Pediatric Seizures (Nursing)

00:01 Hi. This is the lecture on Pediatric Seizures, the most common neurological disorder of childhood. We're going to start by reviewing some terms and concepts, go into the etiology of seizures, the pathophysiology, the classification, and the diagnosis and treatment of them. Let's start, as always, with the terms and concepts. A seizure is basically a burst of uncontrolled abnormal electrical activity in the brain and it basically causes the body to make movements that are unconscious or unintended. A single seizure is not typically considered epilepsy or treated with antiepileptic drugs to stop seizures. However, the most common definition of epilepsy is 2 or more unprovoked seizures more than 24 hours apart. Now, let's talk about the causes or etiology of seizures. Anything that causes some sort of insult or injury to the brain could possibly cause a seizure.

01:05 So, starting with intracranial lesions or bleeding, febrile seizures which we'll talk about more in a moment, infections could cause a diseased area of the brain, some genetic disorders, metabolic disorders, and some toxic ingestions. Alright, let's talk a little bit more about how seizures occur. Basically, when there is an area of the brain that's not working correctly or is diseased or injured, sometimes there's an abnormal electrical activity that occurs all of a sudden. It may be focal so basically limited to a certain area of the brain or it may be more generalized and occur in various parts of the brain or in a larger area. Alright, let's go over how seizures are classified. Seizures are classified based on where they originate in the brain which means whether they're focal, limited to one area, whether generalized or whether there's an unknown onset or area of the brain affected. How the person's level of consciousness is affected and what types of movement occur when they have a seizure. Some of the movements that occur when a child or an adult has a seizure are tonic, clonic, absence, and atonic or akinetic. We're going to go through each of these. Tonic movement is a stiffening. It sometimes happens by itself during a seizure or sometimes it happens in addition to clonic movements or shaking and jerking. Tonic clonic movements are present in generalized seizures and those are the most common seizures and the most recognizable. Absence seizures are when somebody's space is off, does not lose consciousness completely so they don't lose muscle tone and like drop to the ground but they seem very spacey and staring off into one area for a while and you usually can't get their attention. So these are the seizures that probably cause the least degree of mental status change most of the time. And some people will have a seizure and just lose muscle tone completely and drop to the ground, but not have any kind of dramatic movements. So, this is called atonic or akinetic. A means lack of or absence of. Alright, let's talk a little bit about pediatric versus adult seizures. In the infant, seizures can be very very subtle and easy to miss. In fact, some infants will have seizures at home for a good while before the caregivers realize that that's what's happening. They may not realize it at all and just bring the infant into the hospital to the emergency department because they're acting odd or they can't get them to feed. Children and adults present similarly when they have seizures. Those seizures are classified in the same way, the movements are pretty much the same. The basic rule of thumb as with most things in pediatric assessment that the younger the child especially the younger the infant, the more subtle signs and symptoms are including signs and symptoms of seizures. In the neonate and young infant especially, seizures no matter where they occur in the brain or where they originate from in the brain may cause limited movements that are seen as being seizure activity or possible seizure activity. A lot of times they're in the face. So they might be limited to eye deviation, so the eyes may kind of just keep going to one side over and over repeatedly and it kind of looks like they're doing it without intending to. Lip smacking is another common way they present with a seizure and sometimes they have nystagmus which is like a vibration of the eye that keeps going, it's kind of rhythmic vibration that repeats. If the infant is hospitalized or if the child is hospitalized and they're being monitored and you're watching their vital signs when they have a seizure, they'll usually spike their heart rate up. Their respiratory rate will usually also go up a little bit at least and their breathing pattern will be irregular. Infantile spasms are really scary types of seizures that are also difficult to identify. Basically they look like the infant is startling, so they usually throw their limbs back. It doesn't usually last very long, but sometimes it will repeat over and over. Some of that really needs to be caught and identified so it can be treated. So basically it's the most common epilepsy of infancy. Its peak onset is around 4-8 months and this makes it even tougher because they're likely to get startled by that age anyway by things like loud noises and that kind of thing. It's very poorly understood as far as what causes it and it usually leads to cognitive impairment especially if it's not caught because seizures, I mean even though temporary quick seizures can be benign and not cause any kind of damage. If they repeat and repeat and repeat, it can be hard on the brain and also cause things like irregular breathing, which can lead to further damage. Children deal with something special especially unique type of seizure called febrile seizures that can be really misunderstood quite often, so I'm going to give you a couple points that might be helpful. Basically, when a child has a febrile seizure, it means that their brain is just firing in a weird way real quickly in response to the fever and those specific thing that causes the febrile seizures is just a quick spike in the temperature. A lot of people think that it's the level of temperature, but it's really not. It has to do with how quickly it spikes. So, we may not even be able to control them honestly, but some children are just prone to this and usually the good news is they're not usually dangerous at all, they usually resolve very quickly on their own and then very few of these children go on to develop epilepsy, in fact less than about 5%.