TBL 4 - convulsion in children

8/7/2019 TBL 4 - convulsion in children

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Q1. When you might

consider a child to have a

fever? Briefly describepathophysiology of fever?


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Normal temperature : 37C - 38C

Always considered to be 37C

The normal rectal temperature is 0.5Chigher; the axillary temperature is 0.5C

lower

Axillary temperature above 37.5C are

considered abnormalRectal temperature more than 38C are

considered abnormal


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Exogenous

pyrogens(infections,

inflammatory

process,

malignancy)

Stimulate release of

endogenous

pyrogens

Liberating

arachidonic acid

thus metabolized to

prostaglandins E2

Increase

thermoregulatory

set point

Heat conservation Heat production

Reach to anteriorhypothalamus via

arterial blood

circulation


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Q2. What is the abnormalmovement described and

the complication whichcan arise from such

events?


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Tonic-clonic seizures

Consciousness and control of posture are

lostFollowed by tonic stiffening and upward

deviation of the eye

Complication: If the activity everlasting longer that 20 minutes

= status epilepticus

May lead to irreversible brain injury


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Cyanotic breath holding spells

Breathing stops in expirations

involuntarilyOccur in response to fear, confrontation,

traumatic event, being startled

Complication:

Injury due to fall as can beaccompanied by loss of consciousness.


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Do the seizure appear generalized, or focal? (to know the typesof febrile seizures) How long has she been having this fever? What cause the fever? (to ruled out if its due to viral or bacterialinfection)Are they any associated symptoms? (to know if patient has pain,headache) Do you have night sweats or loss of weight? (to ruled out TB) Do you take the temperature? Is it getting higher or lower?Does the fever continuous or intermittent? (to ruled out typhoid,malaria or TB)Is the child has had any seizures before?Besides her father, are they any of the family members have thesame problem? (to ruled out that genetic predispositioncontributes to the disease) Does your child experience any developmental delay? Has there been any exposure to drugs/alcohol duringpregnancy? ( some drugs may cause damage to the brain)


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Adult and older children Infants and toddlers

Headache Fever

Neck stiffness Drowsiness

Photophobia Loss of consciousness

Fever Poor feeding

Vomiting Irritability

Lethargy

Bulging fontanelle


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CT/MRI scan to detect any increase in

ICP

EEG test-To identify asymmetry, any

focal abnormalities such as sharp waves

or slowing that might indicate

underlying abnormalities.

Blood and CSF culture Full blood count test

Glucose and protein level in CSF

C-reactive protein level


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The first and priority treatment is to ensure adequate airway.

Childs oropharynx should be cleared and suctioned.

Oxygen is administered.

If there is violent muscle activity that impairs the patient

sedation can be given. Electrolytes imbalance and glucose level should be

addressed and IV infusion should be given.

Rectal diazepam can be administered during seizures to

abort prolonged event.

Daily administration ofP

henobarbital or valproic acidprevents fibrile seizures.

Anti pyretic drugs can be given to treat the fever.


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CASE

Abnormal movement

Seizure

DEFINITION

Transient dysfunction of part or all of the brain. Causing sudden and transitory phenomena of motor,

sensory, autonomic or physic nature

Causes

Genetic or congenital malformation of the brain CNS infection

Tumor

Trauma

Idiopathic


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Seizure

Focal

Simple complex

Generalised

Absence ClonicTonic-clonic

Myoclonic AtonicTonic


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Differential diagnosis

Breath holding attack

SyncopeCardiac arrhythmias

Tumor

Metabolic impairment

Gastro-oesophageal reflux


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Knowing by:

Primarily detailed history taking of

character, from eyewitness (parents)Any factor that suggest the patient is

prone to fits the condition: i.e. family

history, or in fever.

Neurological examination. (PE andInvestigation) i.e.EEG.


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What have we know:

Abnormal movement, suggesting

convulsion.Convulsion last for 45 minutes.

Had vomiting just before it happened.

Had 2 past history not associated with

fever.No remarkable birth history.

No concern about her development.


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1. About the attack, detailed of what

happened. Before during and after.

2.

What have the baby been eating.3. Associated symptoms

4. Family history

5. Environment history

6. Ask more about vomitting.


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To rule out the types of seizures.


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Provisional diagnosis

Tonic clonic epilepsy with complication

of status epilepticus

Differential diagnosis

Pseudo-seizures

Breath-holding spells Long QT syndrome

Paroxysmal movement disorders


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FBC To rule out any infection or inflammation as secondary cause

Blood glucose level To check the level of glucose as cause of seizures

BUSE To check electrolyte imbalance (hypocalcaemia,

hyponatremia)

EEG

To measure electrical activity in the brain to indicateepilepsy

MRI @ CT scan To indicate progressive neurological disorder


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During an episode of seizure:

Lie child in recovery position (head to side

and lower than trunk) to protect ABC

Do not restraint seizure movement, but

protect the child from injuring themselves.

If persists > 5 mins:

Give anti-epileptic drug therapy

diazepam, phenytoin, phenobarbitone


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Ask parents to try and search for the

cause of seizures/epilepsy i.e.

photosensitivity, stress, and intervene thecause

Avoid sleep deprivation

Better shower than bath

Inform school, nursery or maids ofcondition

Ask parents or maids to learn and know

emergency treatment.


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TBL 4 - convulsion in children

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