Presentation about new born seizure (3).pptx

New born seizure

1. APPROACH TO 1 ST EPISODE OF SEIZURES DR.KEERTHANA SREE VELUMANI

2. SEIZURE Sudden transient occurrence of signs and/or symptoms resulting from abnormal excessive or synchronous neuronal activity in the brain

3. SEMIOLOGY GENERALIZED TONIC – CLONIC : Unconscious, convulsions, muscle rigidity (1-3mins) ABSENCE – Brief loss of consciousness (few secs) MYOCLONIC – Sporadic (isolated) , jerking movements (fraction of secs but in cluster) CLONIC – Repetitive, jerking movements TONIC – Muscle stiffness, rigidity (1min) ATONIC- Loss of muscle tone (15secs) AURA – Visual , Somatosensory, Auditory, Olfactory, Vestibular, Experimental disturbance.

4. HISTORY PROVOKING FACTORS Fever CNS Infection Head injury Tumours Hypoglycemia Electrolyte imbalance Toxic Drugs UNPROVOKED FACTORS History of developmental delay Birth asphyxia Positive family history

5. CLASSIFICATION OF EPILEPSY SYNDROME WITH AGE OF ONSET

6. NEONATES PERIOD-EARLY INFANNCY LATE INFANCY - CHILDHOOD ADOLESCENCE – ADULTHOOD Pyridoxine dependent epilepsy Creatine synthesis defects CoQ10 deficiency PNPO deficiency Gangliosidosis Juvenile Neuronal ceroid lipofuscinosis Folinic -acid responsive seizures Purine metabolism defects Late onset GM2 gangliosidosis ( Sandhoff , Tay–Sachs) GLUT-1 (Glucose transporter-1) deficiency Disorders of methylation and folate metabolism Gaucher type III Biotinidase deficiency Mitochondrial disorders Niemann –Pick type C Menkes disease Congenital disorders of glycosylation Peroxisomal disorders INBORN ERROR OF METABOLISM ASSOCIATED WITH EPILEPSY

7. PHYSICAL EXAMINATION Vitals, including temp. Ht , Wt , HC Developmental delay Signs of Trauma Signs increased ICP Presence or absence of tongue bite Urinary incontinence Skin lesion – suggest neurocutaneous disease.

8. INVESTIGATION Bedside dextrostix (glucose test) CBC Electrolytes(sodium, potassium) Calcium, Magnesium Blood sugar Liver and renal function test Toxicology screen

9. LUMBAR PUNCTURE INFANT < 12months with first time febrile seizure to rule out Meningitis INFANT 12- 18months with simple febrile seizure. Any child with meningeal signs CSF : Analysis, Biochemical, & C/s. IMAGING CRANIAL U/S: Haemorrhages, Cyst , Abnormal ventricles CT scan – Indicated if head trauma is present/suspected. MRI – The child has new / focal neurological deficit, recurrent seizure.

10. EEG To classify epilepsy : Focal vs Generalized epilepsy Diagnosis of an epilepsy syndrome To predict recurrence risk To differentiate ongoing seizure vs prolonged postictal state (if recovery is delayed). Developmental delay or regression with seizure Epilepsy surgery evaluation

11. Principle of drug therapy START WITH SINGLE ADE START WITH LOW DOSE ADE AND INCREASE GRADUALLY ENSURE COMPLIANCE INCREASE DOSE GRADUALLY TO MAXIMUM TOLERATE AED IS WITHDRAWN AFTER 2 YEAR OF SEIZURE FREEDOM

12. Anti-epileptic drugs Febrile , Dyselectrolytemia LOADING DOSE NOT REQUIRED Global delay ,Brain insult , Trauma , Focal ,Family history – LOADING DOSE REQUIRED INTRAVENOUS PREPARATION Phenobarbitone Phenytoin , Fosphenytoin Sodium Valproate Levetiractem Iacosamide

13. DURATION AED LONG TERM Structural lesion( NCC , TUBERCULOMA , INFARCTS) Developmental delay Family history Neurocutaneous markers , Brain malformation

14. SEIZURE MIMICS