SEIZURES

Dr Jonny Taitz, FRACP

Geschn Paediatrician
Sept 2003
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, automatic
function

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Most Common
Tonic (stiffening)
Clonic (jerking)
Absence
Myoclonic
Atonic
Focal
MOST ARE BRIEF
TERMINATE SPONTANEOUSLY
50% in childhood = febrile convulsion
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Which seizures do we
treat?
> 5 minutes brain hypoxia
Status epilepticus
 Generalised seizures > 30 mins
OR
 Repeated convulsions > 30 mins with NO

recovery & consciousness between

convulsions

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Complications

}
 Age related - Long term epilepsy
 > 3 yr - 6% - Motor problems
 < 1 yr - 30% - Learning &
behavioural problems

 5% mortality (1/20)

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Guidelines aim



JHH
SHC
CHW
} clear, succint guidelines in
the care of acute seizures

 Many different anticonvulsants

 Different routes of administration
 Intravenous
 Intramuscular
 Rectal
 Oral
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Important
Seizures < 15 minutes much
more likely to respond to Rx
than seizures > 15 minutes

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History
? Febrile illness 1°
assessment
Underlying CNS problems
ABC
History of epilepsy
Head trauma
toxin ingestion

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Specific features on exam
Airway intubation
Breathing hypoventilation, aspiration,
O2, mask ventilation

Circulation shock, fluid boluses

Neurological 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 } Resp
depression
? Intubate +
 Circulation ventilate
 Rx shock
 Fluid Boluses 11
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 are
available?
How many minutes has the
child been fitting?

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Vascular Access
Yes No Supportive
Diazepam 0.25mg/kg IVI Diazepam 0.25mg/kg PR
measures
Or Midazolam 0.15mg/kg IVI Or Midazolam 0.15mg/kg IMI
ABC
5 Access
Repeat Diazepam IVI
Or Midazolam IVI
No

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LOAD repeat
Phenytoin 20 mg/kg IVI Diazepam or Midazolam
or Phenobarb 20mg/kg IVI

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Rapid sequence induction Paraldehyde 0.4mg/kg PR
Thiopentone, Atropine, Dilute 50:50 (olive oil)
Suxemethonium 14
A little more on
anticonvulsants
 Diazepam
 Effective first line in 80%
 Rectal admin → therapeutic levels 5
minutes
 Rapid seizure control (80%)
 S/E 9% risk of respiratory depression
 Higher in children with CNS abnormalities

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A little more on
anticonvulsants
 Midazolam
 NSW Ambulance drug of first choice in
status epilepticus (IMI)
 Will stop majority of seizures within 1
minute (IVI)
 Takes longer when used IM
 (approx 5-10 mins)
 Intransal midazolam
 More info required before recommending it

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Midazolam (contd)
 Paraldehyde
 Used since 1930’s
 Very dangerous IVI

 Well tolerated rectally

 Rapid onset of seizure control

 Less respiratory depression than

Benzodiazepines
 Smells

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Questions

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