Here is a complete, exam-oriented yet concise paediatrics reference covering seizure disorders, febrile seizures, absence epilepsy, JME, epilepsy syndromes, and status epilepticus.
🧠 SEIZURE DISORDERS (PAEDIATRICS)
Definition
A seizure = transient occurrence of signs/symptoms due to abnormal excessive synchronous neuronal activity in the brain.
Classification (ILAE-based simplified)
1. Focal seizures
- Origin: one hemisphere
- Types:
* Aware (no LOC)
* Impaired awareness
- May evolve → bilateral tonic-clonic
2. Generalized seizures
- Both hemispheres from onset:
* Tonic-clonic
* Absence
* Myoclonic
* Atonic
* Tonic
3. Unknown onset
Causes in Children
- Idiopathic/genetic
- Structural (malformations, tumors)
- Metabolic (hypoglycemia, hypocalcemia)
- Infection (meningitis, encephalitis)
- Perinatal insult (HIE)
- Trauma
- Fever (febrile seizures)
Clinical Features
- Motor: tonic, clonic, myoclonic
- Non-motor: staring, behavioral arrest
- Autonomic: cyanosis, tachycardia
- Postictal phase: confusion, sleepiness (absent in absence seizures)
Investigations
- Blood glucose, electrolytes, calcium
- EEG (key diagnostic tool)
- MRI brain (structural causes)
- CSF (if infection suspected)
General Management
- Ensure airway, breathing, circulation
- Position: lateral
- Treat underlying cause
- Antiepileptic drugs (AEDs)
🌡️ FEBRILE SEIZURES
Definition
Seizures occurring in 6 months–5 years with fever, without CNS infection.
Types
Simple febrile seizure
- Generalized
- <15 minutes
- Single episode in 24 hrs
- Normal neuro exam
Complex febrile seizure
- Focal / >15 min / recurrent
Pathophysiology
- Immature brain + rapid temperature rise → neuronal hyperexcitability
Clinical Features
- Generalized tonic-clonic seizure
- Occurs early in fever
- Rapid recovery
Investigations
- Usually NOT required (simple type)
- Do:
* Lumbar puncture → if meningitis suspected
* EEG → NOT routine
Management
Acute
- Usually self-limiting
- If >5 min → benzodiazepine
Long-term
- No routine AED
- Parental reassurance
- Antipyretics (do not prevent seizures)
Drugs
Diazepam
- Indication: prolonged seizure
- Dose: 0.2–0.3 mg/kg IV / rectal
- MOA: GABA-A agonist
- Adverse: respiratory depression
- Monitor: respiration
Prognosis
- Excellent
- Slight ↑ risk of epilepsy (esp. complex)
⚡ ABSENCE SEIZURES (Childhood Absence Epilepsy)
Definition
Brief episodes of impaired awareness (staring spells)
Pathophysiology
- Thalamocortical circuit dysfunction
Clinical Features
- Sudden staring
- No postictal confusion
- Automatisms (lip smacking)
- Multiple times/day
- Hyperventilation triggers
EEG
- 3 Hz spike-and-wave pattern
Treatment
Ethosuximide (drug of choice)
- MOA: T-type Ca²⁺ channel blocker
- Dose: ~20 mg/kg/day
- Side effects: GI upset, lethargy
Alternatives
- Valproate
- Lamotrigine
⚡ JUVENILE MYOCLONIC EPILEPSY (JME)
Definition
Common genetic epilepsy in adolescents
Clinical Triad
- Myoclonic jerks (early morning)
- Generalized tonic-clonic seizures
- ± Absence seizures
Triggers
- Sleep deprivation
- Stress
- Alcohol
- Photosensitivity
EEG
- 4–6 Hz polyspike-and-wave
Treatment
Valproate (drug of choice)
- MOA: ↑ GABA, Na channel block
- Dose: 10–60 mg/kg/day
- Side effects: weight gain, hepatotoxicity, teratogenic
Alternatives
- Levetiracetam
- Lamotrigine
Prognosis
- Lifelong tendency
- Good control with medication
🧬 EPILEPSY SYNDROMES (IMPORTANT)
1. West Syndrome (Infantile Spasms)
- Age: <1 year
- Triad:
* Infantile spasms
* Developmental regression
* EEG: hypsarrhythmia
Treatment
- ACTH
- Vigabatrin
2. Lennox-Gastaut Syndrome
- Age: 1–8 years
- Multiple seizure types
- Intellectual disability
- EEG: slow spike-wave
Treatment
- Valproate
- Lamotrigine
- Ketogenic diet
3. Benign Rolandic Epilepsy
- Focal seizures during sleep
- Good prognosis
4. Dravet Syndrome
- Severe, prolonged febrile seizures
- SCN1A mutation
🚨 STATUS EPILEPTICUS (PAEDIATRICS)
Definition
- Seizure >5 minutes
OR
- Recurrent seizures without recovery
Pathophysiology
- Failure of inhibitory mechanisms (↓ GABA)
- Excitotoxicity → neuronal injury
Clinical Features
- Continuous convulsions
- Altered consciousness
- Autonomic instability
Emergency Management (STEPWISE)
Step 1 (0–5 min)
- ABC stabilization
- Oxygen, IV access
- Check glucose → give dextrose if low
Step 2 (5–10 min)
Benzodiazepine (first-line)
- Lorazepam: 0.1 mg/kg IV
OR
- Diazepam: 0.2 mg/kg IV
Step 3 (10–20 min)
Second-line AED
- Phenytoin: 20 mg/kg IV
OR
- Levetiracetam: 20–60 mg/kg IV
Step 4 (Refractory)
- Phenobarbital
- Midazolam infusion
- ICU care
Drugs Summary
Lorazepam
- MOA: GABA enhancement
- Longer CNS action
- Less respiratory depression vs diazepam
Phenytoin
- MOA: Na channel blocker
- Side effects: arrhythmia, gingival hyperplasia
- Monitor: ECG, BP
Levetiracetam
- MOA: SV2A modulation
- Fewer interactions
- Well tolerated
Complications
- Hypoxia
- Brain injury
- Metabolic acidosis
Prognosis
- Depends on cause & duration
- Early control → better outcome
🔑 HIGH-YIELD SUMMARY
- Febrile seizure → benign, no long-term AED
- Absence → 3 Hz spike-wave, treat with ethosuximide
- JME → morning myoclonus, lifelong, valproate
- West syndrome → ACTH
- Status epilepticus → benzodiazepine first
If you want, I can convert this into:
- MCQs (exam practice)
- Flowcharts for quick revision
- Comparison tables (very useful for viva)
