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