3. Definition
• A seizure the clinical expression of abnormal,
excessive, synchronous discharges of neurons
residing primarily in the cerebral cortex
• Epilepsy has been defined as recurrent
convulsive or nonconvulsive seizures
• The tendency to have recurrent, unprovoked
seizures.
4. TERMINOLOGIES
• Acute symptomatic seizures -occur 20 to an
acute problem
eg; electrolyte imbalance or meningitis
• Unprovoked seizure- is seizure with out
precipitating factor
• Remote symptomatic seizure- is 20 to a
distant brain injury such as an old stroke
5. Pathophysiology
• Inhibitory circuits (GABA) limits synchronous
discharge.
• When GABA receptors blocked Rhythmic
and repetitive hypersynchronus discharge of
neurons seizures
• Excitatory NT Ach , Aspartate and
Glutamate also involved to develop seizures
• inhibitory system + excitation
genesis of seizures
• Abnormalities in Ion Channels (Na+, K+, Ca-)
may cause seizures. (Prolongation of depolarization state)
8. A, Simple Partial Seizures characterized by:
• Motor, sePsory, autonomic, or psychic
symptomatology
• Consciousness is preserved
• Postictal (Todd's) paralysis that can last
minutes or hours
9. B, Complex Partial Seizures
• Last 1-2 min and are often preceded by an
aura
• With an alteration of consciousness
• Seizures often begin with a motionless stare
or arrest of activity followed by automatisms
10. C, Secondary generalized seizure
• Start as simple or complex partial seizures
with subsequent clinical generalization
• Most such seizures last 1-2 min
• Tongue biting, urinary and stool incontinence,
vomiting with risk of aspiration
11. II, Generalized seizures
A, Absence Seizures
1-Typical absence seizures
Usually start at 5-8 yr of age
They do not have an aura
Usually last for only a few seconds
Do not have a postictal period
Hyperventilation for 3-5 min can precipitate
the seizures
12. 2-Atypical absence seizures
Have associated myoclonic components
and tone changes of the head and body
Also usually more difficult to treat
They are precipitated by drowsiness
13. 3-Juvenile absence seizures
Are similar to typical absences but occur at a
later age
Are accompanied by 4-6 Hz spike–and–slow
wave discharges
These are usually associated with juvenile
myoclonic epilepsy
14. B, TONIC-CLONIC SEIZURES
Consciousness is lost immediately
Massive sustained contractions of the entire
musculature
This tonic phase lasts 10 to 20 seconds and is
followed by the clonic phase, which lasts
about 30 seconds
15. Cont,
During the tonic phase, marked autonomic
phenomena are evident
The complete tonic-clonic sequence is rare in
infants and young children
16. C, MYOCLONIC SEIZURES
Characterized by short duration
Rapid, bilaterally symmetric muscle
contractions
When severe, the myoclonus may cause the
patient to fall
The ketogenic diet may be effective in children
with myoclonic seizures resulting from brain
damage
17. III, Unclassified seizures
A, Neonatal Seizures
1) -Subtle seizures occur more
commonly in premature
Include transient eye deviations
Bicycling, pedaling, and stepping
Hypertension episodes, and apnea
18. Cont,
2) -can be focal or multifocal
Multifocal are migratory in nature
Generalized clonic seizures are uncommon
due to incomplete myelination
19. Cont,
3) -can be focal or generalized
Generalized tonic seizures are bilateral tonic
limb extension or tonic flexion of upper
extremities
Focal tonic seizures include persistent
posturing of a limb or posturing of trunk or
neck in an asymmetric way often with
persistent horizontal eye deviation
20. Cont,
B, Infantile spasms
• Are sudden generalized jerks lasting 1-2 sec.
