Seizures
Prof,Jiang Li
Department of Neurology
Children’s Hospital of CHUMS
Definitions
? Seizure （发作）, a sudden attack,spasm,or
convulsion,as in epilepsy or another disorder
? Epileptic seizure（癫痫样发作）, a transient
episode of abnormal and excessive neuronal
activity in the brain that is apparent either to the
subject or an observer,
? Epilepsy（癫痫）, a chronic disorder of the brain
characterized by recurrent,unprovoked epileptic
seizures.
Features of epileptic seizures
? The abnormal neuronal activity during an epileptic
seizure may be manifested as a motor,sensory,
autonomic,cognitive,or psychic disturbance,The
neurophysiological basis is inferred on clinical
grounds.
? A convulsion is a subtype of seizure in which
motor activity occurs.
? Can be provoked in individuals who do not have
epilepsy ( examples of provoking insults including
fever,trauma,hypoglycaemia and hypoxia)
? There are many paroxysmal disturbances (‘funny
turns’) that mimic epileptic seizures,
Different diagnosis of epileptic seizures
? Breath-holding attacks,provoked by temper or
frustration;the screaming toddle holds their breath in expiration,goes
blue,then limp,and then makes a rapid spontaneous recovery.
? Reflex anoxic seizures,provoked by pain or fear; the infant
or toddler becomes pale and loses consciousness( reflecting syncope,
secondary to vagal-induced bradycardia); The subsequent hypoxia may
induced a tonic-clonic seizure.
? Vasovagal syncope (simple faints),usually occurs in
teenagers; provoked by emotion,hot environment;
preceded by nausea and dizziness; sudden loss of
consciousness and posture; rapid recovery.
? Rigors,transient exaggerated shivering in association
with high fever.
Classification of epileptic seizures
? Generalized seizures,the first clinical
change indicates initial involvement of both
cerebral hemispheres
? Partial seizures,there is initial activation of
pare of one cerebral hemisphere
Generalized seizures
? Absence seizure,brief unawareness lasting a few seconds; no
loss of posture; immediate recovery; may be very frequent; associated
with automatisms.
? Myoclonic seizures,repaid,brief,usually isolated jerks of the
limbs,neck or trunk.
? Tonic seizures,a generalised increase in tone
? Tonic-clonic seizures,tonic phase of rigidity with loss of
posture followed by clonic movements of all four limbs; loss of
consciousness; duration 2-20minutes; postictal drowsiness.
? Atonic seizures,a trainsient loss of muscle tone caused
a sudden fall to the floor or drop of the head.
Partial seizures
? Simple Partial seizures,when the child will retain
awareness with consciousness unpaired
? Complex Partial seizures,when there is an altered
conscious state or confusion due to the abnormal electrical
discharge spreading from the originating site to become
generalised
? Partial seizures with secondary generalisation,
when there is a focal seizure manifest clinically or on an ictal
EEG followed by a generalised tonic clonic seizure.
Causes of epileptic seizures
? Febrile seizures
acute seizure associated with fever in the absence
of intracranial infection or an identifiable
neurological disorder
? Epilepsy
chronic disorder of the brain charaterized by
recurrent,unprovoked epileptic seizures
Febrile Seizure(FS)
? associated with a rapidly rising temperature
(usually develop when the core temperature
reaches 390C or greater )
? occur with the diseases out side the CNS
? age dependent,6mon-3mon-6mon ( peak age of
onset:14-18mo of age)
? With normal CNS structure and function
? No no-febrile seizure history
? Genetic predisposition
Clinical Manifestation of Simple febrile
Seizure(SFS)
? Occurs in the children:6mo to 5 yr of age
? Typically generalized seizure (tonic-clonic)
? Duration,a few seconds to 10-min
? Only has once or twice of seizures during a
period of disease
Clinical Manifestation of Simple febrile
Seizure(SFS)
? Age of seizure onset,<6mo or >6yrs
? Seizure persisting for more than 15 min
? Repeated convulsions during a febrile period
? A focal seizure.
? An EEG is indicated for atypical febrile seizures
or for the child at risk for developing epilepsy
Information for parents about ferible seizures
? Will it happen again?
★ about one third children have recurrent febrile seizures;
★ recurrence is more likely more likely if the first seizure occurs under
the age of 18 months or if there is a family history
? Can I prevent further episodes?
