Childhood Seizures (yr3-CBL)pptx [Auto-saved].pptx

childhood seziure

1. Case 1 Q1

2. Paeds Protocol Answers:

3. Q2 6 relevant in HOPI 3 in other histories

4. Answers

5. Answer- continue asking others

6. Q3 Give (3) D.Dx

7. Part 2

8. Q4 Q5 Part 3 Answers (4) PE Answer (3)

9. PAEDS Year 3 CBL (05/02/24) Children with Afebrile fits Dr. San Thitsa Aung MBBS, M.Med.sc ( Paeds ), MRCPCH(UK) PGDip (Resp)(UK)

10. Learning outcomes • List the causes of afebrile seizures • Define epilepsy • Classify epileptic seizures • Describe the relevant facts in history taking a child with epilepsy • Describe the important clinical features to look for in a child with epilepsy • Describe the relevant investigations and interpretations of the results • Outline the management of acute seizure attack • Outline the principles of management of childhood epilepsy

11. Causes of afebrile seizures

12. Afebrile seizures

13. epilepsY

14. Introduction Epilepsy has an incidence of about 0.05% (less common during first year of life) and a prevalence of 0.5%. most large secondary schools will have about six children with an epilepsy. Most epilepsy is “genetic” (“idiopathic”) with complex inheritance

15. DIFINITION ONE or multiple unprovoked seizures within 24hr with recovery of consciousness between seizures 20-25% first unproved seizures will recur. .., 25% risk of recurrence in next year and ⍨ 50% risk of recurrence over next 10-15 years Classified according to seizure type, epilepsy type, and underlying aetiology.

16. Classification (Illustrated Textbook of Paeds , 5 th edit)

17. Motor tonic- clonic clonic tonic myoclonic myoclonic-tonic- clonic myoclonic-atonic atonic epileptic spasms 2 Non-Motor (absence) typical atypical myoclonic eyelid myoclonia Unknown Onset Motor Onset automatisms atonic 2 clonic epileptic spasms 2 hyperkinetic myoclonic tonic Non-Motor Onset autonomic behavior arrest cognitive emotional sensory focal to bilateral tonic-clonic Generalized Onset Focal Onset Aware Impaired Awareness Motor tonic- clonic epileptic spasms Non-Motor behavior arrest ILAE 2017 Classification of Seizure Types Expanded Version 1 Unclassified 3 1 Definitions, other seizure types and descriptors are listed in the accompanying paper and glossary of terms. 2 These could be focal or generalized, with or without alteration of awareness 3 Due to inadequate information or inability to place in other categories From Fisher et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia doi : 10.1111/epi.13671

18. EPILEPSY SYNDROME

19. Infantile spasm

20. Approach to a child with AFEBRILE seizures HISTORY Type – tonic / clonic State of Consciousness- Aura- epigastric pain, feeling of fear Loss of sphincter control- urinary bladder Postictal state- sleep, headache, hemiparesis Frequency, precipitating factors, alternation in the type

21. Ante-natal, Natal H/o- TORCH, birth asphyxia, birth trauma, Post natal- Neo J, CNS infections Head injury Lead contact (lead fumes from burning batteries) Development H/o Drug H/o Family History - IEM , epilepsy

22. P/E Careful General condition Head size, shape L ook for facial dysmorphism Skin- neurocutaneous lesions/ stigamata

23. Thorough CNS exam; conscious level, posture, deformity, movement, tone, DTR Spine- Look for any deformity, tenderness especially if abnormality is confined to lower limbs eg . meningomyelocele * Developmental assessment examination Other- system exam: look for clues of underlying aetiology

24. Videos SESSIONS

25. Breath-holding attacks Toddlers upset → cry, hold their breath → turn blue → brief loss of consciousness(LOC) but rapidly & spontaneously recover fully Drug therapy unhelpful, but behaviour modification therapy , with avoidance of confrontation, may help 1 st Unprovoked Seizure-to be excluded

26. Reflex anoxic seizures Infants & toddler → triggering event (pain or discomfort, fever) → cardiac asytole due to vagal inhibition → hypoxia (pale & fall to floor)→ Generalised tonic- clonic seizure (brief & rapidly recover) SYNCOPE Brief tonic stiffening, clonic jerking and incontinence Posture : occur in hot & stuffy environment while standing for long periods, or when suddenly moving from a supine to upright posture Recall : awareness of light-headedness , visual loss and a cold sweat prior to the even are clues to the diagnosis. Situation : frequently associated with vomiting illnesses, prolonged standing, veni -puncture, or sustaining or witnessing and injury

27. INVESTIGATION For (SECOND)afebrile SEIZURES/ 1. EEG is indicated whenever epilepsy is suspected, EEG & video recording to supplement the h/o for an accurate Dx, classify epilepsy type, syndrome , selection of AEDs and Px . sleep deprived /24hour ambulatory EEG/video-telemetry 2. Imaging-MRI/ CT Brain scans 3. Serum Ca, PO 4 , Mg, RBS, FBC, BUSE* 4. Toxicology screen 5. Genetic test**

28. MRI/ CT Brain scans Structural - MRI and CT brain scans are generally required routinely for childhood epilepsies unless there is a characteristic history of childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and childhood rolandic epilepsy. Indications: age <1 yr , focal type (except BETEC), MRI fluid-attenuated inversion recovery (FLAIR) sequences are better at detecting mesial temporal sclerosis in temporal lobe epilepsy, which can sometimes be surgically cured. PET and SPECT (single photon emission computed tomography)

29. Treatment Acute management* Definitive Tx - it depends on underlying cause AEDs for epilepsy a clear explanation of the diagnosis and advice to help adjustment to the condition is needed t he decision whether to treat or not is related to the risk of recurrence, how dangerous or impairing, and how upsetting further seizures would be, in the context of the child or young person’s life Supportive - assist families by providing education and continuing advice on lifestyle issues

30. STATUS EPILEPTICUS (CONVULSIVE EPILEPTIC SEIZURES) an epileptic seizure lasting 30 minutes or repeated epileptic seizures for 30 minutes without recovery of consciousness.

31. Traditionally, the seizures had to last 30 min, but it is now recognized that shorter periods may damage the brain, and that a seizure is not likely to end spontaneously after 10 min. In reality, you are not going to finish your cup of tea waiting for 30 min of fitting, but will start the protocol as soon as you have arrived at the scene and have drawn up medication.

32. Prognosis: - Sudden unexpected death in epilepsy, (SUDEP), is very rare in childhood, - Children with epilepsy do less well educationally, with social outcomes and with future employment - Two-thirds of children with epilepsy go to a mainstream school, but some require educational help for associated learning difficulties. One-third attend a special school, but they often have multiple disabilities, and their epilepsy is part of a severe brain disorder.

33. References: Illustrated Textbook 5 th Edition Paediatric Protocols for Malaysian Hospital, 4 th edition Paediatrics Exams (Survival Guide), 2 nd edition Thank you