Generalized Seizures in Children – Pediatric Neurology | Lecturio

Generalized Seizures in Children – Pediatric Neurology | Lecturio

Let’s move on to generalized seizures. In a patient with generalized seizures, i it’s important to control the seizure
but you probably got about five minutes remember most pediatric seizures will stop of their own accord
within five minutes. An EEG after a seizure is done maybe useful
for identiyfing underlying seizure syndromes. Let me give you an example. Lennox Gastaut Syndrome has an onset between typically three
and five years of age. These patients have mixed varieties
of seizure and they may develop mental
retardation. And severe behavioral problems. Lennox Gastaut has a very typical
EEG pattern.It is not so important for a medical
student or a resident
or even a fellow would probably need to know it
if there is a neurology fellow. But most of us don’t really need
to know how to read EEGs But we should be aware that there are
certain patterns in them that give away certain diagnosis. And Lennox Gastaut does have
a typical EEG appearance. The reason why it is important to make
the diagnosis of Lennox Gustaut is because it is a difficult to manage disease
and will require the guidance of a pediatric neurologist. Here is an example of an EEG. What you see here is a patient
with Lennox-Gastaut You can here that there are intermittent
periods of independent polywave spikes lasting for roughly one to eight seconds. And that is classic and emblematic
of that disease. Ok, let’s move on to anti-epileptic
drugs. We’e got Dilatin or Phenytoin We’ve got Phenobarbital and another that we might talk
about is Ethosuximide. This are all drugs that we are going to use to place a child on all the time to help prevent them from
getting recurrent seizures, when their seizures are frequent. Dilantin is good for partial
or generalized seizures The problem is you need to know
the serum drug levels of the patients on this drug and over time
they can develop side effects. The side effects that you are going to be
asked about on your tests is probably Gingival hypertrophy. They get excessively growing gums. They also have increased body hair. Usually in the arms
you can see it very easily. And long term, they can have
neurotoxic effects with actually a loss of IQ points over time. So we like to avoid the seizure
drugs unless we need them. Phenobarbital generally used and better
on children under one year of age. It is good for partial or generalized
seizures, and again, we are going to have to
follow drug levels. Again, this can cause a loss of IQ points
over time. It has a general sedating effect, which mitigates somewhat over time
as they get used to the drug. But be careful to warn the parents
that for the next week or two, their child may be excessively
sleepy. Ethosuximide is our first line anti-seizure medicine for
children with absence seizures. So, I threw it in here as an alternative
example of a seizure medication that you will see
children being on. The side effects of Ethosuximide is
drowsiness behavioral changes, nausea and they can get an Aplastic
anemia or a lupus-like syndrome. The general principle here is that there are
lots of drugs we use in children we need to know what the side effects are and we need to know which drugs
are most effective in which seizure syndromes. It really a matter of what the
side effect profile what are your monitoring needs
and what is the seizure type. Let’s switch goals to focal seizures. Now remember, only children with focal seizures are
going to have auras warning them of an impending seizure. Auras are unique things for each child.
Sometimes they will see certain colors or just get a sense that a seizure is coming
on. Focal seizures usually affect one area of the
body. Let’s say an arm or a face. The child may be fully awake
during the event. If we diagnose it with EEG, but an MRI is absolutely indicated in
a child with a first time focal seizure because we need to rule out
a focal abnormality in the brain. We’re going to treat focal seizures with AEDs, implanted devices and in bad cases, ketogenic
diet or surgercal removal of the lesion. Infantile spasms are a severe and very sad disease that happens
to infants and can have terrible progrnosis. These look really unique. And I urge you to go online and
get to Youtube and find a video of infantile spasms.
They are all over the place. It is important to be able to recognize them
because diagnostically, It is important to make this
diagnosis. These children have generalized myoclonic
jerks of the neck, trunk and limbs. It generally begins between 3
and 7 months of age. The specific etiology of the majority
are unknown or they’re genetic or syndromic. Children who are not actively seizing
will start off with having a normal neurologic exam and the typical
EEG finding is something called hypsarrhythmia. You should probably remember that
that might show up on a test. Infantile spasms have a very
bad diagnosis. And it is a very bad prognosis. The death occurs for
about 1/3 within 3 years of diagnosis. These children have profound cognitive
effects from their recurring seizures These seizures are profoundly hard
to control. and in survivors, they gradually turn
into other types of seizures which can persist into adulthood. Another type of seizure that is much less
concerning is Benign Rolandic Epilepsy. This is also called Benign Epilepsy with
Centrotemporal spikes or BECTS. That’s because these patients tend to have
Centrotemporal spikes on their EEG. This present as several partial seizures
usually in the face and in the hand. It begins a little bit older
between 5 and 12 years of age. And usually with normal children
who are developing normally. What is key is they usually occur
during sleep. or within an hour of falling asleep. Almost all are outgrown during adolescence. They have those specific EEG findings, and treatment is optional because they
are asleep while having the problem.


  1. When I was a baby I had a febrile seizure I stopped breathing and turned blue my mom gave me mouth to mouth and by the time the EMTS arrived I stopped seizing. in pre k I would get angry and punch any thing that was in front of me that is when it was suggested that my parents should take me to a therapist. he took one look at me and said that I was having seizures he then referred me to a neurologist. At the at the age of 5, I was diagnosed with childhood absence epilepsy but I have been seizure free since the age of thirteen. And so was taken of meds which caused massive weight gain a hand tremor and memory loss. The point is meds are good up until a point and then it becomes a pill, no pun intended. My triggers are flashing lights, the transition from the out doors to inside a classroom getting too hot and recently sleep deprivation. when i have an absent my pupils will go from normal to pin point that is the only physical sign the eye can lasts My seizures last one second and happened every minute to every minute and a half. So there are 60 seconds in a minute and 24 hours in a day then I was having seizures every 1440 minutes or 86400 seconds so in total I would have 86400 seizures per day with meds. my parents were told to treat me as a normal child and to see how fare I would develop and look at me now I have graduated high school with honors . I am in collage as you can infer I was not expected to do much of what I just mentioned
    The effects of my seizures is that I have Aspie like tendencies due to my epilepsy which I know is difficult to understand to put it in simple terms as a result of my seizures my brain compensated and rewired itself and so I have all of the symptoms of Aspergers but lack any sort of understanding math as a result I have no understanding of money and never really learned my basic math facts.(I am just learning them now in college which for most Aspergers people they are gifted with math abilities ) I also have orthotic issues due to my seizures I also have a  processing disorder. I have low gross motor control and other motor issues as well.
    After my father died, it seems I have had a relapse if that is possible. I still have my absence seizure but it is not enough to put me on meds . I take omega 3 cod liver oil liquid form as I cannot swallow pills this helps decrease the too small to medicate seizures I have very small seizures that show up on the EEG as misfired neurons and the Dr. called them "flurries" so here is what my flurries are typically like I will become very spacey I can not interact with my surroundings I also felt locked in to place. I am completely aware my vision becomes like a tunnel and thing start to move or vibrate on their own an absent seizure lasts 1 second but these flurries can last 5-10 minutes.

  2. Dear Sir,

    My Son had seizure that lasted for less then 45 Seconds. It came when he was sleeping. Whole body was twitching and became unconscious for 20 Minutes. After he was awake he had fever which lasted for 2 days.

    Within 25 Days he had Another Seizure which lasted for less then 4 Minutes. Became Unconscious for 20 Minutes and hd fever 102F. When he woke up. Fever lasted for Few Hours.

    We are really worried. We want to Know what kind of Seizure he is having. We consulted a pediatric doctor but What needs to be done further.

    Please Share ur Advise.

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