Pediatric Seizures and Status Epilepticus

Management Work

Seizures represent a common neurologic complaint among pediatric patients in the emergency department (ED). They can be classified as generalized or focal. In terms of etiology, seizures are most basically broken down into “acute symptomatic” seizures, which are due to another primary medical cause, and unprovoked seizures which occur as a primary pathology. Febrile seizures are the most common types of seizures in children, which themselves can be simple or complex. The most concerning seizures are those which associate with meningismus, encephalitis, metabolic derangements, intracranial mass, and, of course those which progress to status epilepticus. Significantly, it is appropriate and even critical to assume status epilepticus and intervene accordingly whenever a child arrives to the ED seizing for an unspecified period of time. This review covers the initial evaluation, resuscitation, management, work-up, and disposition of pediatric patients who present to the emergency room with seizures. Figures in this chapter illustrate stepwise and algorithmic approaches to initial management, expanded differential, systematic diagnostic approach, and disposition for pediatric patients presenting with seizures and status epilepticus. Tables list important physical exam components for evaluating children with seizures, classifications of seizures, common seizure look-alikes in children, features of febrile seizures, etiologies of pediatric seizures. This review contains 5 figures, 11 tables, and 22 references. Key Words: pediatric seizures, febrile seizures, pediatric neurologic emergencies, pediatric emergency medicine, status epilepticus

Pediatric Seizures and Status Epilepticus

10.2310/tywc.4406 ◽

2018 ◽

Author(s):

Lindsey Retterath ◽

Dale Woolridge

Keyword(s):

Status Epilepticus ◽

Pediatric Patients ◽

Febrile Seizures ◽

Pediatric Emergency ◽

Initial Management ◽

Symptomatic Seizures ◽

Algorithmic Approaches ◽

Work Up ◽

Management Work

Seizures represent a common neurologic complaint among pediatric patients in the emergency department (ED). They can be classified as generalized or focal. In terms of etiology, seizures are most basically broken down into “acute symptomatic” seizures, which are due to another primary medical cause, and unprovoked seizures which occur as a primary pathology. Febrile seizures are the most common types of seizures in children, which themselves can be simple or complex. The most concerning seizures are those which associate with meningismus, encephalitis, metabolic derangements, intracranial mass, and, of course those which progress to status epilepticus. Significantly, it is appropriate and even critical to assume status epilepticus and intervene accordingly whenever a child arrives to the ED seizing for an unspecified period of time. This review covers the initial evaluation, resuscitation, management, work-up, and disposition of pediatric patients who present to the emergency room with seizures. Figures in this chapter illustrate stepwise and algorithmic approaches to initial management, expanded differential, systematic diagnostic approach, and disposition for pediatric patients presenting with seizures and status epilepticus. Tables list important physical exam components for evaluating children with seizures, classifications of seizures, common seizure look-alikes in children, features of febrile seizures, etiologies of pediatric seizures. Key Words: Pediatric seizures, febrile seizures, pediatric neurologic emergencies, pediatric emergency medicine, status epilepticus

Pediatric Seizures and Status Epilepticus

10.2310/fm.4406 ◽

2016 ◽

Author(s):

Lindsey Retterath ◽

Dale Woolridge

Keyword(s):

Status Epilepticus ◽

Pediatric Patients ◽

Febrile Seizures ◽

Pediatric Emergency ◽

Initial Management ◽

Symptomatic Seizures ◽

Algorithmic Approaches ◽

Work Up ◽

Management Work

Seizures represent a common neurologic complaint among pediatric patients in the emergency department (ED). They can be classified as generalized or focal. In terms of etiology, seizures are most basically broken down into “acute symptomatic” seizures, which are due to another primary medical cause, and unprovoked seizures which occur as a primary pathology. Febrile seizures are the most common types of seizures in children, which themselves can be simple or complex. The most concerning seizures are those which associate with meningismus, encephalitis, metabolic derangements, intracranial mass, and, of course those which progress to status epilepticus. Significantly, it is appropriate and even critical to assume status epilepticus and intervene accordingly whenever a child arrives to the ED seizing for an unspecified period of time. This review covers the initial evaluation, resuscitation, management, work-up, and disposition of pediatric patients who present to the emergency room with seizures. Figures in this chapter illustrate stepwise and algorithmic approaches to initial management, expanded differential, systematic diagnostic approach, and disposition for pediatric patients presenting with seizures and status epilepticus. Tables list important physical exam components for evaluating children with seizures, classifications of seizures, common seizure look-alikes in children, features of febrile seizures, etiologies of pediatric seizures. Key Words: Pediatric seizures, febrile seizures, pediatric neurologic emergencies, pediatric emergency medicine, status epilepticus

