Febrile seizures

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Febrile seizures

  1. 1. Seizures Prof.Dr.P.Soundararajan
  2. 2. seizure is a transient occurrence of signs and symptoms resulting from abnormal excessive or synchronous neuronal activity in the brain.
  3. 3. Febrile seizure; definition • Between 6m to 60months • Fever >38oc • no CNS infection, no metabolic imbalance • No prior febrile seizure
  4. 4. SFS • GTC • <15mts • No >1 episode <24hrs • No postictal complications
  5. 5. CFS • Focal • >1 episode in 24hrs • >15mts • Post ictal abnormality
  6. 6. • 2-5% incident • SFS; No risk of complications • CFS; 2 fold increase in morbidity
  7. 7. Cause • Autosomal dominant • Many genes, • sodium channel genes • generalized epilepsy with febrile seizures plus (GEFS+) • severe myoclonic epilepsy of infancy
  8. 8. Recurrence • <1yr age • <24hr of fever • Family h/o febrile fit or epilepsy • CFS • Male • Low serum sodium
  9. 9. RISK FACTOR RISK FOR SUBSEQUENT EPILEPSY Simple febrile seizure 1% Neurodevelopmental abnormalities 33% Focal complex febrile seizure 29% Family history of epilepsy 18% Fever <1 hr before febrile seizure 11% Complex febrile seizure, any type 6% Recurrent febrile seizures 4%
  10. 10. Workup • Thorough history & examination • LP [assess sensorium] • Prior antibiotics?
  11. 11. EEG • Normal CNS; no need • Doesn’t predict epilepsy • Spikes seen during drowsy • To do >2 weeks • To know type of epilepsy • 30mts wakefulness & sleep
  12. 12. • Serum glucose • CT or MRI – Status epilepticus [hippocampal atrophy]
  13. 13. Management • Counsel parent • Antipyretics • SFS; no drugs • CFS; Diazepam, lorazepam, midazolam • Rectal diazepam • Intranasal midazolam • Intermittent prophylaxis – Diazepam, phenobarbitone, clobazam • Iron deficiency?
  14. 14. Status epilepticus • continuous seizure activity or recurrent seizure activity without regaining of consciousness lasting for >30 min. • impending status epilepticus ; seizures between 5 and 30 min. • Nonconvulsive status epilepticus • Refractory status epilepticus
  15. 15. Causes • 30% 1st episode SFS • CNS infection • Trauma • CVA • Metabolic imbalance • Poisoning
  16. 16. • Imbalance between excitation & inhibition • Increased excitability [glutamate, aspartate] • Decreased GABA mediated inhibition • Inadequate O2 supply • Hypoxia • Cerebral edema • Ca influx into neurons • Neuronal death
  17. 17. Management • A B C • Detect underlying etiology • Electrolytes, BUN, glucose • CSF study • EEG • Imaging
  18. 18. Drugs • IV lorazepam • midazolam • Fosphenytoin • Phenobarbitone • Valproate • propofol, thiopentol • Isoflorane • Induced acidosis.
  19. 19. SE Protocol - 0 - 10 min • Verify and describe seizure • Airway - Positioning & suctioning • O2 through mask, Attach pulse oxymeter • NGT, BMV if needed • Start IV / IO - IV lorazepam 0.1 mg / kg (1st dose) • If no IV / IO, Midazolam IM 0.15 mg / kg • Monitor HR, RR, perfusion, BP, SaO2
  20. 20. SE Protocol - 10 - 20 min • Check Glucose - Dextrostix, IV dextrose • Lab investigations • IV lorazepam 0.1mg / kg (2nd dose) • Monitor HR, RR, Perfusion, BP, SaO2 • BM ventilation if needed • IV Phenytoin 20 mg / kg over 20 min. (1st dose) • Fever reduction
  21. 21. SE Protocol - 40 - 50 min • BM ventilation • IV Phenytoin 10 mg / kg (2nd dose) • If seizure still persists, IV Phenobarbitone 20mg / kg over 10 min. • Intubate prior to Phenobarbitone • Manage ICT • Consider IV Pyridoxine if > 3 yrs old
  22. 22. SE Protocol - 60 min. Refractory Status Epilepticus • Admit in PICU • Involve Anesthetist / PICU team • Support circulation • Correct metabolic problems (Hypoglycemia, Hypocalcemia, Hypomagnesemia) • IV Midazolam infusion, Pentothal, IV Sodium valproate
  23. 23. • IV Midazolam 0.15 mg / kg stat. dose Maintenance - 1 mcg / kg / min. • Raise / 1 mcg / kg / min. every 15 min. if seizure persists. Maximum 20 mcg / kg / min. • Higher the dose, need for ventilation • After control, same rate of infusion for 24 hours then taper by 1 mcg every 2 hours
  24. 24. Approach to seizure • Assess CVS, RS status • Metabolic screen • Head examination • Eye ex • NCM • HSM • FND • EEG, imaging
  25. 25. Thank you

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