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Page 1: I. Neonatal Seizures

I. Neonatal SeizuresI. Neonatal Seizures

II. Conditions That II. Conditions That Mimic SeizuresMimic Seizures

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SeizureSeizure transienttransient andand reversiblereversible alteration of behavior alteration of behavior caused by a paroxysmal, abnormal and excessive caused by a paroxysmal, abnormal and excessive neuronal dischargeneuronal discharge attack ofattack of cerebralcerebral originorigin

sudden and transitory abnormal phenomenasudden and transitory abnormal phenomena motor, sensory, autonomic, or psychicmotor, sensory, autonomic, or psychic

transient dysfunction of part or all of the brain

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EpilepsyEpilepsyA A paroxysmalparoxysmal brain disorder of various etiologies brain disorder of various etiologies characterized bycharacterized by recurrent seizuresrecurrent seizures due todue to excessive electrical discharge of cerebral neuronsexcessive electrical discharge of cerebral neurons associated with a variety of clinical and laboratory associated with a variety of clinical and laboratory manifestationsmanifestations

two or more seizurestwo or more seizures not directly provokednot directly provoked by by intracranial infection, drug withdrawal, acute intracranial infection, drug withdrawal, acute metabolic changes or fevermetabolic changes or fever

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Neonatal SeizuresNeonatal Seizures• Tonic Seizures—focal or generalized, may mimic

decorticate or decerebrate posturing, primarily seen in preterms with intracranial hemorrhage & generally have poor prognosis

• Subtle seizures– Consist of chewing motion, excessive salivation and

alteration in respiratory rate including apnea, blinking, nystagmus, bicycling and pedaling movements, changes in color

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ClonicClonic- focal (repetitive movements localized to a - focal (repetitive movements localized to a single limb) or multifocal (random migration of single limb) or multifocal (random migration of movements from limb to limb), consciousness may movements from limb to limb), consciousness may be preserved, primarily seen in term infantsbe preserved, primarily seen in term infants

• Myoclonic- sudden flexor movements (lightning-like jerks), may be focal, multifocal or generalized, may occuring singly or in clusters, if due to early myoclonic encephalopathy it carries a poor prognosis. Brief focal or generalized jerks of the extremities or body that tend to involve distal muscle groups

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Why are seizure patterns in neonates more Why are seizure patterns in neonates more fragmentary than in older children? fragmentary than in older children?

• The cellular organization of the mature and immature brain is different. The neonatal brain has incomplete glial proliferation, w/ continuing migration of neurons, establishing complex axonal & dendritic contacts and myelin deposition.

The electrical discharges therefore spread incompletely and may remain localized to one hemisphere. The electrical discharges are slow to diffuse and bilateral synchronous discharges are rare.

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Neonatal SeizuresNeonatal SeizuresEEG ClassificationEEG Classification

• Clinical seizure with consistent EEG event– Clinical seizure occurs in relationship to seizure

activity– Includes focal clonic, focal tonic and myoclonic– Responds to antiepileptic drugs

• Clinical seizure with inconsistent EEG event– Clinical seizures with no EEG abnormality– Seen in all generalized tonic and subtle seizures– Seen in patients who are comatose, HIE

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Neonatal SeizuresNeonatal SeizuresEEG ClassificationEEG Classification

• Electrical seizures with absent clinical seizures– Electrical seizures associated with markedly

abnormal background EEG– Seen in comatose patients

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Epileptic vs Non-epileptic Epileptic vs Non-epileptic Neonatal PhenomenaNeonatal Phenomena

Clinical Characteristics

Epileptic Non-epileptic

Increases with Sensorystimulation

Rare Common

Suppresses with restraint

- +Autonomic Accompaniments

+ -

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Major Causes of Neonatal Seizures In Relation to Time of Major Causes of Neonatal Seizures In Relation to Time of Seizure Onset and Relative FrequencySeizure Onset and Relative Frequency TIME OF ONSETTIME OF ONSET* * RELATIVE FREQUENCYRELATIVE FREQUENCYCause 0-3 Days >3 Days Premature Cause 0-3 Days >3 Days Premature Full Term Full TermHypoxic-Ischemic encephalopathyHypoxic-Ischemic encephalopathy + +++ ++++ +++ +++Intracranial hemorrhage + + ++ +Intracranial hemorrhage + + ++ +Intracranial infection + + ++ ++Intracranial infection + + ++ ++Developmental defects + + ++ ++Developmental defects + + ++ ++Hypoglycemia + + +Hypoglycemia + + +Hypocalcemia + + + Hypocalcemia + + + Other metabolic + + Other metabolic + + Epileptic syndromesEpileptic syndromes + + + + + +

