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Dr. Richard B. Fynn

Dormaa Presby Hospital

Dept. of Child Health

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Seizuresare a sudden uncontrolled electricalcharge of neurons in the brain that interruptsnormal function.

Symptom of an underlying illness

Any seizure resulting from a systemic ormetabolic disturbance that is resolved whenthe underlying problem is corrected is notepilepsy.

Epilepsyis a condition in which a person hasspontaneously recurring seizures caused by achronic underlying condition.

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Approximately 2.7 million people suffer from activeepilepsy each year.

The incidence rates are high during the first years of

life,

Decline through childhood and adolescence, Plateau in middle age,

Rise sharply again among the elderly.

Those over the age of 60 are the greatest population

with the highest prevalence of new-onset epilepsy.

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Perinatal:

HIE- Hypoxic ischemic encephalopathy

Metabolic Hypoglycemia, hypocalcemia

hypomagnesemia

Other

Infections

Structural abnormalities

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Definition:

Seizure in children between the age of 6 months

and 3-5 years in association with fever but

without evidence of an intracranial infection

Majority occurs before the age of 3 years

Average age of onset: 18 months to 22

months

Boys more than girls

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Simple febrile seizures

Generalise

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Recurrence

1/3 may have at least one recurrence

The younger the age of onset the greater the risk

of recurrence

Low fever at first seizure

Family hx

Risk of developing epilepsy

2% (vs 1% in gen pop), complex febrile seizure

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The role of heredity in the etiology of seizuredisorders has been difficult to determine becauseof the problem of separating hereditary fromenvironmental or acquired influences:

Seizure activity is often a symptom of many othermedical conditions such as: hypoxia, infection,DM, HTN, alcohol or drug overdose or withdraw,cancer, and head trauma to name just a few.

Some families carry a predisposition to seizuredisorders in the form of an inherently lowthreshold to seizure-producing stimuli, such astrauma, disease, and high fever.

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GENERALIZED SEIZURES:Involves both sides of the

brain.

Bilateral synchronous discharges in the brain from theonset of a seizure.

Entire brain is affected.

Usually no warning or aura. Subtypes

Tonic-Clonic (AKA Grand Mal) Clinical Manifestations:

Loss of consciousness.

Stiffening of the body for 10-20 sec. (Tonic)

Jerking movements of the extremities. (Clonic)

May appear cyanotic, have excess salivation, bite theirtongue or cheek, and may experience incontinence.

During postictal phase, usually sore, tired, andconfused; may sleep for several hours.

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Typical Absence (AKA Petit Mal)

Usually occurs in children; rarely goes beyond

adolescence.

May develop into another type of seizure.

Clinical Manifestations: Brief staring spell lasting a few seconds.

Brief loss of consciousness.

May occur up to 100 times a day if untreated.

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Atypical Absence

Clinical Manifestations: Staring spells.

Brief warnings.

Peculiar behavior during the seizure.Confusion after the seizure.

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PARTIAL SEIZURES: Begins in a specific region of thecortex.

Caused by focal irritations.

Unilateral manifestation arising from a localized area ofthe brain.

Exception:

Partial seizures may spread to involve the whole brainleading to a generalized tonic-clonic seizure.

A tonic-clonic seizure that is preceded by an aura orwarning is a partial seizure that generalizes secondarily.

Many tonic-clonic seizures sometimes appear to be

primarily generalized, but the partial component can bemissed.

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Subtypes

Simple Partial

Clinical Manifestations:

No loss of consciousness.

Usually last < 1 minute.May involve an alteration in motor, sensory, or

autonomic system.

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Complex Partial

Clinical Manifestations:

Usually in the temporal lobe.

Lasts > 1 minute.

Psychomotor sx: Lip-smacking, continuing an

activity before seizure began, or fumbling withobjects.

Psychosensory sx: vertigo, visual or auditory

sensations, altered thought processes

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Prodromal Phase:

Sign or activity which precedes a seizure.

Aural Phase:

Sensory warning.

Ictal Phase:

Full seizure.

Postictal Phase:

Period of recovery after the seizure.

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Children > 5 years:

Typical, generalized tonic-clonic seizure lasts