★ during febrile illness,the child should be kept cool with antipyretics,
removal of clothing,and tepid sponging
? What should I do if a convulsion occurs?
★ place child in recovery position
★ to administer rectal diazepam if a seizure lasts longer than 5 minutes
? Is it epilepsy?
★ febrile seizures are not classified as epilepsy,about 3% of children
with FS go on to develop afebrile recurrent seizures ( epilepsy)
★ risk factors for epilepsy include,seizures that are focal,prolonged
(>15mins) or recur in the same illness; first-degree relative with
epilepsy; neurological abnormality
Classification of epilepsies
? According to the seizure type
★ Generalized epilepsies and syndromes
★ Localization-related epilepsies and syndromes
? According to aetiology
★ Idiopathic ( or primary) ---in which there is no
apparent cause except perhaps for genetic
predisposition
★ Symptomatic---in which the cause is known or
suspected
Diagnosis of epilepsy
? A careful and complete history,detailed
description of the events before,during,and after
a suspected seizure
? EEG:routine interictal EEG;ambulatory EEG
monitoring; Video EEG recording
? Neuroimaging (CT,MRI)
★ partial seizures
★ Intractable,difficult to control seizures
★ A focal neurological deficit
★ Evidence of a neurocutaneous syndrome or
neurodegeneration
Management of epilepsy
? Educations,about the condition,the prognosis,and the
nature of the particular epilepsy or epilepsy syndrome.
? Special precautions:
★ Swimming,a competent adult swimmer shoukd
be present to provide supervision.
★ Domestic bathing,patients should be supervised
in the bath
★ Cycling,a helmet must be worn and traffic
avoided
★ Climbing,climbing trees and rocks is best
avoided
Management of epilepsy
? Use of anti-epilepsy drugs (AEDs)
★ Not all the children require AEDs treatment
★ Choice of AEDs based on the type of seizure
● first-line drugs for generalized epilepsy,Sodium valproate
● first-line drugs for partial epilepsy; Carbamazepine
★ monitoring the serum anticonvulsant levels
● if toxicity is suspected
● to check compliance
● with multiple drug therapy
● in children who are severely disabled,when toxicity is
difficult to recognise
★ Withdrawal of AEDS
● after 2 years free of seizures,slowly,recurrence of seizure
Prof,Jiang Li
Department of Neurology
Children’s Hospital of CHUMS
Definitions
? Seizure （发作）, a sudden attack,spasm,or
convulsion,as in epilepsy or another disorder
? Epileptic seizure（癫痫样发作）, a transient
episode of abnormal and excessive neuronal
activity in the brain that is apparent either to the
subject or an observer,
? Epilepsy（癫痫）, a chronic disorder of the brain
characterized by recurrent,unprovoked epileptic
seizures.
Features of epileptic seizures
? The abnormal neuronal activity during an epileptic
seizure may be manifested as a motor,sensory,
autonomic,cognitive,or psychic disturbance,The
neurophysiological basis is inferred on clinical
grounds.
? A convulsion is a subtype of seizure in which
motor activity occurs.
? Can be provoked in individuals who do not have
epilepsy ( examples of provoking insults including
fever,trauma,hypoglycaemia and hypoxia)
? There are many paroxysmal disturbances (‘funny
turns’) that mimic epileptic seizures,
Different diagnosis of epileptic seizures
? Breath-holding attacks,provoked by temper or
frustration;the screaming toddle holds their breath in expiration,goes
blue,then limp,and then makes a rapid spontaneous recovery.
? Reflex anoxic seizures,provoked by pain or fear; the infant
or toddler becomes pale and loses consciousness( reflecting syncope,
secondary to vagal-induced bradycardia); The subsequent hypoxia may
induced a tonic-clonic seizure.
? Vasovagal syncope (simple faints),usually occurs in
teenagers; provoked by emotion,hot environment;
preceded by nausea and dizziness; sudden loss of
consciousness and posture; rapid recovery.
? Rigors,transient exaggerated shivering in association
with high fever.
Classification of epileptic seizures
? Generalized seizures,the first clinical
change indicates initial involvement of both
cerebral hemispheres
? Partial seizures,there is initial activation of
pare of one cerebral hemisphere
Generalized seizures
? Absence seizure,brief unawareness lasting a few seconds; no
loss of posture; immediate recovery; may be very frequent; associated
with automatisms.
? Myoclonic seizures,repaid,brief,usually isolated jerks of the
limbs,neck or trunk.