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Neonatal SeizuresNeonatal SeizuresEtiologic diagnosisEtiologic diagnosis

• Hypoxic –ischemic encephalopathy• Metabolic• Infections• Trauma• Structural abnormalities• Hemorrhagic and embolic strokes• Maternal disturbances

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Causes of neonatal seizuresCauses of neonatal seizuresAges 1 – 4 daysAges 1 – 4 days

• HIE• Drug withdrawal• Dug toxicity

– Lidocaine, penicillin• Intraventricular hemorrhage• Acute metabolic disorder

– Hypocalcemia– Hypoglycemia– Inborn errors of metabolism

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Causes of neonatal seizuresCauses of neonatal seizuresAges 4 – 14 daysAges 4 – 14 days

• Infection• Metabolic disorders

– Hypocalcemia– Diet– Hypoglycemia– Inherited disorder of

metabolism such as galactosemia,fructosemia

– Hyperinsulinemic hypoglycemia

– Becwith syndrome– Anterior pituitary hypoplasia

• Drug withdrawal• Benign neonatal

convulsion• Kernicterus,

hyperbilirubenemia

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Causes of neonatal seizuresCauses of neonatal seizuresAges 2 – 8 weeksAges 2 – 8 weeks

• Infection• Head injury

– Subdural henatoma• Inherited disorder of

metabolism– Aminoacidurias– Urea cycle defects– Organic acidurias– Neonatal ALD

• Malformations of cortical development– Lissencephaly– Focal cortical

dysplasia– Tuberous sclerosis– Sturge weber

syndrome

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Neonatal SeizuresNeonatal SeizuresEtiologic diagnosisEtiologic diagnosis

• Blood– Glucose, calcium, magnesium, electrolytes, BUN– In hypomagnesemia MgSO4 0.2 ml/kg

• Lumbar puncture– Indicated in all neonates with seizures unless related

to a metabolic disorder• Inborn errors of metabolism

– Inherited as autosomal recessive or X-linked recessive

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Neonatal SeizuresNeonatal SeizuresEtiologic diagnosisEtiologic diagnosis

• Inborn errors of metabolism– Serum ammonia urea cycle abnormalities– Acidosis + anion gap + hyperammonemia

urine organic acids should be determined• Unintentional injection of local anesthetic

– Supportive measures– Promotion of urine output with IV fluids

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Idiopathic Syndromes of Clinical Idiopathic Syndromes of Clinical Seizures in the NewbornSeizures in the NewbornEpileptic Syndromes Epileptic Syndromes Benign familial Neonatal SeizuresBenign familial Neonatal SeizuresBenign idiopathic neonatal seizures (fifth-day fits)Benign idiopathic neonatal seizures (fifth-day fits)Early myoclonic encephalopathy Early myoclonic encephalopathy Early infantile epileptic encephalopathy (Ohtahara Early infantile epileptic encephalopathy (Ohtahara syndrome)syndrome)Malignant migrating partial seizuresMalignant migrating partial seizuresNonepileptic SyndromesNonepileptic SyndromesBenign neonatal sleep myoclonusBenign neonatal sleep myoclonusHyperekplexiaHyperekplexia

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Neonatal SeizuresNeonatal Seizures(Epileptic Syndromes)(Epileptic Syndromes)

• Benign familial neonatal seizures– Begins on the 2nd – 3rd day of life– Seizure frequency : 10 – 20 /day– Patients are normal between seizures– Seizure stops in 1 – 6 months

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Neonatal SeizuresNeonatal Seizures

Fifth-day fits – • 5th day of life• normal appearing neonates with mulifocal

seizures• Present for less than 24 hours• Good prognosis

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Neonatal SeizuresNeonatal SeizuresEtiologic diagnosisEtiologic diagnosis

• Pyridoxine dependency– resistant to conventional AED’s– Inherited as autosomal recessive– Tx: Pyridoxine 100 – 200 mg IV– May not have a dramatic effect with IV

pyridoxine thus maintain on oral pyridoxine 10 -20 mg/day x 6 weeks

– Lifelong supplementation : 10 mg/day

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Neonatal SeizuresNeonatal SeizuresEtiologic diagnosisEtiologic diagnosis

