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Seizures

Summary

Seizures in children can occur as a one-time event or may happen repeatedly, which is known as epilepsy. They can have various causes, including structural brain abnormalities, genetic factors, infections, metabolic disorders, immune conditions, or unknown origins.

Identifying the type of seizure and epilepsy syndrome is essential for effective treatment. This is done by analyzing the child’s seizure patterns, medical history, and electroencephalogram (EEG) findings. A detailed medical history is often the most important factor in diagnosis, as additional tests may not always be necessary.

Treatment depends on the specific epilepsy syndrome and may include medications, dietary therapies like the ketogenic diet, vagus nerve stimulation, surgery, or lifestyle adjustments.

Diagnosis and When to Seek Help

A child should see a doctor if they experience:

  • A sudden loss of awareness, muscle jerking, or unusual movements
  • Recurrent or prolonged staring spells
  • Repeated episodes of confusion or unresponsiveness
  • Loss of muscle control leading to sudden falls
  • Seizures lasting longer than five minutes or repeated seizures without recovery in between (medical emergency)

Doctors diagnose epilepsy by reviewing the child’s medical history, seizure patterns, and EEG results. Other tests, such as brain imaging, may be needed in some cases.

Management

Treatment options depend on the type of seizures and epilepsy syndrome and may include:

  • Medication: Anticonvulsant drugs are the most common treatment for seizure control.
  • Dietary therapy: The ketogenic diet, a high-fat, low-carbohydrate diet, may help in specific epilepsy syndromes.
  • Vagus nerve stimulation (VNS): A device implanted under the skin sends electrical impulses to help control seizures.
  • Surgery: In cases where seizures originate from a specific brain area, surgery may be an option.
  • Lifestyle adjustments: Getting enough sleep, managing stress, and avoiding known triggers can help reduce seizure frequency.

Follow-Up and Monitoring

Regular follow-ups with a neurologist are essential to monitor seizure control and adjust treatment if necessary. Parents and caregivers should be educated on seizure first aid and safety precautions to protect their child during episodes.

With appropriate care, many children with epilepsy can lead active and fulfilling lives.

History and Exam

Key diagnostic factors

  • Presence of risk factors
  • Staring spells or inattention
  • Tonic-clonic seizures
  • Brief, arrhythmic muscular jerking movements

Other diagnostic factors

  • Incontinence
  • Tongue biting
  • Post-ictal phenomena
  • Precipitated by fatigue or lack of sleep

Risk factors

  • Genetic predisposition or family history
  • Antenatal or perinatal insults
  • Metabolic/neurodegenerative disorders
  • Traumatic brain injury

Diagnostic Investigations

1st investigations to order

  • Electroencephalogram (EEG)
  • Blood glucose level
  • Basic metabolic panel
  • FBC

Investigations to consider

  • MRI brain
  • CT brain
  • Genetic testing

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