Seizures in Children – Pediatric Neurology | Lecturio


In this lecture we are going
to discuss seizures What are seizures? Seizures are uncontrolled firing
of nerves in the brain. If involing both cerebral hemispheres,
seizures are generalized. it’s the whole body. If it is involing one hemisphere or one
area, it may be focal involving one extremity or one simple area
of the body. In young infants, seizures maybe vey subtle and my look very different
than in older folks. They can just be little jittery movements and sometimes they are missed
by doctors and parents alike. Let’s talk first about Status Epilepticus. Status Epilipticus is frequent or
recurrent or prolonged seizures without returning to
baseline in a 30 minute period. It can be convulsive, or non-convulsive with few
symptoms and usually focal. So, seizures in general affect
about 1 percent of the population but Febrile seizures, which
we will get ino the end of this talk affect a much larger part
of the population; 4-10 percent of children. and 15 percent of the children who
have a first seizure have another within the next year. So, recurrence actually isn’t that common, at least
not right away. Many children have one seizure and never have another one
and we never know why it happened. Seizures are different depending
on where they are on the brain. A frontal lobe seizure may result in bizarre behavior. A temporal lobe seizure may result in depression
or mood affect changes. But a generalized seizure is what we expect
to see with motor movements predominantly appearing. Alteration of vital signs
and respiratory suppression are absolutely possible during seizures. And after seizures, they may be
a period of sleepiness. postictal period. This is especially true
for generalized seizures. Also after seizures, patient may develop a paralysis
transly of one side of the body even if it’s a generalized seizure and that’s called Todd’s paralysis. patients feel that they report
they feel absolutely lousy
after a seizure. so we know seizures are no fun
to have and would like to prevent them. the types of seizures can be categorized
in many different ways. Tonic-clonic seizures are the ones
which you classically see on television. an initial atonic phase of stiffening and then a clonic
phase of shaking. Patients usually fall down the may have loss
of lower bladder or bowel function and then may be very sleepy afterwards. or have Todd’s paralysis they may just have a tonic phase in their seizure or they may just have
a clonic phase in their seizures. myotonic jerks are unique type of seizure that happens in children. They will happen up to say 100 times a day. and it will be a sudden jerking spasm
of one arm or one extremity. Atonic-akinetic seizures are literally a drop spell, where there is a complete loss of tone
and patients will collapse to the floor. and absence seizures
are unique and the children will what we call space out. there will be a complete lack
of awareness of the world and they will pop right back in again without any postictal phase. It may be so subtle that children don’t even know
they’re doing it but are simply confused in the classroom because for them the teacher
is jumping forward in time. if you detect a seizure in a child, especially a tonic-clonic seizure we have to be concerned that
there may be other causes to the seizure infectious causes are innumerable and include brain abscesses, encephalitis again they might just have a febrile seizure meningitis, Neurocystercercosis is an unusual cause
from eating raw beef tuberculosis may cause calcified lesions
in the brain that cause seizure, toxoplasma, same thing and HIV can cause an encephalitis
that can cause seizures. the birth injuries can result in damage to the brain that can cause seizures congenital anomalies the brain such as polymicrogyria can cause seizures. degenerative cerebral disease hypoxic ischemic encephalopathy tuberous sclerosis of the brain
these tumors can cause seizures neurofibromatosis can cause seizures patients who have shunts
to drain excessive fluid may have misfunction of that drainage patients may get acute hydrocephalus
and may present the seizure and hydrocephalus untreated can certainly
present with seizure. many metabolic conditions that can present procedures
such as hypercarbia and then the hypos hypocalcemia hypoglycemia hyponatremia and hypomagnesemia. think of the hypos, calcium glucose sodium
and magnesium. inborn errors of metabolism may leave children prone to seizures especially some of the metabolic disorders that are mitochondrial in nature like mirth. or MELAS syndrome paradoxine deficiency can also cause seizures and sometimes a dose of vitamin B6
is the cure, especially with newborns. in traumatic or vascular disease patients can get seizures
from cerebral contusions child-abuse, trauma or any cause of intracranial hemorrhage. toxins can also cause seizures. Drugs of abuse such as cocaine and methamphetamine cause
vasoconstriction which can cause ischemia of the brain and seizure. Lead poisoning can do it in severe cases as can rarely organophosphates salicylates, sympathomimetics tricyclic antidepressants, or withdrawal from drugs of abuse. Those can all cause seizures and then once we’ve gone through all these causes including
oncologic causes could it be a tumor or obstetric causes. Is the patient have a baby inside them? and now they have a problem
with their liver. and are getting seizures of results
like preeclampsia. and then after
we ruled out all these other causes we’re left with
epilepsy. So, epilepsy is really a diagnosis of exclusion after you’ve ruled out all these
other potential causes. also keep in mind there are things that children do that look a lot like seizures but it breath holding spells can be truly remarkable. These start around six months of age and go from to go for several years they usually happen when a child
is upset or displeased or terrified. they just hold their breath and they can hold their breath until they turn blue
and literally pass out unconscious. children tend to eventually outgrow this they have no long-term sequelae at all. but there’s a lot of counseling
needed for the families syncope can look like a seizure. panic attacks are often mistaken
as seizures. especially since when patients breathe
very quickly they get a respiratory alkalosis and that can cause a carpal pedal
spasm of the hands if you see a patient looks scared and
has clenching of the fist but almost always a panic attack and all that’s required is calm. Tic disorders may look like a focal seizure. Keep in mind, tics can be fairly complex. We have another talk about Tics later Benign myoclonus is common in babies and parents may bring up videos
of their child doing shaking movements that they are concerned might be a seizure. Remember it’s common for babies to have
an exaggerated startle reflex when their arms come out and they shake And commonly these children will have brief shaking episodes
or twitches of the arms and legs as they’re falling asleep. People, adults do that to. Dystonic reaction is a unusual side effect to certain medications. for example Reglan or some medicines for nausea The dystonic reaction is a sudden spasm of the muscles that is
relieved by IV Benadryl. It really is not a seizure. Patients may fake seizures in outright
desire to get more attention or they maybe so stressed out that their body is seizing even though they’re not actually having true
seizures. We call these pseudo seizures and
their very common in adolescents. likewise night terrors,
sleepwalking, narcolepsy all of these things
can be mistaken for seizures.

