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Seizure Disorders in Children

Seizures in children can be caused by brain injuries, infections, genetic factors, or unknown reasons. They are classified based on whether they affect part or all of the brain, and common types include absence, atonic, myoclonic, tonic-clonic, and febrile seizures. Diagnostic tools include medical history, physical exams, imaging, and EEGs. Treatment focuses on medication, dietary therapies, surgery, and education to manage seizures and prevent injuries. Parents should learn first aid like clearing spaces, timing seizures, and calling for emergency help if they last over five minutes.

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Bheru Lal
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248 views22 pages

Seizure Disorders in Children

Seizures in children can be caused by brain injuries, infections, genetic factors, or unknown reasons. They are classified based on whether they affect part or all of the brain, and common types include absence, atonic, myoclonic, tonic-clonic, and febrile seizures. Diagnostic tools include medical history, physical exams, imaging, and EEGs. Treatment focuses on medication, dietary therapies, surgery, and education to manage seizures and prevent injuries. Parents should learn first aid like clearing spaces, timing seizures, and calling for emergency help if they last over five minutes.

Uploaded by

Bheru Lal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Seizure Disorders in Children

Seizures and Epilepsy


• A seizure is defined as a transitory disturbance in consciousness or
in motor, sensory, or autonomic function caused by uncontrolled
electrical discharges in the brain
• A seizure is a transient episode of abnormal electrical brain activity,
with an excessive discharge rate in a group of cerebral neurons that
leads to involuntary changes in behavior, level of consciousness
(LOC), sensation, and/or motor activity. A seizure may be prolonged
or so brief it’s barely noticeable. Physiologic changes occurring
during a seizure include altered cerebral blood flow, autonomic
changes (such as tachycardia and blood pressure changes),
increased glucose and oxygen consumption, and increased
production of lactic acid and carbon dioxide.

• Epilepsy refers to disorders characterized by recurrent seizures


rather than a single seizure
- Categorized by causes and types of seizures
Causes of Seizures
• brain injury

• trauma

• infection

• metabolic and neurodegenerative diseases

• cortical malformation
Classification of Seizures
• Symptomatic - symptom of underlying disease

• Idiopathic - caused by genetically inherited trait

• Cryptogenic - unknown cause

• Partial - uncontrolled electrical activity in area of brain

• Generalized - affects both hemispheres of brain at once


Types of Partial Seizures
• Simple - person remains alert

• Complex - person experiences aura, with altered


consciousness during seizure and confusion following the
seizure
More Seizure Types
• Absence seizures - “staring episodes,” also called
petit mal seizures

• Atonic seizures - sudden loss in muscle strength, often


resulting in a fall

• Infantile spasms - brief flexion/extension of the upper body,


usually not seen after 18 to 24 months of age
More Seizure Types
• Tonic seizures - usually occur during sleep involving most of
the brain, causing increased muscle tone

• Clonic seizures - rhythmic jerking movements of the entire


body

• Tonic-clonic seizures - also known as “grand mal” seizures,


whole-body jerking movements with loss of bowel, bladder,
and consciousness
Seizure Syndromes
• Juvenile myoclonic epilepsy - inherited, myoclonic seizures
late in childhood, responds to medication but rarely resolves

• Benign rolandic epilepsy - common seizure syndrome with


good prognosis for the child to outgrow

• Lennox-Gastaut syndrome - early childhood onset, no cure,


treated with medications
Causes of Lennox-Gastaut
• brain malformations

• perinatal asphyxia

• severe head injury

• central nervous system infection

• inherited genetic or metabolic conditions

• unknown in 30% to 35% of cases


Febrile Seizures
• Brought on by fever in infants and children

• Classified as typical or atypical

• Typical febrile seizure- occurs in 2% to 5% of children ages 6


months to 5 years of age, usually during first day of acute
infection
Atypical Febrile Seizure
• Febrile seizure that recurs in a 24-hour period

