Fits Faints and Funny turns

Differential diagnosis of a Differential diagnosis of a seizureseizure

Syncope-         VasovagalSyncope-         Vasovagal                                               Cardiac causes- cardiomyopathy/prolonged Cardiac causes- cardiomyopathy/prolonged

QTcQTc Breath holdingBreath holding Reflex anoxic seizures/ Reflex anoxic syncopeReflex anoxic seizures/ Reflex anoxic syncope Psuedo seizuresPsuedo seizures Emotional syncopeEmotional syncope Valsalva/ constipationValsalva/ constipation Stereotypical behavioursStereotypical behaviours Tics Tics Gratification habitsGratification habits Basilar migraineBasilar migraine Paroxysmal spasmodic torticollisParoxysmal spasmodic torticollis Benign paroxysmal vertigoBenign paroxysmal vertigo

Is the episode a seizures?Is the episode a seizures? What’s the cause of the seizure?What’s the cause of the seizure? Is this epilepsy?Is this epilepsy? What is the cause of the epilepsy? What is the cause of the epilepsy?

---------- ---------- NOW think EEGNOW think EEG Classify epilepsy into a syndrome?Classify epilepsy into a syndrome?

If not then TREAT the “funny turn”If not then TREAT the “funny turn”

If not sure then watchful waitingIf not sure then watchful waiting

Get more informationGet more information

Important key point to learn Important key point to learn today !today !

What is the difference between a What is the difference between a generalised seizure and a generalised seizure and a generalised epilepsy?generalised epilepsy?

NoahNoah

18 months18 months Three episodes when his mother says he is found on the Three episodes when his mother says he is found on the

floor unresponsive floor and jerks lasts about 30mins but floor unresponsive floor and jerks lasts about 30mins but father thinks less.father thinks less.

Preceded by a cryPreceded by a cry After he appears confused and inconsolable After he appears confused and inconsolable EEG performed by the SHO after being seen in A/E- normal EEG performed by the SHO after being seen in A/E- normal ECG normal QTc 0.42secECG normal QTc 0.42sec 24hr ECG normal24hr ECG normal FH father used to do this as a child and was treated with FH father used to do this as a child and was treated with

PhenytoinPhenytoin Comes to discuss if they should give a trail of Comes to discuss if they should give a trail of

anticonvulsantanticonvulsant

EllieEllie 12 years of age 12 years of age C/O fit at school C/O fit at school Fat lasting 5 minutes witness by the first aider (whose sister Fat lasting 5 minutes witness by the first aider (whose sister

used to have fits)used to have fits) Called 999 by the maths teacher was sick and confused Called 999 by the maths teacher was sick and confused

afterwards afterwards In A/E now feeling better fully conscious a slight headache In A/E now feeling better fully conscious a slight headache B?S by paramedics 6.5B?S by paramedics 6.5 PMH febrile convulsion resulting in an PICU admission for 24 PMH febrile convulsion resulting in an PICU admission for 24

hours given rectal diazepam  that mother still carrieshours given rectal diazepam  that mother still carries FH Mother has epilepsy on TegretolFH Mother has epilepsy on Tegretol Exam normal Exam normal No focal signs to find No focal signs to find One café au lait  spot One café au lait  spot Referred to you asking if they could attend first fit clinic and Referred to you asking if they could attend first fit clinic and

an EEG has been organised an EEG has been organised

Part two - clinicPart two - clinic

Further episode occurred during home Further episode occurred during home tec and at home witness by her older tec and at home witness by her older sistersister

School refuse to have her back unless School refuse to have her back unless “some things is done”“some things is done”

Mother is sleeping in her bedroom on Mother is sleeping in her bedroom on the floorthe floor

EEG –non specfic changes has EEG –non specfic changes has occasional spikesoccasional spikes

MAXMAX 4 years of age- 8 daily episodes cries sits down goes rigid 4 years of age- 8 daily episodes cries sits down goes rigid

eyes roll back lasting 2mins then confused afterwards for a eyes roll back lasting 2mins then confused afterwards for a bout 30mins.bout 30mins.

