PEDIATRIC SEIZURES. Illinois Emergency Medical Services for Children 4th Edition November 2018
|
|
- Evelyn Nelson
- 5 years ago
- Views:
Transcription
1 PEDIATRIC SEIZURES Illinois Emergency Medical Services for Children 4th Edition November 2018 This educational module is eligible for 1.5 CEs.
2 ILLINOIS EMERGENCY MEDICAL SERVICES FOR CHILDREN (EMSC) Illinois EMSC is a collaborative program between the Illinois Department of Public Health and Ann & Robert H. Lurie Children s Hospital of Chicago aimed at improving pediatric emergency care within our state. Since 1994, the Illinois EMSC Advisory Board and several committees, organizations and individuals within EMS and pediatric communities have worked to enhance and integrate the following pediatric specific components into our state emergency care system: Education Practice standards Injury prevention Data initiatives Disaster preparedness 2
3 PROGRAM GOAL The goal of Illinois EMSC is to ensure that appropriate emergency medical care is available for ill and injured children at every point along the continuum of care. This educational activity is being presented without bias or conflict of interest from the planners and presenters. 3
4 Acknowledgements Illinois EMSC Facility Recognition & Quality Improvement Committee The Illinois EMSC Advisory Board gratefully acknowledges the commitment and dedication of the EMSC Facility Recognition & Quality Improvement Committee for their assistance with this module which was originally published in June This 4 th Edition underwent committee review in 2018 to assure that it is consistent with current practice standards. The contributions of this committee have led to this valuable resource and assists Illinois EMSC in striving toward the goal of improving pediatric emergency care within our state. Note: nothing in this module should be considered a replacement for prudent and cautious judgment of the health care provider treating the child. Every situation is unique and requires individualized care and independent treatment options. 4
5 PURPOSE The purpose of this educational module is to enhance the care of pediatric patients who present with seizures through appropriate Assessment Management Prevention of complications, and Disposition (including patient and parent/caregiver education) Suggested Citation: Illinois Emergency Medical Services for Children (EMSC), Pediatric Seizures, 4 th Edition November
6 EXCLUSIONS Management of post traumatic seizures is beyond the scope of this module and will not be addressed. Neonatal seizures are not addressed in the body of this module. However, information can be found in Appendix C. 6
7 PEDIATRIC SEIZURES Few health care problems elicit more distress than witnessing a child having a seizure. It is terrifying to many. When the victim is a child, and the observer is a parent or caregiver, that terror can become panic. This module seeks to aid you in minimizing that distress and maximizing the outcome for your patient with evidence-based guidelines. 7
8 OBJECTIVES At the conclusion of this module, you will be able to: Manage the child with a seizure in the prehospital and Emergency Department (ED) settings Identify the distinguishing characteristics between types of seizures in the pediatric patient Explain the rationale for specific diagnostic testing Provide educational information related to care of a child with seizures NOTE: Hyperlinks are provided throughout the module to offer additional information 8
9 TABLE OF CONTENTS 1. Introduction and Background 2. Febrile Seizure 3. First Unprovoked Seizure 4. Status Epilepticus 5. References 6. Resources 7. Appendices APPENDIX A EMSC Prehospital Protocols APPENDIX B Sample Emergency Department Guidelines APPENDIX C Neonatal Seizures 9
10 INTRODUCTION AND BACKGROUND Return to Table of Contents 10
11 U.S. DEMOGRAPHICS 1,2 3.4 million people in the U.S. have active epilepsy 3 million are adults (age 18 years and older) 470,000 are children (age 0-17 years) General Epilepsy Population costs 3 The direct health costs of epilepsy in the U.S. range from $10,192 to $47,869 per person annually. 11
12 INCIDENCE IN ILLINOIS 4 In 2014, 10,027 children age 0-17 years in Illinois were seen in the emergency department with the principle diagnosis of epilepsy/convulsions. 12
13 ILLINOIS EMSC STATEWIDE PEDIATRIC SEIZURE QI PROJECT 5 In , Illinois EMSC conducted a statewide survey of Emergency Department practice patterns (including medical record reviews) related to children presenting with: Simple Febrile Seizure (SFS) Unprovoked Seizures (UnS), and Status Epilepticus (SE) 13
