Epilepsy in children, Febrile Seizures (paediatrics, learning outcomes)

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Epilepsy in children, Febrile Seizures (diagnosis)

Pediatric Seizures: Childhood Epilepsy and Febrile Seizures

1. Explain the pathophysiological mechanisms leading to the high incidence of seizures in childhood

  • Relative predominance of excitatory synapses over inhibitory synapses, lower stability of the internal environment (homeostasis), and the manifestation of both acquired and inherited CNS (Central Nervous System) diseases.

2. List the 3 basic groups of pediatric seizures according to etiology

  • Symptomatic seizures (Acute provoked seizures)
  • Febrile seizures
  • Epileptic seizures (Unprovoked seizures/Epilepsy)

3. Provide at least 5 causes of symptomatic seizures in children

  • Examples: Febrile seizures, epilepsy, CNS infections (meningitis/encephalitis), head trauma, congenital structural anomalies and malformations, metabolic disorders and electrolyte imbalances, intoxication, and cerebrovascular accidents (stroke).
  • The student knows basic diagnostic procedures to identify the cause of symptomatic seizures: Blood glucose (glycemia), electrolytes (ions), ABG (Arterial Blood Gas/Acid-Base Balance), and neurological imaging.

4. Diagnose febrile seizures; differentiate between simple and complex febrile seizures

The student can explain:

  • Differences between uncomplicated (simple) and complicated febrile seizures (age of onset, clinical presentation/duration/recurrence within 24h).
  • Diagnostic workup and prognosis (considering the possibility of symptomatic seizures, e.g., neuroinfection).
  • First aid and treatment of febrile seizures.

5. Define epilepsy and explain the basic pathophysiology of an epileptic seizure and its types

  • Recurrent, unprovoked seizures.
  • Imbalance between excitatory and inhibitory activity within neuronal circuits.
  • Focal vs. Generalized; Symptomatic vs. Idiopathic.
  • Seizures with impaired awareness vs. preserved awareness (focal), and unknown onset.
  • Basic types: Clonic, tonic, myoclonic, epileptic spasms, absence, sensory, sensitive, and autonomic (vegetative) seizures.

6. State the basic characteristics of childhood epilepsies and describe at least one pediatric epileptic syndrome

  • 1) Typical age of onset, 2) Seizure type, 3) EEG patterns, 4) Neurological findings + auxiliary examinations (e.g., MRI).
  • Examples: Childhood Absence Epilepsy (CAE), Benign Epilepsy with Centrotemporal Spikes (BECTS/Rolandic Epilepsy), Juvenile Myoclonic Epilepsy (JME).

7. Define Status Epilepticus (SE), explain its risks, and initial therapy in a chronological context

The student explains:

  • The significance of the two time points (T1: 5 minutes for initiating treatment and T2: 30 minutes for the risk of long-term consequences).
  • Basic first aid during a seizure and post-ictal management (ABCD approach).
  • Knowledge of first-line anticonvulsants (Benzodiazepines), including routes of administration and dosages (mg/kg + max absolute dose).
    • 1st Line: Diazepam (rectal/I.V.), Midazolam (buccal/nasal/I.V.).
  • Awareness of second and third-line anticonvulsants and the risks of complications (e.g., hypoventilation).
    • 2nd Line: e.g. Phenytoin Levetiracetam, Valproate (dependent on condition/age).
    • 3rd Line: Anesthetics – ICU/Anesthesiology involvement, intubation.

8. Take a targeted medical history to assist in the differential diagnostic process

Prodromes, aura, age, developmental history, family history (FH), and associated symptoms.

9. Perform a physical examination including a screening neurological exam

Level of consciousness (GCS - Glasgow Coma Scale), meningeal signs, focal neurological deficits, and sensory impairments.

10. Indicate acute laboratory and imaging tests and explain their clinical utility

  • Blood: Glucose, electrolytes, CBC (Complete Blood Count), CRP (C-Reactive Protein), and ABG.
  • Imaging: CT/MRI.
  • EEG (Electroencephalography).

11. Explain the following principles to parents of a child with epilepsy

  • Lifestyle modifications: Sleep hygiene, prohibition of alcohol and illicit drugs, injury prevention during cycling and physical activities, drowning prevention (including supervision during baths).
  • Seizure manifestation and management: Clinical presentation (type of movements, symmetry/asymmetry, duration), home first aid protocols, when to call Emergency Medical Services (EMS), and critical information to report to the physician.

12. Discuss the differential diagnosis of paroxysmal events (seizures) in children

ALTE (Apparent Life-Threatening Event), BRUE (Brief Resolved Unexplained Event), breath-holding spells (affective seizures), infantile masturbation, tic disorders, anxiety states with hyperventilation and tetany, cardiac syncope, vasovagal syncope, etc.

13. Explain the specifics of neonatal seizures

  • Predominance of symptomatic seizures; necessity of laboratory screening and CNS imaging.
  • Early-onset genetic causes.
  • Atypical clinical manifestations (motor automatisms: orofacial movements, "swimming," "boxing," "pedaling"), apnea, changes in muscle tone, and autonomic (vegetative) signs (tachycardia, bradycardia, vasomotor changes).
  • First-line acute anticonvulsant: Phenobarbital.
  • Requirement for transfer to a specialized neonatal center.
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