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Seizures in Childhood

Seizure is defined as a paroxysmal involuntary disturbance of brain function on that may manifest as an impairment or loss of consciousness, abnormal motor activity, behavioral abnormalities, sensory disturbance or autonomic dysfunction.

Epilepsy is defined as recurrent seizures unrelated to fever 

Classification of seizures.

  1. Partial seizures
    1. Simple partial
    2. Complex partial
    3. Partial seizures with secondary generalization
  2. Generalized seizures.
    1. Tonic                    
    2. Clonic                  
    3. Tonic clonic
    4. Absences              
    5. Mycolonic              
    6. Infantile spasm
  3. Unclassified seizures. 

1. Partial seizures

  1. Simple Partial Seizures – without loss of consciousness with motor, sensory, autonomic or mixed symptoms. When the simple seizure spreads from one area of body to the other according to the representation in the precentral gyrus of the motor cortex, it is called Jacksonian march. 
  2. Complex partial seizures { psychomotor, temporal lobe seizures)
    1. Consciousness is impaired
    2. Brief visceral, olfactory or visual aural are followed by peculiar posture, tonic jerk of the face and or limbs.
    3. Automatisms are common featureQ
    4. Drug of choice is carbamazepine Q 

2. Generalized seizures


Tonic seizures are characterized by increased tone or rigidity

  1. Clonic seizures consists of rhythmic muscle contraction and relaxation
  2. Myoclonus is described as shock line contraction.
  3. Atonic seizures are characterized by flaccidity or by lack of movement during a convulsion.
  4. Absence seizure (petit mal) characterized by:
    1. Sudden cessation of motor activity with blank facial expression
    2. Uncommon before 5 yrs Of ageQ
    3. More common in girlsQ
    4. Not associated with an aura
    5. Not associated with a post ictal state
    6. Rarely persist longer than 30 sec
    7. Countless seizures daily
    8. Hyperventilation for 3-4 min routinely produces an absence seizures
    9. EEG shows a typical 3/sec spike Q

Infantile spasm

  1. Usually begins between ages of 4-8 months.
  2. Characterized by brief symmetric contractions of the neck, trunk and extremities.
  3. EEG shows hypsarrhythmiaQ
  4. ACTH used in treatment Q 

Lenox Gastaut Syndrome


Characterized by the triad of – intractable seizures of various type, a slow spike wave EEG during awake state and mental retardation.


Landau Kleffner syndrome – is characterized by loss of language skill in a previously normal childQ.

  1. Mean age of onset is 5.5 yrQ
  2. More common in boysQ
  3. Associated with seizure disorder
  4. Hearing is normal 

Febrile seizures – are the commonest cause of seizures during early childhood


Definition  when seizures are preceded by the fever and cause of fever is extracranial.

Febrile seizures are age dependent and are rare before 9 month and after 5 yr of age (6-60 month) peak age is 14-18 month.


Simple benign febrile convulsion

  1. The convulsion occurs with in 24 hrs of the onset of fever
  2. Duration less than 10 min
  3. Generalized convulsions
  4. No post ictal neurological deficit
  5. EEG few days after convulsion is normal
  6. Family history of febrile convulsion present
  7. Age between 6 months – 5 year (6 – 60 months)

Risk factors for development of epilepsy as a complication of febrile seizures include

  1. Positive family history of epilepsy
  2. A typical febrile convulsion
  3. Delayed developmental milestone
  4. Abnormal neurologic findings               

Incidence of epilepsy

  1. 9% when risk factor present
  2. 1% when No risk factor present  

Treatment :


Search for the cause of the fever, measures to control the fever including antipyretics and hydrotherapy diazepam or clobazam used with fever to decrease chance of febrile convulsion phenobarbitone and sodium valproate may be used for continuous prophylaxis. But generally continuous prophylaxis is not indicated Q

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