14 PEDIATRIC SEIZURE QI PROJECT 5 Opportunities for improvement: Less than half of responding facilities had a protocol/policy/guideline/clinical pathway that addressed the clinical management of seizures (44%) or clinical management of SE in particular (19%) In the prehospital management of pediatric seizures, blood glucose assessments were documented in only 34% of SFS patients and slightly over half of UnS/SE patients For UnS/SE patients, seizure precautions were either not taken or not documented in more than 1/3 of the cases 14
15 A SEIZURE IS: Abnormal neuronal activity A sudden biochemical imbalance at the cell membrane Repeated abnormal electrical discharges Seen clinically as changes in motor control, sensory perception and/or autonomic function 6 15
16 CLINICAL PRESENTATION: MOTOR CHANGES Parents/caregivers may report seeing: Repetitive non-purposeful movements Staring Lip-smacking Falling down without cause Stiffening of any or all extremities Rhythmic shaking of any or all extremities Seizure activity cannot be interrupted with verbal or physical stimulation 7 16
17 CLINICAL PRESENTATION: SENSORY AND AUTONOMIC Parents/caregivers may report the child is: Feeling nauseated Feeling odd or peculiar Losing control of bowel or bladder Feeling numbness, tingling Experiencing odd smells or sounds 17
18 CLINICAL PRESENTATION: CONSCIOUSNESS Consciousness is the usual alertness or responsiveness the child demonstrates. Parents/caregivers may report or you may observe the child to have: Baseline alertness Diminished level of consciousness Unresponsive and unconscious 18
19 CLINICAL PRESENTATION: EVENTS THAT MIMIC SEIZURES Apnea Breath Holding Dizziness Myoclonus Pseudoseizures Psychogenic Seizures Rigors Shuddering Syncope Tics Transient Ischemic Attacks 19
20 SEIZURE CLASSIFICATIONS Generalized Involves BOTH hemispheres of the brain Always involves loss of consciousness Complex Involves motor* or autonomic # symptoms with altered level of consciousness May start in one muscle group and spread Partial Simple Can involve motor,* autonomic # or somatosensory + symptoms May start in one muscle group and spread Types: Tonic or clonic movements or combination (grand mal) Absence (petit mal) Myoclonic Atonic (e.g., drop attacks) Infantile spasms Types of symptoms: 1) Motor* - head/eye deviation, jerking, stiffening 2) Autonomic # - pupillary dilatation, drooling, pallor, change in heart rate or respiratory rate 3) Somatosensory + - smells, alteration of perception (déjà vu) 20
21 GENERALIZED SEIZURE CLASSIFICATION: DESCRIPTIONS 1 Absence Abrupt lapses of consciousness lasting a few seconds Atonic Abrupt, unexpected loss of muscle tone Myoclonic Rapid short contractions of one or all extremities 21
22 Return to Table of Contents 22
23 FEBRILE SEIZURE 8,9 Febrile seizures are the most common seizure disorder in childhood, affecting 2-4% of children between the ages of 6 months and 5 years. 23
24 FEBRILE SEIZURE 10 Caused by the increase in the core body temperature greater than o F or 38 o C Threshold of temperature which may trigger seizures is unique to each individual Can occur within the first 24 hours of an illness Can be the first sign of illness in 25-50% of patients 24
25 Are benign FEBRILE SEIZURE: CHARACTERISTICS Occurrence: between 6 months to 5 years of age May be either simple or complex type seizure Seizure accompanied by fever (before, during or after) WITHOUT ANY Central nervous system infection Metabolic disturbance History of previous seizure disorder 25
26 FEBRILE SEIZURE: TWO TYPES 8 Simple Febrile 6 months 5 years of age Febrile before, during or after seizure Includes all of the following Seizure lasting less than 15 minutes Generalized seizure Occurs once in a 24-hour period Complex Febrile 6 months 5 years of age Febrile before, during or after seizure One or more of the following Prolonged (lasting more than 15 minutes) Focal seizure Occurs more than once in 24 hours 26
27 Assess the A,B,Cs FEBRILE SEIZURE: PREHOSPITAL ASSESSMENT Assess neurological status (D = Disability using AVPU) Obtain seizure history from a dependable witness: How long was the seizure? What did it look like (movements, eye deviation)? History of previous seizures (child and family)? Does the child have a current illness/fever? Any indications of trauma or abuse? Length of postictal phase? List current medications Include any antipyretics given (time and dose) 27
