1. Seizures
Prof.Dr.P.Soundararajan

2. seizure is a transient occurrence of signs and symptoms
resulting from abnormal excessive or synchronous
neuronal activity in the brain.

3. Febrile seizure; definition
• Between 6m to 60months
• Fever >38oc
• no CNS infection, no metabolic
imbalance
• No prior febrile seizure

4. SFS
• GTC
• <15mts
• No >1 episode <24hrs
• No postictal complications

5. CFS
• Focal
• >1 episode in 24hrs
• >15mts
• Post ictal abnormality

6. • 2-5% incident
• SFS; No risk of complications
• CFS; 2 fold increase in morbidity

7. Cause
• Autosomal dominant
• Many genes,
• sodium channel genes
• generalized epilepsy with febrile
seizures plus (GEFS+)
• severe myoclonic epilepsy of infancy

8. Recurrence
• <1yr age
• <24hr of fever
• Family h/o febrile fit or epilepsy
• CFS
• Male
• Low serum sodium

9. RISK FACTOR RISK FOR SUBSEQUENT EPILEPSY
Simple febrile seizure 1%
Neurodevelopmental abnormalities 33%
Focal complex febrile seizure 29%
Family history of epilepsy 18%
Fever <1 hr before febrile seizure 11%
Complex febrile seizure, any type 6%
Recurrent febrile seizures 4%

10. Workup
• Thorough history & examination
• LP [assess sensorium]
• Prior antibiotics?

11. EEG
• Normal CNS; no need
• Doesn’t predict epilepsy
• Spikes seen during drowsy
• To do >2 weeks
• To know type of epilepsy
• 30mts wakefulness & sleep

12. • Serum glucose
• CT or MRI
– Status epilepticus [hippocampal atrophy]

13. Management
• Counsel parent
• Antipyretics
• SFS; no drugs
• CFS; Diazepam, lorazepam, midazolam
• Rectal diazepam
• Intranasal midazolam
• Intermittent prophylaxis
– Diazepam, phenobarbitone, clobazam
• Iron deficiency?

14. Status epilepticus
• continuous seizure activity or recurrent
seizure activity without regaining of
consciousness lasting for >30 min.
• impending status epilepticus ; seizures
between 5 and 30 min.
• Nonconvulsive status epilepticus
• Refractory status epilepticus

15. Causes
• 30% 1st episode SFS
• CNS infection
• Trauma
• CVA
• Metabolic imbalance
• Poisoning

16. • Imbalance between excitation & inhibition
• Increased excitability [glutamate, aspartate]
• Decreased GABA mediated inhibition
• Inadequate O2 supply
• Hypoxia
• Cerebral edema
• Ca influx into neurons
• Neuronal death

17. Management
• A B C
• Detect underlying etiology
• Electrolytes, BUN, glucose
• CSF study
• EEG
• Imaging

18. Drugs
• IV lorazepam
• midazolam
• Fosphenytoin
• Phenobarbitone
• Valproate
• propofol, thiopentol
• Isoflorane
• Induced acidosis.

19. SE Protocol - 0 - 10 min
• Verify and describe seizure
• Airway - Positioning & suctioning
• O2 through mask, Attach pulse oxymeter
• NGT, BMV if needed
• Start IV / IO - IV lorazepam 0.1 mg / kg (1st dose)
• If no IV / IO, Midazolam IM 0.15 mg / kg
• Monitor HR, RR, perfusion, BP, SaO2

20. SE Protocol - 10 - 20 min
• Check Glucose - Dextrostix, IV dextrose
• Lab investigations
• IV lorazepam 0.1mg / kg (2nd dose)
• Monitor HR, RR, Perfusion, BP, SaO2
• BM ventilation if needed
• IV Phenytoin 20 mg / kg over 20 min. (1st dose)
• Fever reduction

21. SE Protocol - 40 - 50 min
• BM ventilation
• IV Phenytoin 10 mg / kg (2nd dose)
• If seizure still persists, IV Phenobarbitone
20mg / kg over 10 min.
• Intubate prior to Phenobarbitone
• Manage ICT
• Consider IV Pyridoxine if > 3 yrs old

22. SE Protocol - 60 min.
Refractory Status Epilepticus
• Admit in PICU
• Involve Anesthetist / PICU team
• Support circulation
• Correct metabolic problems (Hypoglycemia,
Hypocalcemia, Hypomagnesemia)
• IV Midazolam infusion, Pentothal, IV Sodium
valproate

23. • IV Midazolam 0.15 mg / kg stat. dose
Maintenance - 1 mcg / kg / min.
• Raise / 1 mcg / kg / min. every 15 min. if seizure
persists. Maximum 20 mcg / kg / min.
• Higher the dose, need for ventilation
• After control, same rate of infusion for 24 hours then
taper by 1 mcg every 2 hours

24. Approach to seizure
• Assess CVS, RS status
• Metabolic screen
• Head examination
• Eye ex
• NCM
• HSM
• FND
• EEG, imaging

26. Thank you