Makindo Medical Notes

Seizures or "fits" in children can vary in presentation and severity. Early recognition and appropriate management are essential to reduce complications. Below are common types of seizures seen in children:

Initial Emergency Care

• Airway, Breathing, Circulation (ABC): Ensure the child has a clear airway, is breathing adequately, and has stable circulation.
• Safety during the seizure: Protect the child from injury. Remove dangerous objects and place the child in a safe position (on their side).
• Time the seizure: Seizures lasting more than 5 minutes may require urgent intervention for status epilepticus.

History Taking

• Detailed Seizure Description: Onset, duration, progression, type of movements (tonic, clonic, focal).
• Preceding Events: Triggers like fever, head trauma, infection, sleep deprivation, or flashing lights.
• Family History: Ask about any family history of epilepsy or other neurological conditions.
• Developmental History: Note any delays in developmental milestones, which could indicate underlying neurological issues.
• Medication and Vaccination History: Consider recent vaccinations or medications the child is taking.

Physical Examination

• Neurological Examination: Assess mental status, motor and sensory function, reflexes, and coordination.
• Signs of Infection or Trauma: Check for neck stiffness (meningitis), fever, or head injury.
• Skin and Vital Signs: Look for any unusual skin findings (neurocutaneous syndromes) or fever.

Classification of Seizure Type

• Focal vs Generalized Seizures: Determine whether the seizure was focal (localized) or generalized (involving the whole brain).
• Provoked vs Unprovoked: Identify if the seizure was provoked (fever, infection, trauma) or unprovoked (spontaneous).

Differentials

Type of Seizure	Description	Common Age Group	Key Features
Febrile Seizures	Seizures triggered by high fever, commonly seen in children with no prior history of epilepsy.	6 months to 5 years	Short duration, generalized tonic-clonic activity, no long-term neurological effects. Can be simple or complex.
Generalized Tonic-Clonic Seizures	Involves the entire brain, causing loss of consciousness followed by stiffening (tonic phase) and jerking movements (clonic phase).	Any age	Typically lasts 1-3 minutes, post-seizure confusion or fatigue.
Absence Seizures	Brief episodes of staring or loss of awareness, commonly mistaken for daydreaming.	4 to 14 years	Lasts for a few seconds, often unnoticed by others, can occur multiple times a day.
Myoclonic Seizures	Sudden, brief jerks or twitches of a muscle or muscle group.	Adolescents and young adults	Quick, shock-like jerks usually affecting arms and legs. Can occur in clusters.
Infantile Spasms (West Syndrome)	A rare type of seizure characterized by sudden flexion of the body, arms, and legs.	Infants (under 1 year)	Often occurs in clusters, associated with developmental delays and serious underlying neurological disorders.
Focal (Partial) Seizures	Seizures originating from one area of the brain, which may or may not affect consciousness.	Any age	May involve sensory, motor, or autonomic symptoms depending on the brain region affected.

Investigations

• Blood Tests: Look for infection (CBC), electrolyte imbalances (Na, K, Ca, Mg), and glucose levels.
• Neuroimaging: Consider MRI or CT scan if structural brain abnormalities or trauma are suspected.
• Electroencephalogram (EEG): Perform an EEG to classify seizure type and assess for epilepsy.
• Lumbar Puncture: Indicated if meningitis or encephalitis is suspected (based on fever, neck stiffness).

Management

• Acute Seizure Management: Benzodiazepines (e.g., diazepam or lorazepam) for seizures lasting more than 5 minutes (status epilepticus).
• Long-term Management: Antiepileptic drugs (AEDs) for recurrent or unprovoked seizures.
• Treat Underlying Causes: Manage triggers like infections, electrolyte imbalances, or trauma.