28 AVPU The AVPU scale (Alert, Voice, Pain, Unresponsive) is a system by which a healthcare professional can measure and record a child s level of consciousness. The AVPU scale should be assessed using these identifiable traits, looking for the best response of each: A V P U Alert t he infant is active, responsive to parent s and interacts appropr iately with s urroundings ; t he child is lucid and fully responsive, can answer questions and s ee what you're doing. Voice t he child or infant is not looking around; responds to your voice, but may be drowsy, keeps eyes closed and may not speak coherently, or make s ounds. Pain t he child or infant is not alert and does not respond to your voice. Responds to a painful stimulus (e.g., s haking t he shoulders or possibly applying nail bed pressure). Unresponsive t he child or infant is unresponsive to any of t he above; unconscious. 28
29 FEBRILE SEIZURE: PREHOSPITAL MANAGEMENT Monitor the A, B, C, Ds Position with spinal motion restriction (if trauma) Follow seizure and aspiration precautions (per EMS System protocol) Physical exam Check blood glucose If blood glucose < 60 mg/dl, treat as appropriate Refer to the EMSC Seizure protocols (Appendix A) 29
30 FEBRILE SEIZURE: ED ASSESSMENT Baseline assessment Vital signs (including temperature) Assess the A, B, C, Ds Continue providing and documenting seizure and aspiration precautions 30
31 FEBRILE SEIZURE: ED ASSESSMENT (CONT.) Full History Obtain seizure history from a dependable witness: When did the seizure occur? How long was the seizure and what did it look like? How was the child acting immediately before the seizure? History of previous seizures (child and family)? History of developmental delay/recent loss of milestones? Does the child have a current illness/fever? Any indications of trauma or abuse? Length of postictal state? Immunization history? List current medications Include any antipyretics given (time and dose) 31
32 FEBRILE SEIZURE: ED MANAGEMENT 11 If still having a seizure, follow Status Epilepticus protocol Complete physical exam to identify the source of fever Lab testing No routine lab tests are necessary for the diagnosis of simple febrile seizures Direct lab testing toward identifying the source of fever 32
33 SIMPLE FEBRILE SEIZURE: LUMBAR PUNCTURE Evidence-based recommendations from the 2011 American Academy of Pediatrics (AAP) Subcommittee on Febrile Seizures 12 are as follows: A lumbar puncture should be performed in any child who presents with a seizure and a fever and has meningeal signs and symptoms (e.g., neck stiffness, Kernig and/or Brudzinski signs) or in any child whose history or examination suggests the presence of meningitis or intracranial infection. Current data does not support routine lumbar puncture in well-appearing, fully immunized children who present with a simple febrile seizure. 33
34 SIMPLE FEBRILE SEIZURE: LUMBAR PUNCTURE (CONT.) Additional evidence-based recommendations from the 2011 AAP Subcommittee on Febrile Seizures 12 are as follows: In any infant between 6 and 12 months of age who presents with a seizure and fever, a lumbar puncture is an option when: - the child is considered deficient in Haemophilus influenza type b (Hib) or Streptococcus pneumoniae immunizations (i.e., has not received scheduled immunizations as recommended) or - when the immunization status cannot be determined because of an increased risk of bacterial meningitis. A lumbar puncture is an option in the child who presents with a seizure and fever and is pretreated with antibiotics, because antibiotic treatment can mask the signs and symptoms of meningitis. 34
35 SIMPLE FEBRILE SEIZURE: DIAGNOSTIC TESTING 8,12 Simple Febrile Seizure EEG Should not be performed in a neurologically healthy child. Results are not predictive of recurrence or development of epilepsy CT/MRI Not indicated There are no current national guidelines addressing diagnostic testing recommendations for complex febrile seizures. 35
36 SIMPLE FEBRILE SEIZURE: ED ONGOING MANAGEMENT Reassess temperature Consider giving antipyretic if not previously administered As source of fever is identified, treat appropriately 36
37 SIMPLE FEBRILE SEIZURE: FAMILY EDUCATION 8,12,13 Here are some frequently asked questions parents/caregivers may have prior to discharge: Is my child brain damaged? There is no evidence of impact on learning abilities after seizure from SFS. Will this happen again? If child is under 12 months of age at time of first seizure, recurrence rate is 50% If child is greater than 12 months of age at time of first seizure, recurrence rate is 30% Most recurrences occur within 6-12 months of the initial febrile seizure 37
38 SIMPLE FEBRILE SEIZURE: FAMILY EDUCATION (CONT.) 8,12,13 Will my child get epilepsy? For simple febrile seizures, there is no increased risk of epilepsy Why not treat for possible seizures or fever? Anticonvulsants can reduce recurrence. However potential side effects of medications outweigh the minor risk of recurrence Prophylactic use of antipyretics does not have impact on recurrence For complex febrile seizures, there is a slight increase in the risk of epilepsy. 38
