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Paediatric convulsions

Overview

Paediatric convulsions, also known as seizures, are sudden, uncontrolled electrical disturbances in a child's brain. They can manifest in various forms, ranging from subtle staring spells to dramatic shaking and loss of consciousness. Such events can be alarming for parents and healthcare providers, requiring prompt and effective management. Tertiary care hospitals, such as ours, play a critical role in diagnosing, managing, and treating paediatric convulsions, supported by specialised staff and advanced medical technology.

Causes of paediatric seizures can vary and include the following:

  • Febrile seizures: These seizures are generally triggered by a rapid increase in the body temperature and are typically caused by infections, such as viral or bacterial infections. These seizures are most common in children between the ages of 6 months and 6 years.
  • Afebrile seizures: These seizures occur without fever and are often caused by underlying conditions, which include the following:
    • Neurological disorders, such as recurrent seizures (epilepsy) or motor disorder (cerebral palsy)
    • Metabolic imbalances, such as low blood sugar (hypoglycaemia), low calcium (hypocalcaemia), or electrolyte imbalances
    • Genetic conditions (a family history of epilepsy or seizure disorders)
    • Brain injuries due to trauma or hypoxia during birth
    • Infections that affect the brain, such as meningitis or encephalitis
    • Structural abnormalities in the brain identified through neuroimaging

  • Family history of epilepsy or seizures
  • Previous febrile seizures
  • Premature birth or low birth weight
  • Developmental delays or neurological impairments
  • Brain infections or trauma
  • Exposure to toxins or drugs

The symptoms of seizures depend on the type of seizure and can range from mild to severe. Seizure symptoms include:

  • Brief episodes of disorientation
  • Periods of unresponsiveness or vacant staring
  • Uncontrollable jerking of the arms and legs
  • Loss of consciousness or awareness
  • Cognitive or emotional changes, including sensations of fear and anxiety, or a sense of déjà vu (where one feels they have experienced the current moment before)

To diagnose epilepsy, a comprehensive evaluation is conducted, which typically includes:

  • Medical history review: This involves an investigation of the detailed family history of epilepsy or seizures to assess potential hereditary factors.
  • Electroencephalogram (EEG): This is a key neurology diagnostic test that measures electrical activity in the brain and helps detect abnormal brain wave patterns linked to epilepsy.
  • Diagnostic imaging: Brain magnetic resonance imaging (MRI) or computed tomography (CT) scans are performed to identify structural abnormalities or lesions in the brain that may contribute to seizures.
  • Blood tests: These tests are performed to detect infections, metabolic imbalances, or genetic conditions that may be the underlying causes of the seizures.
  • Electromyography (EMG) tests: In some cases, EMG may also be used to assess muscle responses, especially in differential diagnosis.

This thorough approach helps guide effective epilepsy management.

Managing childhood epilepsy and seizures requires a multidisciplinary approach in specialised neurology hospitals. Key aspects of epilepsy management and treatment include:

  • Paediatric seizure treatment: Antiepileptic drugs (AEDs) are the first-line therapy with the choice of medication tailored to the type of seizure and the child's overall health.
  • Epilepsy surgery for children: For children with drug-resistant epilepsy, surgery may be considered to remove the brain area causing seizures or mitigate abnormal brain activity.
  • Neonatal seizure management: In newborns, management of seizures involves identifying the underlying cause and administering appropriate medication or supportive therapies.
  • Childhood epilepsy treatment: Along with medication, treatment may include lifestyle changes, dietary interventions (like the ketogenic diet), or neuromodulation techniques (such as vagus nerve stimulation).
  • Long-term epilepsy management: Ongoing care involves regular follow-up, monitoring seizure control, adjusting medications, and assessing cognitive and developmental progress.

Regular follow-up is critical for managing paediatric convulsions. Tertiary care hospitals provide structured follow-up programmes, including routine EEG monitoring, medication adjustments, and ongoing assessment of the child’s developmental and cognitive progress. Support services, such as counselling and educational support for families, are integral to long-term care.

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