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Seizures in Children

Seizures in Children. Dr Penny Mancais Consultant Paediatrician Dorset County Hospital Foundation trust . To be Covered. Terminology History taking Prognosis of Seizures Fits, faints and funny turns When to refer Pragmatic advice in Epilepsy. Definition of Seizure.

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Seizures in Children

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  1. Seizures in Children Dr Penny Mancais Consultant Paediatrician Dorset County Hospital Foundation trust

  2. To be Covered • Terminology • History taking • Prognosis of Seizures • Fits, faints and funny turns • When to refer • Pragmatic advice in Epilepsy

  3. Definition of Seizure ANY SUDDEN ATTACK FROM WHATEVER CAUSE. • Many manifestations determined by site of origin. • Many causes: • Non Epileptic (reflex anoxic ,fainting, Tics ,migraines, night terrors ) • Epileptic

  4. Definition of Epileptic Seizure • Manifestation of Epileptic (excessive) usually self limited activity of neurons in the brain • ILAE

  5. Prognosis of seizures 1% afebrile seizure • 50% will have a recurrence 3% febrile seizure • Risk of recurrence 35% • Risk of Epilepsy following simple 1% • Risk of Epilepsy following complex 6% • Risk of Epilepsy following complex/FH 30%

  6. Taking the History Diagnosis is in the History • No Ix to confirm epilepsy • RELIANT ON HISTORY

  7. What to ask • Eye witness account • Role play • Avoid interpretations • Time line • Use counting • Home videoing

  8. Racing heart Tingling sensations Headache Generalised stiffening Floppiness Ringing noises Hiccups Sudden loss of vision Features that may occur in Seizures • Sudden fall • Jerking limbs • Blank stare • Urinary incontinence • Funny smell • Feeling of fear • Facial flushing • Seeing coloured spots • vomiting

  9. Fits Faints and funny turns • Collapsing with convulsions • Drop attacks • Stiffening attacks • During sleep

  10. Fits faints and funny turns

  11. When to refer • Any child with ‘unexplained seizure’ (NICE) • <1years discuss ?admit • NO investigations • Advise home videoing, diary monitoring • All children with a diagnosis of epilepsy should have a named paediatrician.

  12. Pragmatic advice in Epilepsy Will my child die? • Risk from fit is negligible • SUDEP 1:200 (poor control,teenagers,male) • Accidents • NO climbing/harness, swimming 1:1, shower • Alcohol (1=3 on anticonvulsants) • Recreational drugs (increase risk of seizure)

  13. Advice continued • Contraception: Higher doses of Oestrogen for enzyme inducing drugs plus barrier protection Starting a family • Driving • Nocturnal seizures ok • Fit free 1yr on/off medication • DVLA latest advice

  14. Medication • Now 17 drugs available • Aim to improve seizure control • Minimises effects on learning and behaviour • Blood tests not needed

  15. Summary • History, History, History • All children with unexplained seizure need referral • <1 pick up phone ? Admit • Web sites: • National Society for Epilepsy • Epilepsy action

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