Acute Provoked Seizures—Work-Up and Management in Adults

Seminars in Neurology ◽

10.1055/s-0040-1719075 ◽

2020 ◽

Vol 40 (06) ◽

pp. 595-605

Author(s):

Rana Moosavi ◽

Christa B. Swisher

Keyword(s):

Status Epilepticus ◽

Initial Treatment ◽

Nonconvulsive Status Epilepticus ◽

Convulsive Status Epilepticus ◽

Medical Work ◽

Acute Setting ◽

Symptomatic Seizures ◽

Work Up ◽

First Time ◽

AbstractAcute provoked seizures, also known as acute symptomatic seizures, occur secondary to a neurological or systemic precipitant, commonly presenting as a first-time seizure. In this article, we will discuss etiology, emergent protocols, medical work-up, initial treatment, and management of these seizures. The definitions, classifications, and management of convulsive status epilepticus and nonconvulsive status epilepticus in an acute setting will also be reviewed.

Emergency Management of Epilepsy and Seizures

Seminars in Neurology ◽

10.1055/s-0038-1677008 ◽

2019 ◽

Vol 39 (01) ◽

pp. 073-081 ◽

Cited By ~ 3

Author(s):

Carl Bazil ◽

Anna Bank

Keyword(s):

Emergency Department ◽

Status Epilepticus ◽

Emergency Management ◽

Emergency Department Visits ◽

Emergency Physicians ◽

Common Cause ◽

Medical Evaluation ◽

Symptomatic Seizures ◽

New Onset

AbstractSeizure- and epilepsy-related complications are a common cause of emergency medical evaluation, accounting for 5% of 911 calls and 1% of emergency department visits. Emergency physicians and neurologists must be able to recognize and treat seizure- and epilepsy-related emergencies. This review describes the emergency evaluation and management of new onset seizures, breakthrough seizures in patients with known epilepsy, status epilepticus, acute symptomatic seizures, and acute adverse effects of antiepileptic drugs.

Epidemiology of Epilepsy

10.1093/med/9780199937837.003.0042 ◽

2017 ◽

Author(s):

Dale C Hesdorffer

Keyword(s):

Risk Factors ◽

Low Socioeconomic Status ◽

Febrile Seizures ◽

Childhood Onset ◽

Low Socioeconomic ◽

Different Types ◽

Symptomatic Seizures ◽

Active Epilepsy ◽

Health Planner

Epilepsy affects 1 out of every 26 people during their lifetime. Worldwide, the incidence of epilepsy ranges from 28.0/100,000 to 235.5/100,000, with the large variation attributable to differences in methodology across studies. The prevalence of active epilepsy provides important information about the burden of epilepsy in the population and spurs public health planner to assess the needs of the epilepsy population. The active prevalence of epilepsy ranges from 2.4/1,000 to 22.8/1,000 worldwide and more than 65 million people have active epilepsy. Risk factors for childhood-onset and adult-onset epilepsy are discussed, considering epilepsy etiologies (e.g., severe traumatic brain injury), newer risk factors without bidirectional relationships with epilepsy (e.g., low socioeconomic status), risk factors with bidirectional relationships (e.g., psychiatric disorders), and different types of acute symptomatic seizures (e.g., febrile seizures).

Acute-on-chronic subdural hematoma: a new entity for prophylactic anti-epileptic treatment?

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01508-9 ◽

2020 ◽

Author(s):

Sae-Yeon Won ◽

Daniel Dubinski ◽

Thomas Freiman ◽

Volker Seifert ◽

Florian Gessler ◽

...

