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SEIZURES. Dr Jonny Taitz, FRACP Geschn Paediatrician Sept 2003. Introduction. Common 8% of children will have a seizure by 15 years of age. Seizure. Sudden Attack of altered behaviour LOC abnormal sensation, automatic function. Most Common. Tonic (stiffening) Clonic (jerking)
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SEIZURES Dr Jonny Taitz, FRACP Geschn Paediatrician Sept 2003
Introduction • Common • 8% of children will have a seizure by 15 years of age
Seizure • Sudden • Attack of altered behaviour • LOC • abnormal sensation, automatic function
Most Common • Tonic (stiffening) • Clonic (jerking) • Absence • Myoclonic • Atonic • Focal • MOST ARE BRIEF • TERMINATE SPONTANEOUSLY • 50% in childhood = febrile convulsion
Which seizures do we treat? • > 5 minutes brain hypoxia • Status epilepticus • Generalised seizures > 30 mins OR • Repeated convulsions > 30 mins with NO recovery & consciousness between convulsions
Complications } - Long term epilepsy - Motor problems - Learning & behavioural problems • Age related • > 3 yr - 6% • < 1 yr - 30% • 5% mortality (1/20)
Guidelines aim } • JHH • SHC • CHW clear, succint guidelines in the care of acute seizures • Many different anticonvulsants • Different routes of administration • Intravenous • Intramuscular • Rectal • Oral
Important • Seizures < 15 minutes much more likely to respond to Rx than seizures > 15 minutes
History • ? Febrile illness • Underlying CNS problems • History of epilepsy • Head trauma • toxin ingestion 1° assessment ABC
Specific features on exam • Airway intubation • Breathing hypoventilation, aspiration, O2, mask ventilation • Circulation shock, fluid boluses • Neurological focal signs, LOC, RIP, asymmetrical seizures • Underlying illness trauma, meningitis, head injury, metabolic abnormalities
Management • Priority no 1: ABC • Airway(Control seizures control airway) • Breathing • Effective and efficient • All fitting kids high flow O2 • NB: repeated seizures • high dose anticonvulsants • Circulation } Resp depression ? Intubate + ventilate • Circulation • Rx shock • Fluid Boluses
Management (contd) • NEVER FORGET!!! GLUCOSE + BP • Hypoglycaemia • Rx 5mls/kg 10% Dextrose • Hypertension • Antihypertensives: • (I.e nifedipine, hydralazine)
Questions to ask • Do I have vascular access? • What anticonvulsants are available? • How many minutes has the child been fitting?
Vascular Access Supportive measures ABC Yes No Diazepam 0.25mg/kg IVI Diazepam 0.25mg/kg PR Or Midazolam 0.15mg/kg IVI Or Midazolam 0.15mg/kg IMI 5 Access Repeat Diazepam IVI Or Midazolam IVI No 10 LOAD repeat Phenytoin 20 mg/kg IVI Diazepam or Midazolam or Phenobarb 20mg/kg IVI 20 Rapid sequence induction Paraldehyde 0.4mg/kg PR Thiopentone, Atropine, Dilute 50:50 (olive oil) Suxemethonium
A little more on anticonvulsants • Diazepam • Effective first line in 80% • Rectal admin therapeutic levels 5 minutes • Rapid seizure control (80%) • S/E 9% risk of respiratory depression • Higher in children with CNS abnormalities
A little more on anticonvulsants • Midazolam • NSW Ambulance drug of first choice in status epilepticus (IMI) • Will stop majority of seizures within 1 minute (IVI) • Takes longer when used IM • (approx 5-10 mins) • Intransal midazolam • More info required before recommending it
Midazolam (contd) • Paraldehyde • Used since 1930’s • Very dangerous IVI • Well tolerated rectally • Rapid onset of seizure control • Less respiratory depression than Benzodiazepines • Smells
