JULIANTI MULYA UTAMIFaculty of Medicine

YarsiPediatric Department

Rumah Sakit Bhayangkara tk.I R.S.

Sukanto-JakartaPeriode: 15 March –

24 May 2015

Seizure Disorder In Children

DEFINITION Seizures refer to excessive neuronal

discharge with change in motor activity or behavior.

Epilepsy is a chronic neurological condition characterized by recurrent, unprovoked seizures, occurrence of at least 2 unprovoked seizures 24 hours apart.

ETIOLOGY

Idiopathic (70 – 80%) – cause unknown but presumed genetic

Secondary Cerebral dysgenesis /malformation Cerebral vascular occlusion Cerebral damage

- Antenatal: Congenital infections, drugs, alcohol- Natal: birth trauma- Postnatal: CNS infections, trauma, tumour

Cerebral tumours Neurodegenerative disorders Neurocutaneous syndrome

NON GENETIKMalformasi

vascular

Trauma mekanik

Brain Tumour Struktur abnormal

Parasit chronic

MeningitisInfection

Ensefalitis

Neonatal Asfiksia

CVA

Hipoksemi-iskemi

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Patofisiologi EPILEPSI

CLASSIFICATION

ILAE 2010 CLASSIFICATION

Tonic clonic seizuresTonic phase• The tonic phase begins with flexion of the trunk and

elevation and abduction of the elbows. Subsequent extension of the back and neck is followed by extension of arms and legs.

• Piercing cry may be present due to passage of air through closed vocal cords.

• Autonomic signs are common during this phase and include increase in pulse rate and blood pressure, profuse sweating

• This stage lasts for 10-20 seconds.

Tonic clonic seizuresClonic phase tremor occurs at a rate of 8 tremors per

second, which may slow down to about 4 tremors per second. This is because phases of atonia alternate with repeated violent flexor spasms. Each spasm is accompanied by pupillary contraction and dilation. Some patients may have tongue or cheek bites.

The atonic period lasts about 30 sec.

The clonic phase lasts for 30 sec. to 1minute.

Absence seizures

Patient stares briefly and stop talking or ceases to respond.

Most of the patient are completely motionless while some feel some myoclonic movements in eye lids,facial muscles,fingers at a rate of 3 per sec..and this rate corresponds to the abnormality in EEG as generalized 3 per sec.spike & wave pattern.

Occurs at the age of 4-12 years Prognosis is good.95% remission in adolescense

MYOCLONIC SEIZURES These are brisque,brief muscular contractions some of them involve only single muscle or a part of

the muscle & some of them are so large that they include whole body or both the limbs.

Myoclonic jerks are common in the morning involving entire body both the limbs and sometimes absence seizures are common.

This is the most common form of idiopathic gen.epilepsy in childhood.it begins at adolescence (15 yr).

4 to 6 Hz irregular spikes have been noted in EEG.

SPECIAL EPILEPSY SYNDROME

INFANTILE SPASM:-

-Most cases appears in 1st yr of life. - Single brief recurrent gross flexion

movements of the limb …rarely extension movements

-EEG shows multifocal,multiple small spikes.

-On maturity it disappears(4 to 5yr) -CT & MRI mostly normal.

TREATMENT

STATUS EPILEPTIKUS

DIAGNOSIS EEG is most sensitive tool for

diagnosis which shows electrical activity changes in the brain but it also require clinical correlation

Many children with epilepsy may have normal EEG and many children who will never have epilepsy have EEG abnormalities

DIAGNOSIS MRI and CT -not required routinely for childhood generalized

epilepsy. To identify a tumour,vascular lesion or area of sclerosis.

PET and SPECT. To detect areas of hypometabolism in epileptogenic

lesions OTHER INVESTIGATIONS Blood test and metabolic investigations(seizures related

to feed and fasting). Genetic studies Lumbar puncture

ADVISE FOR PATIENT Educate and counsel on epilepsy. Emphasize compliance if on anticonvulsant. Don’t stop the medication by themselves.this

may precipitate breakthrough seizures. In photosensitive seizures-watch tv in brightly lit

room.avoid sleep deprivation. Use a shower with bathroom door unlocked No cycling in traffic,climbing sports or swimming

alone. Know emergency treatment for seizure Inform teachers and school about the condition.

Febrile Seizure Febrile seizures are the most

common seizure disorder in childhood, affecting 2 - 5% of children between the ages of 6 months and 5 years

Febrile Seizure Caused by the increase in the core

body temperature greater than 100.4F or 38C

Threshold of temperature which may trigger seizures is unique to each individual

Can occur within the first 24 hours of an illness Can be the first sign of illness in 25 - 50% of

patients

MANAGEMENT FEBRILE SEIZURE

Simple Febrile Seizure:Diagnostic Testing

Ongoing Management Reassess temperature

Consider giving antipyretic if not previously administered

As source of fever is identified, treat appropriately

Instruct parent/caregivers to prevent injury during a seizure :

Position child while seizing in a side-lying position

Protect head from injury Loosen tight clothing about the neck Prevent injury from falls Reassure child during event Do not place anything in the child’s mouth

ADVISE FOR PATIENT

ADVISE FOR PARENTS (CONT..)

Educate regarding use of: Thermometer Antipyretics for fever management When to contact 9-1-1 or ambulance

Identify Primary Care Provider for follow-up appointment and stress importance of follow-up

Provide developmentally appropriate explanation of event for child and family members

THANK YOU

Questions 1. Nataly (UPH): komplikasi dari kejang? 2.Hadi ( YARSI): algoritma penanganan kejang

demam? 3. Devina (UPH): faktor risiko seorang anak

dapat mengalami kejang demam? 4.Dika (YARSI): mengapa kejang demam

sering terjadi pada anak-anak? 5. Ayu (YARSI): apakah kejang demam dapat

menyebabkan epilepsi? 6.Hilya (YARSI): kapan seorang anak dapat

dikatakan mengalami kejang demam?