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(Paeds) Seizures
Truly a seizure? (Non-febrile (provoked) (Brain…
Generalized
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Absence
- loss of environmental awareness
- automatisms
- short post-ictal state/ no urinary incontinence
- no loss of muscle tone
- older than3yo
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Atypical
- can respond
- automatism
- last longer >10s
- start and end gradually
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Focal
Aware
motor
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Tics (motor/verbal - urge relieved with the movement) - meds if dysfunctional, usually improved with age (no need refer unless dysfunctional or parents anxious) + check for ADHD/OCD/anxiety
non-motor
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Emotional (anxiety, joy, fear)
Impaired awareness
- automatisms (LOC, unilateral, rhythmic)
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Febrile
38dc at any time (need not be during seizure)
- seizure when temp high/rising
- usually 1st 24h
- RULE OUT MENINGITIS especially in prolong AMS
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Non-febrile (provoked)
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congenital (TS, NF) - neurocutaneous stigmata
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TRO
- status epilepticus (>30min; but give PR diazepam/IV lorazepam if seizure >5min)
- epilepsy - 2 unprovoked seizure >24h apart (unprovoked seizure is epilepsy until proven otherwise)
- TRO NAI/seizure mimics (hypoCa/vit D, hypothyroidism)
- check DA
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Pre-ictal:
- trigger (EtOH, drugs, stress, infection)
- hallucinations (aura, gustatory, olfactory)
- prodromal jamais vu & deja vu
Ictal:
- tongue biting, uprolling of eyes, GTC, urinary/fecal incontinence
Post-ictal:
- confusion
Admit only if:
- complex febrile seizure
- simple febrile seizure <18mo, 1st onset
- SFS >24h after fever
- SFS <38.5dc
Simple febrile seizure
- generalized
- <15min
- 1/24h
- no FND
- <24h from onset of fever
- look for localizing source of fever
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Clonus - irregular jerks
Myoclonus - repeated, rhythmic jerks
spasms - last longer than myoclonus, shorter than tonic
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Admit unprovoked seizure if
- status epilepticus
- <6yo
- HI, meningienchephalism, raised ICP
- developmental regression
- not benign