second, depending on their
relative efficacy.
106. Principles of AED Therapy
(Continued…)
■ If both drugs do not work, another second line drug may
have to be introduced as monotherapy.
■ If the response is poor consider blood levels if facilities are
available.
■ Consider add on or combination therapy only when
monotherapy has failed.
■ Prior to initiation of combination therapy consider the
following.
– Is the diagnosis correct?
– Adherence to treatment
– The appropriateness of the AED for the seizure type.
– The quality of the drug.
107. Long term AED therapy
■ Should be planned by a specialist.
■ Involves adjustment of drug dosage according to
the weight.
■ Should include discussion with the individual
regarding possible side effects, rationale of
treatment and what should be done if a dose is
missed or during illness.
■ Should involve a simplified medication regimen with
116. Follow-up
■ For the older AEDs, before starting treatment,
baseline laboratory studies, including
– Complete blood count
– Platelets
– Liver enzymes
– Kidney function tests
– Urinalysis
are often obtained and repeated periodically.
117. ■ Laboratory monitoring is more relevant early on,
because idiosyncratic adverse effects such as
allergic hepatitis and agranulocytosis are more
likely to occur in the first 3-6 months of therapy.
■ These laboratory studies are usually initially
checked once or twice during the 1st months, then
every 3-4 months thereafter.
Follow-up (Continued…)
118. Follow-up (Continued…)
■ Blood levels, if available, are indicated under the
following circumstances
– Poor response to treatment
– Poor compliance
– Toxic effects
– Management of drug interactions
119. Withdrawal of AED therapy should,
■ be individualized.
■ be under the guidance of the specialist.
■ be considered in those who have been seizure free
for at least two years.
■ be done slowly ( at least over 2 to 3 months)
■ take longer (up to 6 months or longer) when
withdrawing benzodiazepines and barbiturates.
■ be abandoned if seizure recurs.
■ not involve routine EEG prior to withdrawal of
treatment.
120. ■ Algorithm for the approach to the child with a suspected
convulsive disorder
121. Other Treatment Options
■ Often patients who do not respond to AEDs are
candidates for steroids, IVIG, or the ketogenic diet
■ Cannabidiol (CBD) is a non-psychoactive extract of
the cannabis plant that has gained prominence as a
possible adjunct (add-on) therapy for drug-
resistant epilepsies such as Dravet and Lennox-
Gastaut syndromes
■ Precision therapy - Physiology-specific, selection of
therapy as determined by the available information
regarding the underlying pathophysiology based on
the primary specific genetic, metabolic, and/or
other cause of epilepsy in that patient.
122. Approach to Epilepsy Surgery
■ If a patient has failed three drugs, the chance of
achieving seizure freedom using AEDs is generally
< 10%. Therefore, proper evaluation for surgery is
necessary as soon as patients fail two or three
AEDs, usually within 2 year of the onset of epilepsy
and often sooner than 2 year.
– Focal resection
– Hemispherectomy
– multiple subpial transection
– corpus callosotomy
– nerve stimulation
123. Take Home Message
■ Many conditions can present like seizures – need
proper evaluation
■ There can be serious underlying issues
■ Diagnosis always by a specialist to prevent
misdiagnosis
■ Importance of Parent Education
■ Proper Treatment and follow-up
124. References
■ Illustrated Textbook of Paediatrics – 4th Edition
■ Nelson Textbook of Paediatrics – 21st Edition
■ Management of Seizures in Children - Sri Lankan guidelines
■ Standard Treatment Protocols - Paediatrics - 2017