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An 18 m. old baby is admitted to the hospital B/C he is suffering from fever and convulsion.

An 18 m. old baby is admitted to the hospital B/C he is suffering from fever and convulsion.

eugenia-norris
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An 18 m. old baby is admitted to the hospital B/C he is suffering from fever and convulsion.

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  1. An 18 m. old baby is admitted to the hospital B/C he is suffering from fever and convulsion. In the P.H : he was doing well until 4 days of his admission when he had fever, running nose & dry cough. His mother brought him to PHC where the family physician diagnosed him as acute URTI and he prescribed antibiotic, cough syrup and paracetamole. But the fever didn’n subside & in the 4th day he developed convulsion. F.H : his brother developed fever & convulsion when he was 3 y old.

  2. Pediatric Seizures Supervised by: Dr.amani Done by : Eman Al-otibi Darin Al –radadi Dina Al-amam Ebtehal Al-yami

  3. Definitions Seizures : Are transient disturbances in brain function manifesting as episodic impairments in consciousness in association with abnormal autonomic activity.

  4. Epilepsy : Is a group of neurologic conditions, the common and fundamental characteristic of which is the liability to recurrent, usually unprovoked epileptic seizures. NB: A persone with a single or recurrent seizures due to correctable circumstances dose not necessarily have epilepsy

  5. Etiology Epilepsy: Idiopathic: 70-80% Secondary: Cerebral malformation: hydrocephalus Cerebral damage: congenital infection, asphyxia, intraventricularhge/ischemia Cerebral tumor. Degenerative disorders: Alzheimer’s disease Neurocutaneous disorders: tuberous sclerosis

  6. Seizure Outcomes • Injury/Death 15% • Head contusions/Lacerations (Common) • Mortality 1.2% of all seizures 3% to 26% in Status Epilepticus 10X higher in adults (Vs..... Children) Highest with hypoxic or ischemic .

  7. Risk factor History of seizure. Family history. Fever. Stress. Lack of sleep. Missed meal Flashing of light.

  8. Causes of Pediatric Seizures • Infants (0-1yr) • CNS infection • Malformation • Drug withdrawal or toxicity • Genetic • Metabolic • Hypoxia • Young Children (1-12) • CNS infection • Degenerative disorder • Fever • Genetic • Trauma • Idiopathic

  9. Non-epileptic: • Febrile convulsions • Metabolic: • Hypoglycemia • Hypocalcaemia/hypomagnesemia • Hypo/hypernatraemia • Inborn error of metabolism • Head trauma • Meningitis/encephalitis • Poisons/toxins: chemicals, cocaine, isonized, antidepressant

  10. Types of seizures :

  11. Types of Pediatric Seizures “Generalized” Seizure Partial Seizure

  12. Types of Pediatric Seizures • Grand Mal (Tonic/Clonic) • Absence • Myoclonic • Tonic • Clonic • Atonic • Simple Partial • Consciousness not impaired • Complex Partial • Begins locally • Progresses to impaired consciousness Generalized(6-20%) Partial(40-60 %)

  13. Types of Pediatric Seizures • Syndromes • Infantile spasms(West Syndrome) • Lennox-Gastaut Syndrome • Juvenile Myoclonic Epilepsy • Benign focal epilepsy (benign rolandic epilepsy)

  14. Pediatric Seizures are Different • Immature nervous system • Cannot sustain organized seizures • Poorly developed connections • Less capable of repetitive high-frequency firing

  15. 20 X

  16. Partial Seizures Start by activation of group of neuron in one part of one hemisphere Three main types 1)Simple partial Seizures. motor, sensory, behavioral, or autonomic ) 2)Complex partial seizures. 3)Partial Seizures evolving to generalized. 2nd generalized

  17. Simple partial seizures : Consciousness is preserved Simple partial seizures arise from a specific anatomic focus. Clinical symptoms include Motor : Location and direction of spread of the seizure focus determine the clinical symptoms . Sensory : tingling or parasthesia on the face or lomp , visual , aoditory, olfactory disturbance . Psychic ( behavioral ) : DEJA, JAMIAS. Autonomic abnormalities : sweating or flusing .

  18. Complex partial seizures are similar, but in addition, consciousness is impaired. • Commonly origenated from temporal lope. It is associated with alternedconsiousness without the pt. collapsed to the ground . The pt. stop what he is doing & stares blinkly, often macking rhythmic smacking movment of lips or pickling at their cloth. • Usually arise from temporal lobe. • When partial seizures spread to involve the whole brain and produce a generalized tonic-clonic seizure, they show secondary generalization ("jacksonian" seizures).

  19. Generalized seizer

  20. Generalized seizer : It starts by activation of neurones in large area of both hemisphere.

  21. Generalized seizer : It consists of : 1-Generalized • -Tonic • -Clonic, -and Tonic-Clonic Seizures (grandmal). 2-Absence Seizures ( petit mal ). 3-Myoclonic . 4-Atonic seizure

  22. Tonic-Clonic Seizures (grandmal) • Phases of TCS: • Prodromal phase : houres or days before attack . Aura : specific feeling or occurance of seizure . e.g olfactory hallusination, epi. Discomfort .

  23. Consciousness and control of posture are lost followed by: Tonic phase : Rapiddischarg of motor cortix cell causing tonic contraction of muscle ( stiffness ) children do not breath and become cyanosed Upward deviation of the eyes. Pooling of secretion , pupillary dilation ,diaphoresis, hypertension , and piloerection . Clonic phase : Less rapid, gradually & slowing of discharge of cortical cells causes alternating contraction and relaxation ( Jerking of limbs). Irregular breathing & cyanosis persists, saliva may accumulate in mouth, tongue bitting and incontinence . Last for 2 – 3 min.

