PAEDIARTIC SEIZURES

Dr. Mohammed Yaser Jouhara

mohammedjouhra297@gmail.com
 CASE PRAESENTATION
R
ahaf, a 3-year-old female, was transferred to the hospital from a clinic with
complaints of fever and bilateral, convulsive muscle contractions, which lasted
for 15 minutes.

The patient had a temperature of 40 degrees since one day. When seeing the
outside provider, he prescribed “Ceftriaxone (Na)1000mg+ Sulbactam (Na) 500
mg” IM injections. After one injection, she started convulsing. Her parents took her
to the clinic where the doctor gave her “FAUSTAN (Diazepam 5 - 10 mg) and
DICLON”, then send her to the hospital.

When admitting to hospital, the seizure had already resolved, and the accepting
doctor conducted the first aid procedures.
 CASE PRAESENTATION
Presenting Complaint
convulsive seizure

Before the seizure:

Fever
No aura

During the seizure:

● Loss of consciousness.

● Bilateral Limb jerking (tonic-clonic type).

● Cyanosis.

● Salvation.

● No tongue-biting.

● No urinary incontinence.

After the seizure:

The patient felt tired
 CASE PRAESENTATION
Past medical history
▪ No maternal obstetric problems.
▪ Full term.
▪ Vaginal delivery.
▪ Birth weight: unknown.
▪ Didn’t admit to special care baby unit.
▪ Maternal feeding till 6th month.
▪ Left eye atrophy (unknown pathology).
▪ No operations.
▪ No trauma
Medication Past family history
▪ No medication. ▪ No similar problems
▪ No allergies.
 CASE PRAESENTATION
Initial observations
Severity of illness: Temperature: 38.5
moderate HR: 120
RR: 25
growth: normal
● Weight: 13 kg

● Height: 92 cm

General appearance
No congenital abnormalities No purpuric rash
No cyanosis No clubbing
No jaundice Left eye atrophy
No dehydration No other findings
Pallor: +
 CASE PRAESENTATION
Respiratory system
RR: 25\min (normal)
Nose: normal
Pharynx: congested
Trachea: on the median line
Chest shape: normal
Auscultation: mild stridor

Cardiovascular system
Rate: 120 (normal 95-150)
No abnormal findings
 CASE PRAESENTATION
Abdomen
Normal
No tenderness
No hepatomegaly
No splenomegaly

Neurological examination
Normal neurological examination.
Normal Reflexes.
No neck stiffness
Negative Brudzinski / Kernig signs
 CASE PRAESENTATION
Differential diagnosis for the first seizure

● Central nervous system infections: Meningitis, Encephalitis

● Febrile seizure
● :Syncope rapid recovery
● Epileptic seizure
● Medications
● Metabolic disorders
● Brain injury or abnormality
Investigations:

CASE PRAESENTATION
CBC: CXR:
RBC: 4.48 WBC: 7700 PLA: 251
HG: 11.7 LYM: 28 %
HCT: 34.3 GRA: 65 %
MCV: 76.4

Glucose: 149 mg\dl

Electrolytes:
● Na: 1.34 mmol\dl (low)

● K: 3.60 mmol\dl

● iCa: 1.08 mmol\dl

Urea: 27 mg\dl
CREA: 0.35 mg\dl
C-reactive protein: 3,9 (normal)
 CASE PRAESENTATION
Case findings:
Age: 3 y Loss of consciousness Bilateral infiltration on CXR
Pharyngeal congestion with mild stridor Cyanosis
Fever: 40 degrees Salvation
Tonic-clonic seizure for 15 min Low sodium

The most likely diagnosis: simple febrile seizure

 ‫‪CASE PRAESENTATION‬‬
‫العالج ‪Treatment‬‬
‫سيروم مختلط ‪ 1‬لتر ‪ 5 +‬سم مكعب بوتاسيوم تسريب وريدي بمعدل ‪ 50‬نقطة في الدقيقة‬
‫سيتامول ‪ 10‬سم مكعب ‪ 4 x‬تسريب وريدي‬
‫فوستان شرجي ‪ 1‬سم مكعب عند حدوث اختالج‬

‫بعد العالج انخفضت الحرارة إلى ‪ 37‬درجة‬

‫النبض‪ 90 :‬نبضة في الدقيقة‬
‫حيوية جيدة‬
 CASE PRAESENTATION
STATUS EPILIPTICUS MANAGEMENT

ABC
High-flow oxygen
Don’t ever forget glucose
5 min
Vascular Access?
YES: Lorazepam IV/IO
NO: Midazolam (buccal) Or Diazepam (rectal)
15 min
Lorazepam IV/IO
25 min
Phenytoin
Phenobarbital
45 min
Anaesthesia with thiopental