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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
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non-motor
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Emotional (anxiety, joy, fear)
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Febrile
38dc at any time (need not be during seizure)
- seizure when temp high/rising
- RULE OUT MENINGITIS
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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
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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
- 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