• Drug withdrawal seizures– Barbiturates, benzodiazepenes, heroin and

methadone– Jittery, irritable, lethargic, may show

myoclonus or frank seizures– Serum or urine analysis may identify the

responsible agent

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Prognosis of Neonatal Seizures:Prognosis of Neonatal Seizures:Relation to Neurological DiseasesRelation to Neurological DiseasesNeurological Disease* Normal Neurological Disease* Normal DevelopmentDevelopmentHypoxic-ischemic encephalopathy 50%Hypoxic-ischemic encephalopathy 50%Intraventricular hemorrhage 10%Intraventricular hemorrhage 10%Primary subarachnoid hemorrhage 90%Primary subarachnoid hemorrhage 90%Hypocalcemia Hypocalcemia Early-onset 50%Early-onset 50% Later-onset 100%Later-onset 100%Hypoglycemia 50%Hypoglycemia 50%Bacterial meningitis 50%Bacterial meningitis 50%Developmental defect 0%Developmental defect 0%

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Why should the infant with epileptic Why should the infant with epileptic seizures be treated with AEDseizures be treated with AED

Potential adverse effects of seizure on:• Ventilatory function • Circulation• Cerebral Metabolism • Brain Development disturbance in cerebral blood flow energy metabolism homeostasis of excitotoxic amino acids

neurogenesis and synaptic reorganization

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Acute Therapy of Neonatal SeizuresAcute Therapy of Neonatal Seizures

With Hypoglycemia --With Hypoglycemia --Glucose, 10% solution: 2 mL/kg, IVGlucose, 10% solution: 2 mL/kg, IVNo Hypoglycemia No Hypoglycemia Phenobarbital:Phenobarbital: 20 mg/kg, IV (1-2 mg/kg/min) 20 mg/kg, IV (1-2 mg/kg/min)If necessary: If necessary: Additional Additional phenobarbitalphenobarbital: : 5 mg/kg IV to a max. of 40 mg/kg5 mg/kg IV to a max. of 40 mg/kg

(consider omission of this additional phenobarbital (consider omission of this additional phenobarbital if infant is severely “asphyxiated”)if infant is severely “asphyxiated”) Phenytoin*:Phenytoin*: 20 mg/kg, IV (0.5-1.0 mg/kg/min) 20 mg/kg, IV (0.5-1.0 mg/kg/min) (Lorazepam: 0.05-0.10 mg/kg, IV) if available(Lorazepam: 0.05-0.10 mg/kg, IV) if available Midazolam: 0.2 mg/kg, IV;then,0.1-0.4 mg/kg/hr, IVMidazolam: 0.2 mg/kg, IV;then,0.1-0.4 mg/kg/hr, IV

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Acute Therapy of Neonatal SeizuresAcute Therapy of Neonatal Seizures

Other (as Indicated)Other (as Indicated)Calcium gluconate, 5% solution: 4 mL/kg, IVCalcium gluconate, 5% solution: 4 mL/kg, IVMagnesium sulfate, 50% solution: 0.2 mL/kg, IMMagnesium sulfate, 50% solution: 0.2 mL/kg, IMPyridoxine: 50-100 mg, IV; repeat to maximum of 500 mg if Pyridoxine: 50-100 mg, IV; repeat to maximum of 500 mg if neededneededPyridoxal-5-phosphate,30 mg/kg/day, POPyridoxal-5-phosphate,30 mg/kg/day, POFolinic Acid, 4 mg/kg/day, POFolinic Acid, 4 mg/kg/day, PO

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Volpe, Neurology of the Newborn, 5th ed. 2008

Maintenance Therapy of Neonatal SeizuresMaintenance Therapy of Neonatal SeizuresGlucose: Glucose: << 8 mg/kg/, IV 8 mg/kg/, IVPhenobarbital: 3-4 mg/kg/24 hr, IV, IM, or POPhenobarbital: 3-4 mg/kg/24 hr, IV, IM, or POPhenytoin (as fosphenytoin): 3-4 mg/kg/24 hr, IVPhenytoin (as fosphenytoin): 3-4 mg/kg/24 hr, IVCalcium gluconate: 500 mg/kg/24 hr, PO Calcium gluconate: 500 mg/kg/24 hr, PO Magnesium sulfate (50%): 0.2 mL/kg/24 hr, IMMagnesium sulfate (50%): 0.2 mL/kg/24 hr, IM

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Clinical Scenario 1Clinical Scenario 1

F.M. a 36-37 month old baby boy is noted to have blinking of the eyelids with sucking movements of the mouth at 30 hours of life. The extremities are jittery when tactile stimuli is applied.

