Fits / faints (paeds)

Seizure
1. Epileptic
  1. Consciousness may (complex) or map not (simple) be impaired, focal signs, may be aura, may or may not be asscoaited with generalised tonic clonic
    1. Focal
      1. frontal
        motor phenomena - clonic movements, may travel proximally (jacksonian march)
      2. temporal
        auditory or sensory phenomena inc automatisms, deja-vu and jamais vu, consciousness may be impaired (complex partial)
      3. Secondary generalised
        starts focal then spreads
      4. Parietal
        contralateral altered sensation (dysthesia)
      5. Occipital
        +ve or -ve visual phenomena
  2. Consciousness always impaired, no warning / aura, symmetrical seizure,
    1. Generalised
      1. Absence
        transient loss of awareness, few motor signs
      2. Myoclonic
        brief repetitive jerkng movements of limbs, neck, trunk,
      3. Tonic-clonic
        Tonic phase - rigid and may fall, do not breath and become cyanosed. clonic phase - rhythmical jerking, irregular breathing, cyanosis and salivation. may be biting of lateral tongue and incontinence. last several minutes and followed by unconsciousness or deep sleep
      4. Tonic
        generalised increased tone
      5. Atonic
        often combined with a myoclonic jerk, followed by a transient loss of muscle tone
  3. Secondary causes
    1. cerebral tumour
    2. cerebral dysgenesis / malformation
    3. cerebral vascular occlusion
    4. cerebral damage e.g. HIE, congenital infection
    5. neurodegenerative disorders
    6. Neurocutaneous syndromes
  4. treatment
    1. sodium valproate
      1. first line; generalised seizures and focal
      2. TERTOGENIC, weight gain, hair loss, liver failure
      3. Stabalises Na channels?
    2. carbamazepine
      1. First line tonic clonic and focal seizures
      2. Rash, neutropenia, hyponatraemia, ataxia, liver enzyme induction - medication interaction
    3. lamotrigine
      1. first line; focal. second line; generalised
      2. Rash
    4. ethosuximide
      1. first line; absence
      2. Nausea and vomitting
    5. topiramate
      1. 2nd line; tonic clonic, focal
      2. drowsiness, withdrawl, weight loss
    6. vigabatrin
      1. 2nd line; focal
      2. restricted visual fields, sedation
    7. gabapentin
      1. 2nd line; focal
      2. insomnia
    8. ketogenic diet, vagal nerve stimulation, surgery
  5. epilepsy syndromes
2. Non epileptic
  1. Non epileptic attack disorder (NEAD)
  2. Brief tonic clonic seizure associated with rise in temperature (in 6mnths -6yrs)
    1. febrile
      1. Simple
        no increased epilepsy risk
      2. Complex - focal, prolonged or repeated in same ilness
        increased risk of subsequent epilepsy
      3. Management
        Investigate and treat cause especially if suspected bacterial or meniningitic
        advise parents on seizure management - 30-40% likely to have another
        RFs for 2nd seizure; +ve FH, low temp when seizure, young child, short illness before seizure
  3. metabolic - hypoglycaemia, hypocalcaemia, hypomagnesaemia, hypo/hypernatraemia
  4. head trauma
  5. Meningitis / encephalitis
  6. Pseudoseizures or fabricated
3. investigations
  1. EEG - abnormal supports epilepsy diagnosis
  2. Biochem - metabolic abnormalities
  3. MRI / CT - structural causes
Paroxysmal disorders; quick recovery, may jerk, normal EEG
1. Syncope
  1. Cardiac
    1. arrhythmia e.g. prolonged QT interval (related to exercise)
2. Neurocardiogenic
  1. Reflex anoxic seizure; Prodrome, provocation, posture (stood up),
    1. precipitated by pain, head trauma, fright, cold food
3. Breath holding attacks
4. migraine
5. Benign paroxysmal vertigo
6. Self gratification

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Fits / faints (paeds)

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