Pediatric Seizures

Distinguish from mimics:

  1. Lateralized tongue-biting (high specificity)
  2. Flickering eye-lids
  3. Dilated pupils with blank stare
  4. Lip smacking
  5. Increased heart rate and blood pressure during event
  6. Post-ictal phase

Screen Shot 2017-12-05 at 8.06.23 AM

-if the seizure occurs >24hrs after the onset of fever, have higher suspicion for a bacterial cause of the fever (ie meningitis)
older pts who return to baseline after a complex seizure and at no point displayed any focal neurologic symptoms usually do not require an extensive work-up

Risk of Epilepsy is 2% after a simple febrile seizure and 5 % after a complex febrile seizure (compared to 1% in the general population)

Non-febrile seizures
-most common cause in <6mo is overdilution of formula -> 3ml/kg hypertonic (3%) NS
-check BGM

Labs if:

  1. Have prolonged seizures,
  2. < 6 months of age (specifically for hyponatremia)
  3. History of diabetes, metabolic disorder, dehydration, or excess free water intake
  4. Altered LOC

CT head if:

  1. Focal seizure or persistent seizure activity
  2. Focal neurologic deficit
  3. VP shunt
  4. Neurocutaneous disorder
  5. Signs of elevated ICP and history of trauma or travel to an area endemic for cysticercosis.
  6. Patients who have immunocompromising diseases (malignancy or HIV),
  7. Hypercoagulable states (sickle cell disease), or bleeding disorders

<6 months of age – generally require a full workup and are usually admitted for observation.
6 months and 2 years of age – disposition will depend on blood work, reassessment and the ability to have close follow-up.
>2 years of age – those who have returned to baseline, have a normal neurological exam with normal workup are often safe to be discharged to close outpatient follow-up. Otherwise, admit.

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*note that the first dose of benzo should NOT be given iv (other routes just as efficacious, and early time to benzo is more likely to stop the seizure)
*note that fosphenytoin is a precursor to phenytoin with fewer side effects

 

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