Maternal history is unremarkable, NSD, G1P1 (1-0-0-1) no hypertension, no infection. Birth weight is 2.5kg. Apgar 8 and 10 at 1 and 5min.

The blinking of the eyes and jittery movements of the extremities recur within the next hour.

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What is your impression?What work-ups will you request?Hgt, CBC, Serum Calcium, Electrolytes

What will be your management?Na Luminal 20mg/g IV at 1mg/Kg/min

infusion, maintain at 3.5 mg/g/day.

Clinical Scenario 1Clinical Scenario 1

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Management of Neonatal SeizuresManagement of Neonatal Seizures• Na Luminal 20 mg/kg/day IV bolus• Rate of infusion—1 mg/kg/min• Example: Wt is 3 kg, 3 x 20 = 60 mg• Give 60 mg for 20 mins. IV push• Maintenance dose of Na luminal—5mg/kg/day• Example: 3 x 5 = 15 mg• Give 7.5 mg IV q12 hrs

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Duration of Anticonvulsant Therapy GuidelinesDuration of Anticonvulsant Therapy GuidelinesNeonatal PeriodNeonatal PeriodIf neonatal neurological examination becomes normal, discontinue If neonatal neurological examination becomes normal, discontinue therapytherapyIf neonatal neurological examination is persistently abnormal, consider the If neonatal neurological examination is persistently abnormal, consider the cause and obtain an EEG.cause and obtain an EEG.In most such cases:In most such cases: Continue phenobarbital Continue phenobarbital Discontinue phenytoinDiscontinue phenytoin Reevaluate in 1 month Reevaluate in 1 month At 1 Month After DischargeAt 1 Month After DischargeIf neurological examination has become normal, discontinue If neurological examination has become normal, discontinue phenobarbitalphenobarbitalIf neurological examination is persistently abnormal, obtain an EEG.If neurological examination is persistently abnormal, obtain an EEG.If no seizure activity is noted on the EEG, discontinue phenobarbitaIf no seizure activity is noted on the EEG, discontinue phenobarbita Volpe, Neurology of the Newborn, 5Volpe, Neurology of the Newborn, 5thth ed. 2008 ed. 2008

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Conditions that Mimic SeizuresConditions that Mimic Seizures• Night terrors

– Common in boys– 5 – 7 years of age– Sudden onset between midnight and 2:00 am

during stage 3 or 4 of sleep or slow-wave sleep– Child screams and appears frightened, dilated

pupils, tachycardia and hyperventilation– Child thrash violently can not be consoled ,

unaware of parents or surroundings

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Conditions that Mimic Conditions that Mimic SeizuresSeizures• Night terrors

– 1/3 will have somnambulism– Emotional disorder should be explored in

patient with prolonged and persistent night terrors

– Short course diazepam maybe considered while the family dynamics is investigated

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Conditions that Mimic SeizuresConditions that Mimic Seizures• Breath holding spells

– Cyanotic spells• Provoked by upsetting or scolding an infant• Brief shrill cry followed by forced expiration and apnea• Rapid onset of generalized cyanosis or loss of consciousness

may be associated with repeated generalized tonic jerks, opisthotonos, bradycardia

• EEG: normal• Rare before 6 months, peak about 2 years & abate by 5 years old• TX: parent counseling

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Conditions that Mimic Conditions that Mimic SeizuresSeizures

• Breath holding spells– Pallid spells

• Initiated by painful experience• Child stops breathing loss of consciousness pale

and hypotonic tonic seizures• Bradycardia with asystole for 2 seconds may be recorded• EEG: normal• TX supportive but may give atrophine sulfate at 0.01

mg/kg/24 hr in divided doses with a maximum dose of 0.4 mg

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Conditions that Mimic SeizuresConditions that Mimic Seizures• Syncope

– Simple syncope• Decreased blood flow loss of consciousness

ischemia influences the higher cortical centers to release inhibiting influence on reticular formation within the brainstem brief tonic contractions of muscles

• Results from vasovagal stimulation precipitated by pain, fear, excitement , prolonged standing particularly in a warm environment

• Age : 10 -12 years old, females

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Conditions that Mimic Conditions that Mimic SeizuresSeizures

• Syncope– Simple syncope

• Tilt test – effective in producing symptoms including hypotension

• Tx: oral B adrenergic blocking agents

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Conditions that Mimic SeizuresConditions that Mimic Seizures• Syncope