Keyword(s):

Status Epilepticus ◽

Mortality Rate ◽

Subdural Hematoma ◽

Functional Outcomes ◽

Chronic Subdural Hematoma ◽

Control Group ◽

Acute Bleeding ◽

Symptomatic Seizures ◽

Abstract Purpose Acute-on-chronic subdural hematoma (acSDH) describes acute bleeding into a chronic subdural hematoma (SDH), after surgery or second trauma. Because seizures are a well-known complication of SDH, associated with substantial morbidity and mortality, we aimed to analyze the incidence of acute symptomatic seizures (ASz), including status epilepticus, and determine the functional outcomes in this specific cohort of patients. Methods A retrospective analysis was performed, including patients with acSDH who were admitted to our department between 2010 and 2019. The incidence and timely onset of ASz and status epilepticus were evaluated. Functional outcomes at discharge and at 3–6 month follow-up were analyzed based on the modified Rankin scale. Results Of 506 patients with chronic SDH, 29 patients (5.7%) were diagnosed with acSDH. The overall incidence of ASz and status epilepticus were 72.4% and 10.3%, respectively. Favorable outcomes were identified in 11 patients (52.4%) in the ASz group compared with 6 patients (75%) in the non-ASz group. The mortality rate was higher in the ASz group compared with that in the control group (29% vs 0%). At follow-up, favorable outcomes were similar to those observed at discharge (52.4% in the ASz group and 71.4% in the control group). The mortality rate was still higher in the ASz group, at 32% compared with 14% for the control group. Conclusion AcSDH has a high risk for ASz, including status epilepticus, and is associated with unfavorable outcomes and high mortality. Thus, prophylactic treatment with antiepileptic drugs should be considered among this specific cohort of patients.

Hyperosmolar hyperglycaemic state causing atypical status epilepticus with hippocampal involvement

Practical Neurology ◽

10.1136/practneurol-2021-003222 ◽

2021 ◽

pp. practneurol-2021-003222

Author(s):

Emanuele Bartolini ◽

Raffaella Valenti ◽

Josemir W Sander

Keyword(s):

Status Epilepticus ◽

Hippocampal Sclerosis ◽

Convulsive Status Epilepticus ◽

Epileptiform Discharges ◽

Symptomatic Seizures ◽

Mesial Temporal Lobe ◽

Permanent Brain Damage ◽

Diabetes mellitus may arise abruptly and decompensate suddenly, leading to a hyperglycaemic hyperosmolar state. Coma often ensues, although this usually reverses after the metabolic abnormalities have resolved. Acute symptomatic seizures can also occur in patients who are conscious, although these usually resolve after osmolarity and glycaemia have normalised. We describe an elderly woman who failed to regain vigilance despite prompt treatment; the cause was an unusual non-convulsive status epilepticus arising from the mesial temporal lobe and promoting a progressive and selective hippocampal involvement. During follow-up, her seizures recurred after stopping antiseizure medication and she developed hippocampal sclerosis, although she subsequently became seizure-free with antiseizure medications. Patients who are unresponsive in a hyperglycaemic hyperosmolar state may be having subclinical epileptiform discharges and risk developing permanent brain damage and long-term epilepsy.

Acute Seizures—Work-Up and Management in Children

Seminars in Neurology ◽

10.1055/s-0040-1718718 ◽

2020 ◽

Vol 40 (06) ◽

pp. 606-616

Author(s):

Lubov Romantseva ◽

Nan Lin

Keyword(s):

Pediatric Population ◽

Operational Definition ◽

Acute Seizures ◽

Appropriate Treatment ◽

Symptomatic Seizures ◽

Pediatric Populations ◽

Diagnostic Modalities ◽

Definition Of ◽

Work Up ◽

AbstractSeizures are common in the pediatric population; however, most children do not go on to develop epilepsy later in life. Selecting appropriate diagnostic modalities to determine an accurate diagnosis and appropriate treatment as well as with counseling families regarding the etiology and prognosis of seizures, is essential. This article will review updated definitions of seizures, including provoked versus unprovoked, as well as the International League Against Epilepsy operational definition of epilepsy. A variety of specific acute symptomatic seizures requiring special consideration are discussed, along with neonatal seizures and seizure mimics, which are common in pediatric populations.