Described as paleDescribed as pale Max says he feels dizzy before hand.Max says he feels dizzy before hand. Neurodevelopmental normalNeurodevelopmental normal No other reported problems – absence episodes reported by No other reported problems – absence episodes reported by

the nursery but not noted at home the nursery but not noted at home PMH – sinus bradycardia as neonate seen by Cardiologist at PMH – sinus bradycardia as neonate seen by Cardiologist at

GOS happy with him GOS happy with him Examination normal HR 70 nil else Examination normal HR 70 nil else Echo normal Echo normal ECG normalECG normal Normal QTc -0.44secNormal QTc -0.44sec 24hour tape mum went to anyway not cancelled24hour tape mum went to anyway not cancelled

TomTom

4 years of age 4 years of age

Well when went to school had a fit in school and an Well when went to school had a fit in school and an ambulance was called as mum was unavailableambulance was called as mum was unavailable

Lasted for 10mins described in a/e clerking as tonic clonic Lasted for 10mins described in a/e clerking as tonic clonic generalised fit lasting 3 minutes.generalised fit lasting 3 minutes.

Now very wellNow very well Given calpol by the A/E sisterGiven calpol by the A/E sister Examination normal.Examination normal. Mother says has had 15 febrile convulsions normally they Mother says has had 15 febrile convulsions normally they

don’t some to A/E don’t some to A/E Neuro developmentally normal Neuro developmentally normal What do you think is going onWhat do you think is going on What are you going to do What are you going to do

TAKE A HISTORY THE EVENT AND TAKE A HISTORY THE EVENT AND THE RUN UP AND AFTER.THE RUN UP AND AFTER.

If your not sure adopt watchful If your not sure adopt watchful waiting DO NOT order an EEG unless waiting DO NOT order an EEG unless you think it will give you information you think it will give you information and interoperated the information and interoperated the information with the clinical casewith the clinical case

Give advice Give advice

EEGEEG

EEG maybe normal even in a child with EEG maybe normal even in a child with epilepsy MUST council the parents before epilepsy MUST council the parents before handhand

EEG report is as good as the information EEG report is as good as the information you give the neurophysiologistyou give the neurophysiologist

Answer a question Answer a question The result must fit the clinical pictureThe result must fit the clinical picture Non specific abnormalities MUST be Non specific abnormalities MUST be

interpreted correctly interpreted correctly

Important key point to learn Important key point to learn today !today !

What is the difference between a What is the difference between a generalised seizure and a generalised seizure and a generalised epilepsy?generalised epilepsy?

1. What are the risk for a reoccurrence after one seizure? After two seizures?2. What should you tell them to do at school?3. Whats the advice regarding swimming?4. Whats the advice about sleeping arrangements?5. Whats to do about TV and computer games?6. Any other advice?7. You reg wants to give them Midazolam prescribe it?

www.stars.org.ukwww.stars.org.uk

www.epilepsy.org.uk/infowww.epilepsy.org.uk/info

Epilepsy advice and informationEpilepsy advice and information What is epilepsy?What is epilepsy? Caring for a baby or young child when you have epilepsy: a detailed guideCaring for a baby or young child when you have epilepsy: a detailed guide ChildrenChildren Depression and epilepsyDepression and epilepsy Developing epilepsy in later lifeDeveloping epilepsy in later life Disability Discrimination Act (UK)Disability Discrimination Act (UK) Driving and epilepsyDriving and epilepsy EducationEducation Entitlements and benefits for people with epilepsyEntitlements and benefits for people with epilepsy Epilepsy and learning disabilitiesEpilepsy and learning disabilities Epilepsy and Travel abroadEpilepsy and Travel abroad Epilepsy information for prisonsEpilepsy information for prisons Epilepsy, osteoporosis and Epilepsy, osteoporosis and osteomalaciaosteomalacia Flu and epilepsyFlu and epilepsy Getting a diagnosis Getting a diagnosis Identity jewellery Identity jewellery Inheritance Inheritance Living with dificult to control epilepsy Living with dificult to control epilepsy Me and my dadMe and my dad