– Cough syncope• Most common in asthmatic children• Occurs shortly after sleep and coughing paroxysm awakens

the child• Patients face become plethoric, perspires, agitated,

frightened• Loss of consciousness with generalized muscle flaccidity,

vertical upward gaze and clonic muscle contraction lasting for several minutes

• Urinary incontinence is frequent

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Conditions that Mimic Conditions that Mimic SeizuresSeizures

• Syncope– Cough syncope

• Cough causes an increased intrapleural pressure decreased venous return to the right side of the heart decreased right ventricular output reduction of left ventricular filling rapidly diminished cerebral blood flow cerebral hypoxia loss of consciousness

• Tx: Prevention of bronchoconstriction

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Conditions that Mimic SeizuresConditions that Mimic Seizures• Syncope

– Prolonged QT syndrome• Sudden loss of consciousness during exercise or emotional and

stressful experience• Onset late childhood or adolescence• With cardiac arrhythmias such as ventricular fibrillation• ECG: abnormal lengthening of the QT interval (corrected QT of

0.46 or more)• May be associated with acquired heart disease (myocarditis,

mitral valve prolapse, electrolyte abnormalities, drug induced) or congenital forms

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Conditions that Mimic SeizuresConditions that Mimic Seizures• Syncope

– Prolonged QT syndrome• Autosomal recessive trait (Jervell and Lange-

Nielsen syndrome) associated with deafness• Autosomal dominant (Romano-Ward syndrome)

mutations in cardiac potassium channel gene linked to chromosome 11p15.5 LQT1

• LQT2 results from mutation to second potassium channel gene linked to chromosome 7q35-36

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Conditions that Mimic SeizuresConditions that Mimic Seizures• Syncope

– Prolonged QT syndrome• LQT3 result in mutation in cardiac sodium channel linked to

3p21-24• LQT4 linked to chromosome 4q25-27• Testing include supervised exercise test or Holter

monitoring• Tx: B adrenergic antagonist drugs Permanent implantable cardiac pacing or left

thoracic sympathectomy may be considered if drug is not effective Parents shoudls be taught CPR

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Conditions that Mimic SeizuresConditions that Mimic Seizures• Paroxysmal Kinesigenic Choeoathetosis

– Sudden onset of unilateral or occasional bilateral choreoathetosis or dystonic posturing of a leg, arm and facial grimacing and dysarthia

– Precipitated by sudden movements, excitement or stress

– Rare last for more than 1 minute– Onset between 8 – 14 years– Attacks may be daily or intermittent

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Conditions that Mimic Conditions that Mimic SeizuresSeizures

• Paroxysmal Kinesigenic Choeoathetosis– NE, MRI and EEG – normal– Autosomal recessive inheritance is suggested– Tx: Phenytoin

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Conditions that Mimic Conditions that Mimic SeizuresSeizures

• Shuddering attacks– Onset at 4 – 6 months of age– Sudden flexion of the head and trunk and

shuddering or shivering movements– May be a precursor to benign essential

tremors

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Conditions that Mimic Conditions that Mimic SeizuresSeizures

• Benign Paroxysmal torticollis of infancy– Recurrent attacks of head tilt with pallor,

agitation and vomiting– Onset : 2 – 8 months– Spontaneous remission at 2 – 3 years of age– Abnormalities in vestibular function– Some patients develop migraine in childhood

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Conditions that Mimic SeizuresConditions that Mimic Seizures• Hereditary Chin trembling

– Repeated episodes of rapid 3/sec chin trembling movements

– Precipitated by stress, anger, frustration– Autosomal dominant– NE and EEG - normal

• Narcolepsy and cataplexy– Narcolepsy begins before adolescence– Attacks of irrepressible daytime sleep with transient

loss of muscle tone (cataplexy)

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Conditions that Mimic Conditions that Mimic SeizuresSeizures

• Narcolepsy and cataplexy– EEG shows recurrent sleep attacks consist of

REM sleep– Patients are easily aroused– Tx for narcolepsy Modafinil acetamide 200

mg/day

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Conditions that Mimic Conditions that Mimic SeizuresSeizures

• Cataplexy– sudden loss of muscle tone and fall to the

floor precipitated by laughter, stress or frightening experience

– Tx: scheduled naps, amphetamines, methyphenidate, tricyclic antidepressant and counselling regarding occupational safety

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Conditions that Mimic Conditions that Mimic SeizuresSeizures

• Rage attacks or episodic dyscontrol syndrome– Sudden and recurrent episodes of violent

behavior with minimal provocation– Seem to be psychotic at the time of the attack– EEG: normal