39 SIMPLE FEBRILE SEIZURE: FAMILY EDUCATION (CONT.) 12 Instruct parent/caregivers to prevent injury during a seizure: Position child while seizing in a side-lying position Protect head from injury Loosen tight clothing about the neck Prevent injury from falls Reassure child during event Do not place anything in the child s mouth 39
40 SIMPLE FEBRILE SEIZURE: Prior to discharge home DISPOSITION Educate regarding use of: Thermometer Antipyretics for fever management When to contact or ambulance Call after 5 minutes of seizure activity Identify a Primary Care Provider for follow-up appointment and stress importance of follow-up Provide developmentally appropriate explanation of event for child and family members 40
41 FEBRILE SEIZURE: TEST YOURSELF 1. Simple Febrile Seizures: A. Indicate an underlying neurological condition B. Require anticonvulsant medication C. Occur in children 6 months to 5 years of age D. Frequently lead to epilepsy 2. Which of the following are important history questions? A. Was there trauma? B. What did the seizure look like? C. Medications and herbal supplements? D. All of the above 3. Diagnostic workup in the ED is based on suspicions of: A. Meningitis B. Trauma C. Unknown immunization status D. All of the above 4. Discharge education should include instructing parents on which of the following? A. Scheduling an EEG B. Actions to take to protect the child from injury during a seizure C. Importance of a follow up MRI D. Anticonvulsant medications Proceed to next slide for answers 41
42 FEBRILE SEIZURE: TEST YOURSELF: ANSWER KEY 1. Simple Febrile Seizures: C. Occur in children 6 months to 5 years of age 3. Diagnostic workup in the ED is based on suspicions of: D. All of the above 2. Which of the following are important history questions? D. All of the above 4. Discharge education should include which of the following? B. Actions to take to protect the child from injury during a seizure 42
43 Return to Table of Contents 43
44 FIRST UNPROVOKED SEIZURE 14 This is a first seizure that occurs without an immediate precipitating event. Etiology may be: Remote symptomatic (related to a pre-existing brain abnormality/insult) Cryptogenic or idiopathic (no known cause) 44
45 FIRST UNPROVOKED SEIZURE: Parents/caregivers may describe symptoms consistent with the following: Partial seizure Generalized onset, tonic-clonic seizure Tonic seizure PRESENTATION Remember: this is a seizure that occurs without an immediate precipitating event. 45
46 FIRST UNPROVOKED SEIZURE: PREHOSPITAL ASSESSMENT Assess the A, B, C, Ds Obtain seizure history from a dependable witness: How long was the seizure? What did it look like (movements, eye deviation)? History of previous seizures (child and family)? Does the child have a current illness/fever? Any indications of trauma or abuse? Length of postictal state List current medications Include any antipyretics given (time and dose) 46
47 FIRST UNPROVOKED SEIZURE: PREHOSPITAL MANAGEMENT Monitor the A, B, C, Ds Position with C-Spine protection (if trauma) Follow seizure and aspiration precautions (per protocol) Physical assessment Check blood glucose If blood glucose < 60 mg/dl, treat as appropriate Refer to EMSC Seizure protocols (Appendix A) 47
48 FIRST UNPROVOKED SEIZURE: ED ASSESSMENT Baseline assessment Vital signs (including temperature) Assess the A, B, C, Ds Continue providing and documenting seizure and aspiration precautions 48
49 FIRST UNPROVOKED SEIZURE: ED ASSESSMENT (CONT.) If still seizing, follow the Status Epilepticus protocol Full History Obtain seizure history from a dependable witness: Recent exposures (chemical, industrial)? When did the seizure occur? How long was the seizure and what did it look like? How was the child acting immediately before the seizure? History of previous seizures (child and family)? History of developmental delay/recent loss of milestones? Does the child have a current illness? Any indications of trauma or abuse? Immunization history? Length of postictal state? 49
50 FIRST UNPROVOKED SEIZURE: ED ASSESSMENT (CONT.) List current medications Include any antipyretics given (time and dose) Include anticonvulsants given by prehospital team (time and dose) Physical exam Head-to-toe assessment 50
51 FIRST UNPROVOKED SEIZURE: DIAGNOSTIC TESTING 14 Laboratory tests are based on individual clinical circumstances and may include: CBC with differential Blood glucose Electrolytes Calcium, magnesium, phosphorous Urine drug/toxicology screen Urine HCG (age/sex dependent) Lumbar puncture is only indicated if there are other symptoms that suggest a diagnosis of meningitis. 51
