Seizures in Children: Introduction

by Brian Alverson, MD

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    00:01 In this lecture we are going to discuss seizures What are seizures? Seizures are uncontrolled firing of nerves in the brain.

    00:11 If involing both cerebral hemispheres, seizures are generalized.

    00:16 it's the whole body.

    00:17 If it is involing one hemisphere or one area, it may be focal involving one extremity or one simple area of the body.

    00:25 In young infants, seizures maybe vey subtle and my look very different than in older folks.

    00:31 They can just be little jittery movements and sometimes they are missed by doctors and parents alike.

    00:38 Let's talk first about Status Epilepticus.

    00:42 Status epilepticus is a seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes.

    00:54 It can be convulsive or nonconvulsive with few symptoms and usually focal.

    01:04 So, seizures in general affect about 1 percent of the population but Febrile seizures, which we will get ino the end of this talk affect a much larger part of the population; 4-10 percent of children.

    01:17 and 15 percent of the children who have a first seizure have another within the next year.

    01:23 So, recurrence actually isn't that common, at least not right away.

    01:28 Many children have one seizure and never have another one and we never know why it happened.

    01:34 Seizures are different depending on where they are on the brain.

    01:38 A frontal lobe seizure may result in bizarre behavior.

    01:42 A temporal lobe seizure may result in depression or mood affect changes.

    01:49 But a generalized seizure is what we expect to see with motor movements predominantly appearing.

    01:55 Alteration of vital signs and respiratory suppression are absolutely possible during seizures.

    02:00 And after seizures, they may be a period of sleepiness. postictal period.

    02:05 This is especially true for generalized seizures.

    02:09 Also after seizures, patient may develop a paralysis transly of one side of the body even if it's a generalized seizure and that's called Todd's paralysis.

    02:20 patients feel that they report they feel absolutely lousy after a seizure.

    02:25 so we know seizures are no fun to have and would like to prevent them.

    02:31 the types of seizures can be categorized in many different ways.

    02:34 Tonic-clonic seizures are the ones which you classically see on television.

    02:39 an initial atonic phase of stiffening and then a clonic phase of shaking.

    02:44 Patients usually fall down the may have loss of lower bladder or bowel function and then may be very sleepy afterwards.

    02:52 or have Todd's paralysis they may just have a tonic phase in their seizure or they may just have a clonic phase in their seizures.

    03:01 myotonic jerks are unique type of seizure that happens in children.

    03:05 They will happen up to say 100 times a day.

    03:08 and it will be a sudden jerking spasm of one arm or one extremity.

    03:13 Atonic-akinetic seizures are literally a drop spell, where there is a complete loss of tone and patients will collapse to the floor.

    03:22 and absence seizures are unique and the children will what we call space out.

    03:28 there will be a complete lack of awareness of the world and they will pop right back in again without any postictal phase.

    03:36 It may be so subtle that children don't even know they're doing it but are simply confused in the classroom because for them the teacher is jumping forward in time.

    03:46 if you detect a seizure in a child, especially a tonic-clonic seizure we have to be concerned that there may be other causes to the seizure infectious causes are innumerable and include brain abscesses, encephalitis again they might just have a febrile seizure meningitis, Neurocystercercosis is an unusual cause from eating raw beef tuberculosis may cause calcified lesions in the brain that cause seizure, toxoplasma, same thing and HIV can cause an encephalitis that can cause seizures.

    04:19 the birth injuries can result in damage to the brain that can cause seizures congenital anomalies the brain such as polymicrogyria can cause seizures.

    04:30 degenerative cerebral disease hypoxic ischemic encephalopathy tuberous sclerosis of the brain these tumors can cause seizures neurofibromatosis can cause seizures patients who have shunts to drain excessive fluid may have misfunction of that drainage patients may get acute hydrocephalus and may present the seizure and hydrocephalus untreated can certainly present with seizure.

    04:59 many metabolic conditions that can present procedures such as hypercarbia and then the hypos hypocalcemia hypoglycemia hyponatremia and hypomagnesemia.

    05:12 think of the hypos, calcium glucose sodium and magnesium.

    05:17 inborn errors of metabolism may leave children prone to seizures especially some of the metabolic disorders that are mitochondrial in nature like mirth.

    05:27 or MELAS syndrome paradoxine deficiency can also cause seizures and sometimes a dose of vitamin B6 is the cure, especially with newborns.