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Conditions that Mimic SeizuresConditions that Mimic Seizures• Pseudoseizures

– Occurs typically between 10 – 18 years old– Lack of cyanosis, normal reaction of pupils to light,

no loss of sphincter tone– Normal plantar response– Absence of tongue biting– Can be persuade to have an attack by the

physician– EEG-excessive muscle artifact

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Febrile SeizuresFebrile Seizures 3 mo – 6 yrs (peak age of onset 14 – 18

mo) Normal Neurological Exam & development

Mapped to Chromosomes 19p and 8q13-21 in some families- Autosomal Dominant patternIncidence Rate: 3-4% of young children

Occurs with fever (not due to CNS Infection) Most commonly due to viral URTI, otitis media, Roseola, UTINormal EEG

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Simple Febrile SeizuresSimple Febrile Seizures• Seizures are Generalized• Lasts a few seconds, not more than 15 min• Occurs only once in 24 hours

Complex Febrile Seizures• Seizures are focal• Lasts more than 15 min• More than 2 seizures on the first day, (recurrent)

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Factors associated with increased risk of Factors associated with increased risk of recurrencerecurrence

• Age less than 12 mo• A positive family history of febrile seizures• Complex features• Lower temperature before seizure onset• Febrile seizures are not associated with

decreased intellectual performance.

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Factors associated with an increased risk of Factors associated with an increased risk of developing Epilepsy In Children with FSdeveloping Epilepsy In Children with FS

• Complex type of FS – focal seizures / post ictal neurological sx

• Positive family history of Epilepsy• Onset of FS below 12 years • Delayed milestones / Pre Existing Neurologic

Disorder

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Management Of Febrile SeizuresManagement Of Febrile Seizures• In an actively convulsing patient:

1. Do not put anything in the mouth2. Time the event3. Don’t restrain the patient4. Don’t give anything to drink to the patient 5. Turn the patient to the side to prevent

choking6. Put something under the patient’s head to

prevent injury

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ManagementManagement of Febrile Seizures of Febrile Seizures

• In a convulsing patient with seizures lasting more than 5 min or with recurrent seizures

Diazepam 0.2- 0.4mg per kg IV

– In a patient with just a history of febrile seizure

– No maintenance anticonvulsant is recommended

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Management of Febrile SeizuresManagement of Febrile Seizures

• Careful evaluation of the patient to look for the cause of the fever• Antipyretics to lessen discomfort (Have not been

shown to lessen the recurrence of febrile seizures)• Reassurance and Education of the Parents

• Advise the parents regarding the use of oral diazepam at the onset of febrile illness

• Oral Diazepam 0.3 mg/kg every 8 hours on the first day of illness

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Use of Maintenance AnticonvulsantsUse of Maintenance Anticonvulsants

2 AEDs can prevent the recurrence of febrile seizures:

Phenobarbital and ValproateHowever routine use as maintenance anticonvulsants are not recommended for Simple Febrile SeizuresPhenobarbital-decreases cognitive function in treated children Valproate – May cause hepatotoxicity in children <2yrs old

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Use Of AED’S as prophylaxis in Preventing Use Of AED’S as prophylaxis in Preventing Recurrence of Febrile SeizuresRecurrence of Febrile Seizures

• The potential side effects and risks using Phenobarbital and Valproate do not justify its use in a disorder with an excellent prognosis regardless of treatment

(SIMPLE FEBRILE SEIZURES)

• Carbamazepine and Phenytoin do not prevent febrile seizures

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Clinical Practice Guidelines on the First Clinical Practice Guidelines on the First Simple Febrile SeizureSimple Febrile Seizure

1. Lumbar Puncture should be performed in all children below 18 months for a first simple febrile seizure

2. Neuroimaging studies should not be routinely performed In children for a Simple First FS

3. Antipyretic Drugs are used to lower fever and should not be relied upon to prevent the occurrence of FS

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Summary of Recommendations First FSSummary of Recommendations First FS4. The use of continuous anticonvulsants are not

recommended in children after a FIRST SIMPLE FEBRILE SEIZURE .Although anticonvulsants can reduce the recurrence of febrile seizures, the adverse side effects of these do not warrant their use in this disorder.

5. The use of intermittent anticonvulsants are not recommended for the prevention of febrile seizures.

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Clinical Practice Guidelines (Con,t)Clinical Practice Guidelines (Con,t)

6. Electroencephalogram should not be routinely requested in children with a first simple febrile seizure.

Child Neurology Society Philippines and Philippine Pediatric Society, 2000