52 FIRST UNPROVOKED SEIZURE: DIAGNOSTIC TESTING MRI 14,15 MRI should be considered for: Children under 1 year of age All children with significant acute cognitive or motor impairment Unexplained abnormalities on neurologic exam Seizure of focal onset without generalization Abnormal EEG Abnormalities on MRI are seen in up to 1/3 of children However, most abnormalities do not influence immediate treatment or management (such as need for hospitalization) 52
53 FIRST UNPROVOKED SEIZURE: DIAGNOSTIC TESTING CT SCAN 14,15 Emergent CT Scan (without contrast) should be considered for any child who exhibits any of the following: Significant, acute cognitive or motor impairment New focal deficit not quickly resolving Not returned to baseline MRI is the modality of choice, if available. 53
54 FIRST UNPROVOKED SEIZURE: DIAGNOSTIC TESTING EEG 14,15 Obtain on ALL children in whom a nonfebrile seizure has been diagnosed Can be arranged as an outpatient Should be interpreted by a neurologist (preferably pediatric neurologist) EEG results will: Help predict the risk of recurrence Classify the seizure type or epilepsy syndrome Influence the decision to perform additional neuroimaging studies 54
55 FIRST UNPROVOKED SEIZURE: ED MANAGEMENT If child is still actively having seizures Refer to the Status Epilepticus protocol When child is stable Consult with Neurologist (or Intensivist) For possible medication recommendations To determine disposition: Admit to observe Transfer (if neurologist is unavailable) Discharge home with Primary Care Provider and Neurology follow-up 55
56 FIRST UNPROVOKED SEIZURE: RECURRENCE RISK The majority of children who experience an unprovoked seizure will have few or no recurrences Approximately 10% will go on to have additional seizures regardless of therapy Predictors of recurrence include: abnormal EEG, underlying etiology, and abnormal neurologic exams Remote symptomatic recurrence risk over 2 years is above 50% Cryptogenic or idiopathic recurrence risk over 2 years is 30-50% If first seizure is prolonged, recurrent seizures are more likely to be prolonged. 56
57 FIRST UNPROVOKED SEIZURE: DRUG THERAPY 14,15 Type of medication (if offered) depends on: Type, frequency and severity of seizures Side effects, titration, drug interactions, dosing forms, cost of drug Neurologist preference 57
58 FIRST UNPROVOKED SEIZURE: DISCHARGE & FAMILY EDUCATION Prior to discharge home Identify Primary Care Provider and Neurologist for follow-up appointments Provide plan for outpatient EEG Provide parental support Access to prescription resources Social services resources Consider rescue medication for home, based on neurologist recommendation (e.g., rectal diazepam) 58
59 FIRST UNPROVOKED SEIZURE: FAMILY EDUCATION 11 Instruct parent/caregivers to prevent injury during a seizure: Position child while seizing in a side-lying position Protect head from injury Loosen tight clothing about the neck Prevent injury from falls Reassure child during event Do not place anything in the child s mouth 59
60 FIRST UNPROVOKED SEIZURE: FAMILY EDUCATION (CONT.) Instruct in use of or ambulance services Provide developmentally appropriate explanation to child about the seizure event and treatment Discourage swimming alone No driving a car until cleared by a physician 60
61 FIRST UNPROVOKED SEIZURE: FAMILY EDUCATION (CONT.) Here are some frequently asked questions parents/caregivers may have prior to discharge: How likely is it that my child will have seizures again? The risk of recurrence relates to the underlying etiology and EEG results (normal or abnormal). The majority of children who experience an unprovoked seizure will have few or no recurrences. Approximately 10% will go on to have additional seizures regardless of therapy. 14 Is there a risk of dying from the seizure if we don t start medication today? Sudden unexpected death is very uncommon (usually related to an underlying neurologic handicap rather than seizure activity). There are no studies showing treatment after a first seizure alters the small risk of sudden death
62 FIRST UNPROVOKED SEIZURE: TEST YOURSELF 1. Which of the following is a true statement regarding a First Unprovoked Seizure: A. Occurs without a precipitating event B. Is never associated with an underlying neurological condition C. Always leads to epilepsy D. Requires immediate initiation of antiepileptic medication 2. Children who have a First Unprovoked Seizure A. Should have their blood glucose checked by ambulance staff B. Could proceed to have Status Epilepticus C. Will require anti-pyretics to prevent seizures D. A and B 3. All children who have had a First Unprovoked Seizure should have an outpatient EEG. A. True B. False 4. The majority of children who have a First Unprovoked Seizure will have few or no recurrences. A. True B. False Proceed to next slide for answers 62