    05:39 in traumatic or vascular disease patients can get seizures from cerebral contusions child-abuse, trauma or any cause of intracranial hemorrhage.

    05:50 toxins can also cause seizures.

    05:52 Drugs of abuse such as cocaine and methamphetamine cause vasoconstriction which can cause ischemia of the brain and seizure.

    06:01 Lead poisoning can do it in severe cases as can rarely organophosphates salicylates, sympathomimetics tricyclic antidepressants, or withdrawal from drugs of abuse.

    06:13 Those can all cause seizures and then once we've gone through all these causes including oncologic causes could it be a tumor or obstetric causes. Is the patient have a baby inside them? and now they have a problem with their liver.

    06:31 and are getting seizures of results like preeclampsia.

    06:34 and then after we ruled out all these other causes we're left with epilepsy.

    06:40 So, epilepsy is really a diagnosis of exclusion after you've ruled out all these other potential causes.

    06:48 also keep in mind there are things that children do that look a lot like seizures but it breath holding spells can be truly remarkable.

    06:58 These start around six months of age and go from to go for several years they usually happen when a child is upset or displeased or terrified.

    07:08 they just hold their breath and they can hold their breath until they turn blue and literally pass out unconscious.

    07:15 children tend to eventually outgrow this they have no long-term sequelae at all.

    07:19 but there's a lot of counseling needed for the families syncope can look like a seizure.

    07:26 panic attacks are often mistaken as seizures.

    07:28 especially since when patients breathe very quickly they get a respiratory alkalosis and that can cause a carpal pedal spasm of the hands if you see a patient looks scared and has clenching of the fist but almost always a panic attack and all that's required is calm.

    07:46 Tic disorders may look like a focal seizure.

    07:50 Keep in mind, tics can be fairly complex.

    07:53 We have another talk about Tics later Benign myoclonus is common in babies and parents may bring up videos of their child doing shaking movements that they are concerned might be a seizure.

    08:05 Remember it's common for babies to have an exaggerated startle reflex when their arms come out and they shake And commonly these children will have brief shaking episodes or twitches of the arms and legs as they're falling asleep.

    08:20 People, adults do that to.

    08:23 Dystonic reaction is a unusual side effect to certain medications.

    08:29 for example Reglan or some medicines for nausea The dystonic reaction is a sudden spasm of the muscles that is relieved by IV Benadryl.

    08:40 It really is not a seizure.

    08:43 Patients may fake seizures in outright desire to get more attention or they maybe so stressed out that their body is seizing even though they're not actually having true seizures.

    08:57 We call these pseudo seizures and their very common in adolescents.

    09:02 likewise night terrors, sleepwalking, narcolepsy all of these things can be mistaken for seizures.

    About the Lecture

    The lecture Seizures in Children: Introduction by Brian Alverson, MD is from the course Pediatric Neurology. It contains the following chapters:

    • Introduction to Seizures
    • Pathology of Status Epilepticus
    • Rule out Metabolic Cause
    • Things that Look Like Seizures but Aren't

    Included Quiz Questions

    1. Myoclonic jerks
    2. Tonic seizure
    3. Tonic-clonic seizure
    4. Atonic-akinetic seizure
    5. Absence seizure
    1. A seizure is considered focal if it involves both cerebral hemispheres.
    2. Seizures manifest with subtle symptoms in young infants.
    3. Seizures result from the uncontrolled firing of neurons in the brain.
    4. Status epilepticus can be convulsive or non-convulsive.
    5. Febrile seizures are more common than epileptic seizures in children.
    1. Vitamin B6
    2. Vitamin B1
    3. Vitamin B12
    4. Vitamin C
    5. Vitamin A
    1. Status epilepticus: frequent, recurrent, or prolonged seizure with preserved consciousness.
    2. Tonic-clonic seizure: initial "stiffening" phase followed by a "shaking" phase
    3. Myoclonic jerks: multiple jerking spasms of one extremity
    4. Atonic-akinetic: drop spell with complete loss of tone
    5. Absence: complete spacing out without a postictal phase
    1. Dystonic reaction
    2. Syncope
    3. Pseudoseizures
    4. Tics
    5. Panic attacks

    Author of lecture Seizures in Children: Introduction

     Brian Alverson, MD

    Brian Alverson, MD

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    Very good lecture
    By Jalil Z. on 23. July 2020 for Seizures in Children: Introduction

    It's the first time I hear that epilepsy is an exclusion diagnosis but it makes sense. It's better clinical reasoning in this way.