• Risk of epilepsy after is associated with risk factors for seizure


disorders

• Often accompanied with Todd’s paralysis (transient paralysis


of a limb)
Diagnostic Tools
• History and physical - emphasis on seizure event is most
valuable tool

• Lab tests - complete blood cell count, metabolic panel

• Brain imaging studies - Computed tomography scan,


magnetic resonance imaging
Diagnostic Tools
• Electroencephalogram - to correlate with seizure activity and
electrical discharges in the brain

• Possibly a spinal tap for spinal fluid specimen


Managing Seizure Disorders

• Medication is mainstay

• Goals:
- freedom from seizures and adverse events
- avoid drug interactions
- adherence to therapy
- minimal interference with daily life

• Challenge to the health care provider is to meet these goals


with monotherapy
Other Management Options
When medications have limited success:

• ketogenic diet

• vagal nerve stimulation

• surgery
Ketogenic Diet
• rigid food plan

• high fat, essential proteins, low carbohydrates

• requires high level of family commitment

• mixed results of decrease in seizures with medication

• small number of children seizure-free


Vagal Nerve Stimulation
• Surgical implantation (usually in patient’s neck) of a device
delivering electrical stimulation to the vagus nerve

• Decrease in seizures reported with quicker recovery, not


seizure-free
Caring for Your Patient
• Education of family and/or support system is key

• Education about what to do during seizure

• Education about medications and treatments

• Referrals for family support


Teaching parents about first aid for seizures
For a generalized tonic-clonic seizure, teach parents to stay calm and
follow these guidelines:
• Clear the area of hard or sharp objects.
• Place something soft and flat under the child’s head.
• Don’t hold the child down or try to stop the child’s movements.
• Don’t try to force the child’s mouth open or put anything in the mouth.
Contrary to popular belief, a person can’t swallow the tongue during a
seizure.
• Loosen anything around the child’s neck that might make breathing
difficult.
• Turn the child onto one side to promote airway clearance.
• Keep track of how long the seizure lasts, where it started, and whether
it changed.
• Stay with the child until the seizure ends and the child has recovered
fully.
• Don’t give the child anything to eat or drink until fully alert.
• Call 911 if the seizure lasts longer than 5 minutes. If prescribed, give
Diazepam rectal gel (Diastat).
• Explain to parents that various symptoms may
occur right after the seizure, including memory
loss, confusion, depression, fear, and feelings of
frustration or embarrassment. Tell them they may
notice the child has bitten the tongue, has bruises
or other injuries, or has lost bladder or bowel
continence. Other symptoms may include
difficulty talking, exhaustion, headache, nausea,
vomiting, thirst, or weakness. Inform them that a
condition called Todd’s paralysis—weakness on
one side of the body—may last from 30 minutes
to several hours.
Nursing Interventions: Epilepsy
• Administer anticonvulsant therapy as prescribed.
• Protect the patient from injury during seizures.
• Monitor the patient continuously during seizures.
• If the patient is taking antiseizure medications,
constantly monitor for toxic signs and symptoms such
as slurred speech, ataxia, lethary, and dizziness.
• Monitor the patient’s compliance with anticonvulsant
drug therapy.
• Teach the patient to take exact dose of medication at
the times prescribed.
• Encourage the patient to eat balanced, regular meals.
• Advise the patient to be alert for odors that may trigger an attack.
• Limit or avoid alcohol intake.
• Encourage to have enough sleep to prevent attacks
• Avoid restraining the patient during a seizure.
• Loosen any tight clothing, and place something flat and soft, such as
pillow, jacket, or hand, under his head.
• Avoid any forcing anything into the patient’s mouth if his teeth is
clenched.
• Avoid using tongue blade or spoon during attacks which could lacerate
the mouth and lips of displace teeth, precipitating respiratory distress.
• Protect the patient’s tongue, if his mouth is open, by placing a soft
object between his teeth.
• Turn the patient’s head to the side to provide an open airway.
• Reassure patient after the seizure subsides by telling him that he’s all
right, orienting him to time and place, and informing that he’s had a
seizure.

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