Pediatric Seizures

GC
Focal
Myoclonic
Neonatal < 30d
Lorazepam (1st)
Fosphenytoin
Lorazepam (1st)
Fosphenytoin
Lorazepam (1st)
Fosphenytoin
Phenobarbital
Fosphenytoin
EEG, EKG, CMP
——->
———>
———>
Admit for 24h
——->
——–>
——–>
Lorazepam peds dose 0.1 mg/kg q 5 mins (other options PR and intranasal midazolam (same as IV solution))
Fosphenytoin 20 phenytoin equiv / kg
FEBRILE SEIZURES (THE 5 Fs):
– fever
– non-focal
– < 15 mins
– 5 mos to 5 years age
– family history (+) often
– first seizure of life
– < 1 seizure in 24 hours
Diagnostic Criteria for Febrile Seizures:
– T > 38
– 3 mos to 6 years (or 5 mos to 5 yrs, as above)
– no metabolic derangements
– no prior hx of febrile seizures
Simple vs Complex Febrile Seizures:
– Simple – generalized tonic/clonic, self-limited, < 15 mins, no recurrence in 24h
        – 1/3 recur, otherwise benign
        – Only slightly increases baseline risk of a seizure disorder
– Complex – focal, prolonged or several in 24h, heterogeneous group of seizures clinically; these DO increase the risk of developing a seizure disorder
More common with HHV-6, roseola, sixth disease and influenza.  Can also see after vaccinations.
Max HEIGHT of fever determines risk of febrile seizure, not rate of rise.
DDx:  rigors (shaking chills),
Evaluation:
– thorough neuro exam – must be non-focal!
– if more complex or focal neuro exam:  MRI, EEG, consider LP (with meningeal signs or symptoms consistent with CNS infx, infant 6-12 mos without/unknown immunization status, or if presenting with seizures after day 2 of illness).
Absence Seizures:
  • Keppra does not work.
  • Depakote or ethosuxamide are the medications of choice.
  • Include absence seizures in your DDx of poor school performance and ADHD!
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