• Are distinguished from generalized tonic spells
by their shorter duration
• As peak activity is reached, hundreds of
spasms may occur in a 24-hour period
• Usually involve the muscles of the neck, trunk,
and extremities
21. Cont,
• Flexor spasms -sudden flexion of the neck, trunk,
arms, and legs, and contraction of the abdominal
muscles
• Extensor spasms —abrupt extension of the neck
and trunk, with abduction or adduction of the
arms or legs
• Mixed spasms —Mixture of flexor-extensor
spasms
22. Febrile Seizures
Seizures that occur between the age of 6 - 60
months with a temperature of >38 OC
Occur in 2 to 4 percent of children younger
than five years of age
That are not the result of central nervous
system infection or any metabolic imbalance
That occur in the absence of a history of prior
afebrile seizures
23. Simple febrile seizure
Is a primary generalized
Usually tonic-clonic attack
Lasting for a maximum of 15 min
Not recurrent within a 24-hour period
25. Risk factor for recurrence of febrile
seizure
• Family history of febrile seizures
• Family history of epilepsy
• Complex febrile seizure
• Age <1 yr
• Duration of fever <24 hr
26. RISK FACTORS FOR OCCURRENCE OF
SUBSEQUENT EPILEPSY
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%
27. Approach to the patient
• Detailed history
• Thorough general and neurologic examination
INVESTIGATIONS
• Lumbar puncture
• CBC
• Random blood sugar
• Electrolyte
• Blood film
28. Diagnostic modalities of seizure
• Random blood sugar,
• lumbar puncture,
• VDRL
• Metabolic study (Urine for quantitative organic
acids)
• Complete blood count ,
• Electrolyte
• Renal function test,
• Liver function test
• EEG, MRI, CT scan
29. CONTD….
• EEG :
– Recommended in all patients with paroxysmal
event.
– Helps to distinguish seizure from non- seizure,
classification of seizure type & syndrome, deciding
treatment & focus localization.
– Video EEG needed for differentiating true seizures
from non- seizure paroxysmal disorders & pre-
surgical evaluation.
• Time to do EEG :
– Ideally should be done 3-4 days after seizure to
avoid post ictal slowing.
– Sleep deprived EEG increases the yield.
– Photic stimulation & hyper- ventilation helps
• No need to stop AED before EEG.
30. Status Epilepticus
Continuous seizure activity or recurrent
seizure activity without regaining of
consciousness lasting for >5 MIn
Febrile status epilepticus is the most common
type of status epilepticus in children
31. Cont,
Nonconvulsive status epilepticus-
Manifests as a confusional state, dementia,
hyperactivity with behavioral problems
Fluctuating mental status, confusional state,
hallucinations, paranoia
33. Cont,
Refractory status epilepticus
Is status epilepticus that has failed to respond
to therapy
Usually with at least 2 (although some have
specified 3) medications of treatment
34. Treatment of status epilepticus
• ABC of life
• Intravenous lorazepam or diazepam
• Phenobarbital 20 mg/kg loading dose
• Or phenytoin 20 mg/Kg loading dose
• Valproate as a third-line medication
• Monitor for respiratory depression
35. Treatment of Infantile Spasm
• Is best treated with adrenocorticotropic
hormone (ACTH)
• ACTH is gradually tapered over the next 9 wk
• Predinsolon 2mg/kg
• Ketogenic Diet
36. Treatment
• Basic life supporting care
• Diazepam or lorazepam
• Antipyretics-paracetmpol
• Council the parent
37. SYSTEMIC COMPLICATIONS
OF STATUS EPILEPTICUS
• Hypoxemia
• Academia
• Rhabdomyolysis
• Hyperkalemia
• Myoglobinuria
• Acute renal failure
38. Therapeutic Considerations
• Therapy should always begin with a single
agent
• The selection of the preferred drug is based
on the type of seizure and on the potential
toxicity of the drug
• Cautious in using valproate in preschool
children because of the increased risk of liver
damage
39. Cont,
• Anticonvulsant medication should be
withdrawn gradually
• Surgical therapy should be considered in
children with medically intractable epilepsy
40. Selection of Antiepileptic Drugs
Generalized
Tonic-Clonic Partial
Absence
Atypical
Absence,
Myoclonic,
Atonic
Valporic acid Phenytoin
Valproic acid
Valproic acid
Phenobarbit
ol
Carbamazepin
e
Ethosuximide Lamotrigine
Phenytoin Valproic acid Clonazepam
41. Discontinuation of AED Therapy
• Discontinuation of AEDs is usually indicated
when children are free of seizures for at least
2 yr
• Most relapses occur within the first 6 mo