  24. Post-ictal phase : Deep unconsciousness. Flaccid limb & jaw. Loss of corneal reflex. Headache, confusion & malaise. Todd paralysis. Amnesia.

  25. EEG During attack shows : repetitive synchronous bursts of spike activity followed by periodic paraxysmal discharges.

  26. Absence Seizures 2 types : Typical absence seizure Atypical absence seizure :

  27. Typical absence seizure: (*Disorder of childhood (Usually begin between 4 and 6 y • Characterized : • Brief loss of enviromental awareness accompanied by eye fluttering or simple automatisms ,such as head bobbing and lip smacking . The attack lasts for a few second (15-30 sec) Induced by hyperventilation . TYPICAL EEG >>>> 3 hz. SPIK AND WIEVES .

  28. Myoclonic seizures : • It consist of single or multiple myoclonic jerkinvolving one part of the body or entire. • Not proceded by aura.

  29. Atonic Seizures -Sudden loss of postural tone, with sagging of the head or falling. -Rarely loose consciousness.

  30. Epileptic Syndromes Epilepsy : Is a group of neurologic conditions, the common and fundamental characteristic of which is : the liability to recurrent , unprovoked seizures.

  31. Epileptic Syndromes 1-Benign focal epilepsy (benign rolandic epilepsy, benign centrotemporal epilepsy) 2-Juvenile myoclonic epilepsy 3-Infantile spasms (West syndrome) 4-Lennox-Gastaut syndrome 5-Acquired epileptic aphasia (Landau-Kleffner syndrome) 6-Benign neonatal convulsions

  32. Benign focal epilepsy, also known as rolandic epilepsy -usually begins between ages 5 and 10 years. In the central sulcus. Good prognosis. They are usually focal motor seizures involving the face and arm and tend to occur only during sleep or on awakening in more than half of patients.

  33. Symptoms commonly include abnormal movement or sensation around the face and mouth with drooling and a rhythmic guttural sound. Speech and swallowing are impaired. A family history of similar seizures is found in 13% of patients. The disorder is called benign because 1- seizures usually respond promptly to anticonvulsant therapy; 2- intellectual outcome and brain imaging are normal, and epilepsy resolves after puberty. Continued treatment is not needed. EEG : centrotemporal spike

  34. Infantile spasms (West syndrome)

  35. Infantile spasms (West syndrome) • are brief contractions of the neck, trunk, and arm muscles, followed by a phase of sustained muscle contraction lasting 2 to 10 seconds • 3 patterns : • Extensor : extension of trunk and extrimities . least common . • Flexor : flexion of neck , arm and leg onto the trunk . • Mixed : most common . • May occur during sleep or waking .

  36. Classified in to : • 1-Cryptogenic : unknown cause . -10-20% . -Good prognosis . 2-Symptomatic : -related to prenatal or perinatal or pos natal causes . -Prognosis 80_90 % mantal retardation , but the nature of the disease determine the outcomes. Tuberous sclerosis is the most common recognized cause. The EEG during the waking state, hypsarrhythmia, Treatment of infantile spasms includes adrenocorticotropic hormone, oral corticosteroids, benzodiazepines, and valproic acid

  37. Juvenile myoclonic epilepsy occurs in adolescence and is an autosomal dominant disorder The patient may have absence, generalized tonic or clonic, and myoclonic seizures. The hallmark is morning myoclonus occurring predominantly within 90 minutes of awakening. Seizures usually resolve promptly with therapy with valproic acid, but therapy must be maintained for life.

  38. Benign neonatal convultions Outosomal dominant Generalized clonic seizures occur toward the end of first week of life . Lennox gastaut syndrome multiple seizure types Poorly response to treatment Acquredepliptic aphasia (landau-kleffner syndrome ) Characterized by the abrupt loss of previously acqured language in young childrin

  39. Summary seizure Absent seizure Characterized : Brief loss of enviromental awareness accompanied by eye fluttering or simple automatisms ,such as head bobbing and lip smacking . Induced by hyperventilation . TYPICAL EEG >>>> 3 hz. SPIK AND WIEVES . Epileptic Syndromes rolandic epilepsy EEG : centrotemporal spike Infantile spasms (West syndrome) are brief contractions of the neck, trunk, and arm muscles, followed by a phase of sustained muscle The EEG during the waking state, hypsarrhythmia,

  40. Febrile Convulsions • Seizures associated with sudden onset of high fever in absence of other causes of seizures & not due to intracranial infections (should be extra cranial infection). • Viral infection of the URT , roseolainfantum, shigellosis (most important 2 infections)&acute otitis media are most frequently the causes of Febrile convulsion • Affect 4-6% of children. • Commonest seizure in childhood. • Genetic predisposition. • Strong family history “1st degree relative” • Gastroenteritis may cause febrile convulsion especially with campylobacter Giovanni

  41. Types • Typical (simple): • Occur in 1st 24 h of fever. • Age group (6 ms – 6 ys) • More than half occur between ages 1 and 2 years (mean age 22 months). • Single. • No neurological or developmental abnormality. • Negative family history of epilepsy. • Generalized tonic clonic. • Persist < 15 min.

  42. Cont…. • Atypical (complex): • Occur after 1st 24 h of fever. • Age group (<6 ms & >6 ys) • Multiple • Focal convulsion . • Persist > 15 min. • Repeated convulsion for several hours or days in the febrile illness. • Neurodevelopmental abnormality may be present • Positive family history of epilepsy may be present • 4-10% of these cases may develop epilepsy later .

  43. Investigation • Lumbar punctureshould be done at first time of diagnosis. • Glucose level • CBC • EEG • Urine analysis

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