? Tonic seizures,a generalised increase in tone
? Tonic-clonic seizures,tonic phase of rigidity with loss of
posture followed by clonic movements of all four limbs; loss of
consciousness; duration 2-20minutes; postictal drowsiness.
? Atonic seizures,a trainsient loss of muscle tone caused
a sudden fall to the floor or drop of the head.
Partial seizures
? Simple Partial seizures,when the child will retain
awareness with consciousness unpaired
? Complex Partial seizures,when there is an altered
conscious state or confusion due to the abnormal electrical
discharge spreading from the originating site to become
generalised
? Partial seizures with secondary generalisation,
when there is a focal seizure manifest clinically or on an ictal
EEG followed by a generalised tonic clonic seizure.
Causes of epileptic seizures
? Febrile seizures
acute seizure associated with fever in the absence
of intracranial infection or an identifiable
neurological disorder
? Epilepsy
chronic disorder of the brain charaterized by
recurrent,unprovoked epileptic seizures
Febrile Seizure(FS)
? associated with a rapidly rising temperature
(usually develop when the core temperature
reaches 390C or greater )
? occur with the diseases out side the CNS
? age dependent,6mon-3mon-6mon ( peak age of
onset:14-18mo of age)
? With normal CNS structure and function
? No no-febrile seizure history
? Genetic predisposition
Clinical Manifestation of Simple febrile
Seizure(SFS)
? Occurs in the children:6mo to 5 yr of age
? Typically generalized seizure (tonic-clonic)
? Duration,a few seconds to 10-min
? Only has once or twice of seizures during a
period of disease
Clinical Manifestation of Simple febrile
Seizure(SFS)
? Age of seizure onset,<6mo or >6yrs
? Seizure persisting for more than 15 min
? Repeated convulsions during a febrile period
? A focal seizure.
? An EEG is indicated for atypical febrile seizures
or for the child at risk for developing epilepsy
Information for parents about ferible seizures
? Will it happen again?
★ about one third children have recurrent febrile seizures;
★ recurrence is more likely more likely if the first seizure occurs under
the age of 18 months or if there is a family history
? Can I prevent further episodes?
★ during febrile illness,the child should be kept cool with antipyretics,
removal of clothing,and tepid sponging
? What should I do if a convulsion occurs?
★ place child in recovery position
★ to administer rectal diazepam if a seizure lasts longer than 5 minutes
? Is it epilepsy?
★ febrile seizures are not classified as epilepsy,about 3% of children
with FS go on to develop afebrile recurrent seizures ( epilepsy)
★ risk factors for epilepsy include,seizures that are focal,prolonged
(>15mins) or recur in the same illness; first-degree relative with
epilepsy; neurological abnormality
Classification of epilepsies
? According to the seizure type
★ Generalized epilepsies and syndromes
★ Localization-related epilepsies and syndromes
? According to aetiology
★ Idiopathic ( or primary) ---in which there is no
apparent cause except perhaps for genetic
predisposition
★ Symptomatic---in which the cause is known or
suspected
Diagnosis of epilepsy
? A careful and complete history,detailed
description of the events before,during,and after
a suspected seizure
? EEG:routine interictal EEG;ambulatory EEG
monitoring; Video EEG recording
? Neuroimaging (CT,MRI)
★ partial seizures
★ Intractable,difficult to control seizures
★ A focal neurological deficit
★ Evidence of a neurocutaneous syndrome or
neurodegeneration
Management of epilepsy
? Educations,about the condition,the prognosis,and the
nature of the particular epilepsy or epilepsy syndrome.
? Special precautions:
★ Swimming,a competent adult swimmer shoukd
be present to provide supervision.
★ Domestic bathing,patients should be supervised
in the bath
★ Cycling,a helmet must be worn and traffic
avoided
★ Climbing,climbing trees and rocks is best
avoided
Management of epilepsy
? Use of anti-epilepsy drugs (AEDs)
★ Not all the children require AEDs treatment
★ Choice of AEDs based on the type of seizure
● first-line drugs for generalized epilepsy,Sodium valproate
● first-line drugs for partial epilepsy; Carbamazepine
★ monitoring the serum anticonvulsant levels
● if toxicity is suspected
● to check compliance
● with multiple drug therapy
● in children who are severely disabled,when toxicity is
difficult to recognise
★ Withdrawal of AEDS
● after 2 years free of seizures,slowly,recurrence of seizure