63 FIRST UNPROVOKED SEIZURE: TEST YOURSELF: ANSWER KEY 1. Which of the following is a true statement regarding a First Unprovoked Seizure: A. Occurs without a precipitating event 3. All children who have had a First Unprovoked Seizure should have an outpatient EEG. A. True 2. Children who have a First Unprovoked Seizure D. A and B 4. The majority of children who have a First Unprovoked Seizure will have few or no recurrences. A. True 63
64 Return to Table of Contents 64
65 STATUS EPILEPTICUS: DEFINITIONS 19 Seizures that persist without interruption for more than 5 minutes Two or more sequential seizures without full recovery of consciousness between seizures This is a life threatening emergency that requires immediate treatment. 65
66 STATUS EPILEPTICUS 19 Commonly occurs in children with epilepsy (9-27% over time) Complications from Status Epilepticus result from both the impact of the convulsive state on the body systems (such as the cardiac and respiratory systems) and the neuronal cellular injury which leads to cell death Rapid termination of the seizure activity protects against neuronal injury 66
67 STATUS EPILEPTICUS: CLASSIFICATION 20 Type Incidence Description Remote Symptomatic SE 33% Acute Symptomatic SE 26% Febrile SE 22% Status Epilepticus (SE) with no immediate event but the child had a previous history of CNS malformation, traumatic brain injury or chromosomal disorder SE with concurrent acute illness (e.g., meningitis, encephalitis, hypoxia, trauma, intoxication) SE with a febrile illness but not a Central Nervous System infection (e.g., sinusitis, sepsis, upper respiratory infection) Cryptogenic SE 15% SE with no identifiable cause 67
68 STATUS EPILEPTICUS: PREHOSPITAL ASSESSMENT Assess the A, B, C, Ds Obtain seizure history from a dependable witness: When did the seizure begin? What did it look like (movements, eye deviation)? History of previous seizures (child and family)? Does the child have a current illness/fever? Any indications of trauma or abuse? Emergency Information Form for Children with Special Needs? 68
69 STATUS EPILEPTICUS: PREHOSPITAL ASSESSMENT List current medications Include any antipyretics given (time and dose) Do the parents have any anticonvulsant medications (e.g., rectal diazepam)? Have parents given any anticonvulsant medications (time, route, and dose)? 69
70 STATUS EPILEPTICUS: PREHOSPITAL ASSESSMENT Assess the A, B, C, Ds Positioning (with C-Spine protection if trauma) Jaw thrust Recovery position (side-lying) Provide nasal airway, if needed Seizure safety precautions (per protocol) Aspiration precautions (per protocol) Oxygen Suction Blood glucose testing If blood glucose < 60 mg/dl, treat as appropriate 70
71 STATUS EPILEPTICUS: PREHOSPITAL ASSESSMENT If parent/caregiver has rectal diazepam and has not given it, the parent/caregiver should be requested to administer it Document time and dose Follow Pediatric Seizures ALS guideline (if appropriate) Contact Medical Control REFER TO APPENDIX A for EMSC Seizure Protocols 71
72 STATUS EPILEPTICUS: ED GOALS OF THERAPY 19,21 Minimize seizure time as much as possible and provide drug therapy promptly. Drug therapy to halt seizure With IV/IO access, administer *LORazepam IV/IO If no IV/IO access, administer: Diazepam PR, or Midazolam IN *The Institute for Safe Medication Practices recommends using Tall Man (mixed case) letters in order to distinguish drugs with similar sounding names decreasing the chances of safety errors. 72
73 STATUS EPILEPTICUS: ED ASSESSMENT Assess the A, B, C, Ds Full vital signs; check bedside glucose and treat (per protocol) Continue to provide and document seizure and aspiration precautions (per protocol) Review Prehospital History and Treatment 73
74 STATUS EPILEPTICUS: ED MANAGEMENT Full History Obtain seizure history from a dependable witness: How long has the seizure been going on and what did it look like when it started? How was the child acting immediately before the seizure? History of previous seizures (child and family)? History of developmental delay/recent loss of milestones? Does the child have a current illness? Any indications of trauma or abuse? Immunization history? 74
75 STATUS EPILEPTICUS: ED ASSESSMENT Assess E (exposure) List current medications When were they last given? Recent exposures - chemical, industrial, infectious? Was patient recently out of the country? 75
76 STATUS EPILEPTICUS: ED MANAGEMENT FIRST 5 MINUTES 21 Evaluate airway Suction, position and provide nasal airway as needed Provide 100% oxygen (non-rebreather) Establish vascular access Draw labs as determined by history, e.g. : CBC, Electrolytes, Blood glucose, Calcium, Magnesium, Phosphorus Toxicology screen, if indicated by history Antiepileptic drug level, as indicated Administer benzodiazepines LORazepam IV/IO 0.1 mg/kg No IV access, give either: Diazepam PR 0.5 mg/kg (max PR dose = 20 mg) or Midazolam IM 0.1 mg/kg or IN 0.2 mg/kg Benzodiazepines may cause respiratory and cardiac depression. REFER TO APPENDIX B for sample guidelines 76
