Paeds Paces Stations

EJLA

PAEDS PACES STATIONS

Epilepsy and Funny Turns

Scenario…

A mother comes to see you having been referred by the GP. She mentions that she saw her child fall to the floor and “have a fit”. Please take a history from her and explain your findings and what she should do.

Points to ask in a “fit” history…

Age of child
Describe the event

How long did it occur for

Any other symptoms at the time of the event

Any triggering factors

Has it happened before

Any family history of epilepsy

Birth history esp about any birth trauma, hypoxic episodes

Differential Diagnosis

1)Febrile Convulsions

6 months – 6 years

Occurs early in viral infection when

Temperature rapidly rising

Lasts 1-2 mins with full recovery

Generalised seizure

Management

Reassure parents - no subsequent risk of epilepsy unless seizure lasts >30 mins or more than 1 seizure during the same illness

Suggest management if has fever again: remove clothes, tepid sponging, paracetamol. These are designed to lower temperature thus preventing the convulsion.

2)Epilepsy

Consider an epilepsy syndrome eg West, Lennox Gastaut

Most common is Benign Rolandic Epilepsy which

Often occurs during sleep

Ususally stops by mid-adolescence with no serious implications

Investigate if consider to be epilepsy with

EEG

CT/MRI if focal pathology suspected or resistant to treatment

Management

Valproate usually first line

EDUCATION (we should know this!!)

Advise parents about the dangers of swimming, climbing, cycling,

Need to inform school teachers so they know how to deal with an event

Other causes of seizures

3) Head trauma

4) Meningitis

5) Hypoglycaemia

Therefore, rule these out in the history!

Also consider the following “Funny Turn” events:

1)Breath Holding Attacks

Toddlers

Crying

Holds breath

Goes blue

Rapid recovery

Management: Advise parents not to confront child when getting angry, crying

2)Reflex Anoxic Seizures

Infants/toddlers

(Often positive FH)

Triggered by pain, discomfort from

Minor head trauma

Cold food

Fright

Fever

Child becomes pale

Falls to floor

May have a fit

Quick recovery

DD Febrile convulsions

The DD between Febrile Convulsion and Reflex Anoxic Seizure can be difficult but with a reflex anoxic seizure it may or may not be caused by a fever. In reflex anoxic seizure, pallor and falling to the ground precede the fit but in febrile convulsion, the rapid rise in temperature leads to the fit. Ie there is probably not a history of suddenly going pale and falling to the floor and then having the fit.

3)Syncope (in hot stuffy rooms and standing up for a long time)

4)Migraine can make children feel faint/funny

END