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SEIZURES

Dr Jonny Taitz, FRACP

Geschn Paediatrician

Sept 2003

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Introduction

Common

8% of children will have a seizure by

15 years of age

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Seizure

Sudden

Attack of altered behaviour

LOC

abnormal sensation, automaticfunction

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Most Common

Tonic (stiffening)

Clonic (jerking)

AbsenceMyoclonic

Atonic

Focal

MOST ARE BRIEF

TERMINATE SPONTANEOUSLY

50% in childhood = febrile convulsion

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Which seizures do we

treat?> 5 minutes brain hypoxiaStatus epilepticus

Generalised seizures > 30 minsOR

Repeated convulsions > 30 mins with NO

recovery & consciousness betweenconvulsions

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ComplicationsAge related > 3 yr - 6%

< 1 yr - 30%

- Long term epilepsy

- Motor problems

- Learning &behavioural problems

5% mortality (1/20)

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Guidelines aim JHH SHC

CHW

clear, succint guidelines inthe care of acute seizures

Many different anticonvulsants

Different routes of administration Intravenous Intramuscular Rectal

Oral

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ImportantSeizures < 15 minutes muchmore likely to respond to Rx

than seizures > 15 minutes

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History? Febrile illnessUnderlying CNS problems

History of epilepsyHead trauma

toxin ingestion

1assessment

ABC

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Specific features on examAirway intubationBreathing hypoventilation, aspiration,

O2, mask ventilation

Circulation shock, fluid bolusesNeurological focal signs, LOC, RIP, asymmetrical seizures

Underlying illness trauma, meningitis,head injury, metabolic

abnormalities

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Management

Priority no 1: ABC

Airway(Control seizures control airway)

Breathing Effective and efficient

All fitting kids high flow O2

NB: repeated seizures

high dose anticonvulsants

Circulation}

Resp

depression? Intubate +ventilate Circulation

Rx shock

Fluid Boluses

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Management (contd)

NEVER FORGET!!! GLUCOSE + BP

Hypoglycaemia Rx 5mls/kg 10% Dextrose

Hypertension Antihypertensives:

(I.e nifedipine, hydralazine)

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Questions to ask

Do I have vascular access?

What anticonvulsants areavailable?

How many minutes has the

child been fitting?

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Vascular AccessYes NoDiazepam 0.25mg/kg IVI Diazepam 0.25mg/kg PR

Or Midazolam 0.15mg/kg IVI Or Midazolam 0.15mg/kg IMI

5 Access

Repeat Diazepam IVIOr Midazolam IVI

No

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LOAD repeat

Phenytoin 20 mg/kg IVI Diazepam or Midazolamor Phenobarb 20mg/kg IVI

20

Rapid sequence induction Paraldehyde 0.4mg/kg PR

Thiopentone, Atropine, Dilute 50:50 (olive oil)

Suxemethonium

Supportivemeasures

ABC

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A little more on

anticonvulsantsDiazepam Effective first line in 80%

Rectal admin therapeutic levels 5minutes

Rapid seizure control (80%)

S/E 9% risk of respiratory depressionHigher in children with CNS abnormalities

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A little more on

anticonvulsantsMidazolam NSW Ambulance drug of first choice in

status epilepticus (IMI)

Will stop majority of seizures within 1minute (IVI)

Takes longer when used IM (approx 5-10 mins)

Intransal midazolamMore info required before recommending it

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Midazolam (contd)

Paraldehyde Used since 1930s

Very dangerous IVI Well tolerated rectally Rapid onset of seizure control Less respiratory depression than

Benzodiazepines Smells

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Questions