77 STATUS EPILEPTICUS: ED MANAGEMENT NEXT 10 MINUTES 21 Reassess the A, B, Cs Continue supportive airway management Suction, position and provide nasal airway as needed Provide 100% oxygen (non-rebreather) Assess need for intubation Evaluate results of rapid blood glucose testing If the seizure activity continues Administer medications (per guidelines) Repeat IV LORazepam 0.1 mg/kg Administer IV/IM Fosphenytoin 20 mg/kg PE (Phenytoin equivalents) PHENobarbital is preferred in neonates. REFER TO APPENDIX B for sample guidelines 77
78 STATUS EPILEPTICUS: ED MANAGEMENT NEXT 15 MINUTES Having administered 2-3 doses of benzodiazepines, and a dose of Fosphenytoin without halting the seizure, consider the patient in refractory Status Epilepticus 21 Consult with Neurology and/or Intensivist for further management recommendations If available, evaluate lab results REFER TO APPENDIX B for sample guidelines 78
79 STATUS EPILEPTICUS: ED MANAGEMENT REFRACTORY SE If seizure activity persists (after appropriate doses of benzodiazepines and Fosphenytoin), load with a second long-acting AED that was not used initially (e.g., valproic acid, levetiracetam) Manage with continuous EEG monitoring Contact PICU/NICU to begin transfer to higher level of care It is imperative to stop the seizure activity. If rapid sequence induction is necessary, use short-acting paralytics to ensure that ongoing seizure activity is not masked. REFER TO APPENDIX B for sample guidelines 79
80 Status Epilepticus: ED Management Transfer 22 For a child in Status Epilepticus after 30 minutes of refractory SE, enact plans to transfer to your PICU/NICU or transport to a higher level of care Continued testing can be arranged in that setting Consider EEG with new onset SE Neuroimaging (CT/MRI) if etiology is unknown REFER TO APPENDIX B for sample guidelines 80
81 STATUS EPILEPTICUS: DISPOSITION Discuss child s progress and advice regarding admission or transfer based on patient status and neurology consultation with parents/caregiver Utilize a specialty/critical care transport team As applicable, explain these events to the child in a developmentally appropriate manner 81
82 STATUS EPILEPTICUS: PARENT EDUCATION Provide parents/caregivers information regarding child s condition and treatment plan Provide emotional/psychosocial support Encourage use of the Emergency Information Form [developed by the American Academy of Pediatrics (AAP) & American College of Emergency Physicians (ACEP)] for possible future events 82
83 STATUS EPILEPTICUS: EMERGENCY INFORMATION FORM The Emergency Information Form (EIF) for Children With Special Needs resource was developed by the AAP and the ACEP. A standardized medical summary with Information for prehospital and hospital emergency care personnel Updates entered by caregivers English and Spanish versions 24-hour accessibility Free, Downloadable, interactive forms are available at the ACEP website. To be completed by both the child s medical team and parents/caregivers. Copies should be kept by parents, as well as on file at the PCP s office, subspecialist s office, local ED, and school nurse s office. 83
84 STATUS EPILEPTICUS: TEST YOURSELF 1. You respond to a call for a 4-year-old child. You find the child on the floor of the playroom, unresponsive to voice with rhythmic movements of both the upper and lower extremities. The parents report that the child has had seizures, starting at age 2. The seizure activity has always lasted only about 1 minute. The parents called when the initial seizure stopped, but the seizure started again with about one minute in between. They estimate the child has been seizing for about 15 minutes. Your FIRST response is to: A. Move the child to the bed B. Establish vascular access C. Protect/position the airway D. Give rectal diazepam Proceed to next slide for answer 84
85 STATUS EPILEPTICUS: TEST YOURSELF: ANSWER KEY 1. You respond to a call for a 4-year-old child. You find the child on the floor of the playroom, unresponsive to voice with rhythmic movements of both the upper and lower extremities. The parents report that the child has had seizures, starting at age 2. The seizure activity has always lasted only about 1 minute. The parents called when the initial seizure stopped, but the seizure started again with about one minute in between. They estimate the child has been seizing for about 15 minutes. Your FIRST response is to: C. Protect/position the airway 85
