Pediatric Seizures

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Definition: Disease of the brain defined by any of the following conditions:

  • A least two unprovoked (or reflex) seizures occurring >24 h apart
  • One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
  • Diagnosis of an epilepsy syndrome
  • Provoked seizures are not epilepsy (e.g. febrile seizures, convulsive syncope)

Epidemiology of Epilepsy:

  • Incidence: averages ~150,000 or 48 per 100,000 people each year
  • Prevalence in US: 5-11.5 per 1,000
  • In 2015: 1.2% US population had active epilepsy
    • Alaska:7,200 (1,100 children, 6,100 adults)

Diagnosis:

  • clinical (rhythmic/repetative movements, atonic, eye deviation, elevated heart rate) or by EEG (must refer to ANMC)
  • Look for Causes:
    • history of epilepsy
    • febrile/FIRES (Febrile infection-related epilepsy syndrome)
    • metabolic abnormalities (low or high Na, low Ca2+, low or high glucose, low Magnesium)
      • NOTE: Remember to check a glucose if a child presents with new onset seizure. If unable to obtain (glucose monitor not working), consider giving glucose gel. If requiring multiple antiseizure medication doses and good story of hypervolemic hyponatremia (infant given water or poorly mixed formula), consider giving a NS bolus before you are able to get a Na level.
    • Infection
    • trauma
    • Severe Breath Holding: Consider this etiology if the child was crying very hard, held his breath, turned red/purple (occasionally blue), and then passed out with seizure-like activity

Critical Times for Affected Patients:

  • Mortality rate associated with seizures lasting >30 minutes as high as 19%
  • Status Epilepticus (SE):
    • Tonic-clonic (>5 min)
    • Focal SE with impaired consciousness (>10 min)
    • Absence SE (>10-15 min)
  • For all children at least 6months old or older who live in the village presenting with seizure activity, please dispense appropriate dose of Rectal Diastat upon discharge to the village. While village clinics are supposed to be stocked with midazolam, diazepam, and phenobarbital; they may have used these medications and not had time to restock due to weather delay or recent use. The Rectal Diastat may be the only Antiseizure medication available in the village to treat your patient in status epilepticus.

Management:

Morbidity (Epilepsy or prolonged status epilepticus):

  • Focal neurologic deficits
  • Cognitive Impairment
  • Behavioral Problems
  • SUDEP (Sudden Unexpected Death in EPilepsy)
    • each year 1 in 4,500 children die (1 in 150 if seizures uncontrolled)
    • unclear if primary brain, cardiac, or respiratory
    • no data that anti-suffocation pillows prevent

Resources/References


YKHC Clinical Guidelines
Common/Unique Medical Diagnoses