Possible levetiracetam induced encephalopathy presenting as electrical status epilepticus: An unknown occurrence

International Journal of Epilepsy ◽

10.1016/j.ijep.2014.10.001 ◽

2014 ◽

Vol 01 (02) ◽

pp. 084-087 ◽

Cited By ~ 1

Author(s):

Rohan Mahale ◽

Anish Mehta ◽

Mahendra Javali ◽

Suryanarayana Sharma ◽

Byadaralli Madhusudhan ◽

...

Keyword(s):

Status Epilepticus ◽

Hepatic Encephalopathy ◽

Broad Spectrum ◽

Hepatic Metabolism ◽

Renal Elimination ◽

Anti Epileptic Drug ◽

Proven Efficacy ◽

Symptomatic Seizures ◽

Metabolic Encephalopathies

AbstractLevetiracetam is a novel, broad spectrum anti-epileptic drug with proven efficacy in generalized as well as focal onset seizures. It has renal elimination with no hepatic metabolism. Levetiracetam induced encephalopathy is rarely reported in literature. Triphasic waves in the electroencephalogram are seen in toxic-metabolic encephalopathies of various aetiology like hepatic encephalopathy, uraemia. We report a patient who was on levetiracetam for acute symptomatic seizures and developed encephalopathy with electroencephalogram showing generalised triphasic waves. These triphasic waves disappeared with intravenous lorazepam but without clinical improvement in sensorium. The electroencephalographic abnormality appeared as electrical status epilepticus which got normalised on discontinuation of levetiracetam. This is the first report of levetiracetam induced encephalopathy presenting as electrical status epilepticus and also depicts electroencephalographic correlate of levetiracetam induced encephalopathy.

The association between human herpes viruses and acute symptomatic seizures in Kenyan children

Journal of the International Child Neurology Association ◽

10.17724/jicna.2018.64 ◽

2019 ◽

pp. 17

Author(s):

Symon M Kariuki ◽

Christian Schubart ◽

Charles RJC Newton

Keyword(s):

Logistic Regression ◽

Herpes Virus ◽

Febrile Seizures ◽

Herpes Viruses ◽

Human Herpes ◽

Human Herpes Virus ◽

Symptomatic Seizures ◽

Herpès Virus ◽

Human Herpes Viruses

Background In malaria endemic areas, where up to 70% of children have peripheral parasitaemia, it is unclear why some children develop seizures. Human herpes viruses are common causes of febrile seizures. We investigated the hypothesis that seizures in children admitted to hospital are caused by concomitant human herpes virus infections. Methods We examined the presence of parasitaemia in plasma and viruses in cerebrospinal fluid (CSF) of 100 children with acute symptomatic seizures (84% with complex acute symptomatic seizures (focal, repetitive or prolonged)) and in 45 children without seizures using polymerase chain reaction. The analysis compared the distribution of human herpes virus between children with acute symptomatic seizures and those without these seizures by computing odds ratios using a logistic regression accounted for potential confounders. Results Human herpes viruses 6 & 7 were found in the CSF of 22% of children with acute symptomatic seizures and in 24% of those without seizures, and overall, there was no association with acute symptomatic seizures ((adjusted odds ratio (OR)=1.48 (95%CI, 0.54-4.05), p=0.448) nor complex acute symptomatic seizures (OR=2.34 (95%CI, 0.92-5.97), p=0.075). Human herpes virus 7 was significantly associated with complex acute symptomatic seizures (OR=8.80 (95%CI, 1.20-64.84), p=0.033), while herpes virus 6 was not (OR=1.71 (95%CI, 0.55-5.30), p=0.351). The logistic regression model with significant association for human herpes virus 7 and complex acute symptomatic seizures accounted for falciparum malaria, malnutrition and CSF protein levels, whose inclusion effect modified the OR of a baseline model by 81%. Conclusions Human herpes virus 7 but not 6 is associated with common complex acute symptomatic seizures in a malaria endemic area in Kenya. Viruses should be screened in children admitted with acute symptomatic seizures.