19 thoughts on “Seizures in Children – Pediatric Neurology | Lecturio”

  1. Sir my brother is suffering from seizures can you please tell me what is the treatment for this.. From your description it looks like these are tonic clonic and atonic akinetic .. I can send you the videos if you required.. I request you to help me please

  2. When I was a baby I had a febrile seizure I stopped breathing and turned blue my mom gave me mouth to mouth and by the time the EMTS arrived I stopped seizing. in pre k I would get angry and punch any thing that was in front of me that is when it was suggested that my parents should take me to a therapist. he took one look at me and said that I was having seizures he then referred me to a neurologist. At the at the age of 5, I was diagnosed with childhood absence epilepsy but I have been seizure free since the age of thirteen. And so was taken of meds which caused massive weight gain a hand tremor and memory loss. The point is meds are good up until a point and then it becomes a pill, no pun intended. My triggers are flashing lights, the transition from the out doors to inside a classroom getting too hot and recently sleep deprivation. when i have an absent my pupils will go from normal to pin point that is the only physical sign the eye can lasts My seizures last one second and happened every minute to every minute and a half. So there are 60 seconds in a minute and 24 hours in a day then I was having seizures every 1440 minutes or 86400 seconds so in total I would have 86400 seizures per day with meds. my parents were told to treat me as a normal child and to see how fare I would develop and look at me now I have graduated high school with honors . I am in collage as you can infer I was not expected to do much of what I just mentioned
    The effects of my seizures is that I have Aspie like tendencies due to my epilepsy which I know is difficult to understand to put it in simple terms as a result of my seizures my brain compensated and rewired itself and so I have all of the symptoms of Aspergers but lack any sort of understanding math as a result I have no understanding of money and never really learned my basic math facts.(I am just learning them now in college which for most Aspergers people they are gifted with math abilities ) I also have orthotic issues due to my seizures I also have a processing disorder. I have low gross motor control and other motor issues as well.
    After my father died, it seems I have had a relapse if that is possible. I still have my absence seizure but it is not enough to put me on meds . I take omega 3 cod liver oil liquid form as I cannot swallow pills this helps decrease the too small to medicate seizures I have very small seizures that show up on the EEG as misfired neurons and the Dr. called them "flurries" so here is what my flurries are typically like I will become very spacey I can not interact with my surroundings I also felt locked in to place. I am completely aware my vision becomes like a tunnel and thing start to move or vibrate on their own an absent seizure lasts 1 second but these flurries can last 5-10 minutes.

  3. My son is 6 and has focal seizures and takes zonisamide 17ml daily and it seems as if he is having so absence now. He vomits and goes to sleep but doesn’t have any recollection of anything happening at all. I’m nervous for him in his sleep. Should he be constantly supervised, what should we do?

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