86 STATUS EPILEPTICUS: TEST YOURSELF 2. How quickly should the first benzodiazepine be given after Status Epilepticus begins? A. At 30 minutes B. At 20 minutes C. Within 5 minutes D. After 60 minutes 3. What drugs are used first in status epilepticus? A. Lorazepam B. Fosphenytoin C. Diazepam D. A and C 4. Who is likely to have status epilepticus? A. Child with a history of epilepsy B. Child with encephalitis C. Child with a traumatic brain injury D. All of the above Proceed to next slide for answers 86
87 STATUS EPILEPTICUS: TEST YOURSELF: ANSWER KEY 2. How quickly should the first benzodiazepine be given after Status Epilepticus begins? C. Within 5 minutes 3. What drugs are used first in status epilepticus? D. A and C 4. Who is likely to have status epilepticus? D. All of the above 87
88 Resources and Appendices Return to Table of Contents 88
89 Online Resources American Epilepsy Society American Academy of Neurology Patient Education Materials CDC: Epilepsy Citizens United for Research in Epilepsy (CURE) Epilepsy Foundation: Epilepsy and Seizure Response for Law Enforcement and EMS (free online training) Epilepsy Therapy Project Return to Table of Contents 89
90 Video Resources Understanding Epilepsy Types of Seizures Understanding Partial Seizures Understanding Generalized Seizures What Causes Epilepsy? Diagnosing Epilepsy Seizure Imitators Overview Return to Table of Contents 90
91 APPENDIX A EMSC PREHOSPITAL PROTOCOLS Return to Table of Contents 91
92 EMSC PREHOSPITAL All Pediatric Seizure care guidelines follow this sequence: Initial Medical Care/Assessment PROTOCOLS Protect the child from Injury Vomiting and aspiration precautions THE NEXT STEPS DEPEND ON THE LEVEL OF CARE OF THE RESPONDER 92
93 EMSC PREHOSPITAL PROTOCOLS The below prehospital guidelines can be accessed as attachments to this educational module: BLS/EMERGENCY MEDICAL RESPONDER (EMR) CARE GUIDELINE ALS/ILS CARE GUIDELINE Source: Illinois EMSC Pediatric Prehospital Protocols 93
94 APPENDIX B SAMPLE EMERGENCY DEPARTMENT GUIDELINES Return to Table of Contents 94
95 SAMPLE ED SEIZURE GUIDELINES The below organizations are providing access to their ED pediatric seizures guidelines. Please acknowledge/cite these organizations if using their work in developing your guidelines and/or educational resources. Advocate Children s Hospital Emergency Department Guidelines Status Epilepticus Guidelines OSF St. Francis Medical Center/Children s Hospital of Illinois Pediatric Status Epilepticus Guidelines (click on attachment icon at bottom right of this slide) Seattle Children s Hospital Pediatric Seizures Febrile Seizures University of Chicago Comer Children s Hospital Pediatric Emergency Clinical Guidelines 95
96 APPENDIX C NEONATAL SEIZURES Return to Table of Contents 96
97 NEONATAL SEIZURES Neonatal seizures can be difficult to diagnose May consist of very subtle and unusual physical signs Eye deviation, staring episodes, winking In neonates, onset of seizure activity is important in determining etiology First hours of life Ischemic hypoxia 72 hours to 1 week of age Familial neonatal seizures Metabolic disorders 97
98 NEONATAL SEIZURES Beyond the standard history, ask about the pregnancy, labor and delivery and maternal risk factors Physical exam should include head circumference and careful inspection for dysmorphic features and cutaneous lesions 14 Consult with a pediatric neurologist to identify infantile seizure disorders 98
99 NEONATAL SEIZURES: STATUS EPILEPTICUS Assess the A, B, Cs Evaluate and maintain airway Provide 100% oxygen Establish vascular access Obtain rapid glucose Administer Medications PHENobarbital 20 mg/kg IV Repeat up to 40 mg/kg total dose Contact Neurology 99
100 References Return to Table of Contents 100
101 REFERENCES 1. E p i l e p sy a n d S e i z u re S t a t i s t i c s. E p i l e p syfo u n d at i o n. o rg. Re t r i e ve d A u g u s t 3 0, f ro m h t t p : / / w w w. e p i l e p syfo u n d at i o n. o rg /aboute p i l e p sy / w h at i s e p i l e p sy/statistics.cfm. 2. C e n t e rs f o r D i s e a s e C o n t ro l a n d P r e v e n t i o n. E p i l e p sy Fa s t Fa c t s. Re t r i e ve d A u g u s t 3 0, f ro m h t t p : / / w w w. c d c. go v /e p i l e p sy/basics/fa s t - fa c t s. h t m. 3. B e g l e y, C. E. & D u rg i n, T. L. ( ). T h e d i re c t c o s t o f e p i l e p sy i n t h e U n i t e d S t a t e s : a systematic r e v i e w o f e s t i m ate s. E p i l e p s i a, 5 6 ( 9 ), d o i : /e p i A H R Q H C U P n e t o n l i n e q u e r y system, w i t h I l l i n o i s d a t a p ro v i d e d b y I D P H t o A H R Q. Re t r i e ve d A u g u s t 3 0, f ro m h t t p : / / h c u p n et. a h rq. go v / 5. I l l i n o i s E m e r g e n c y M e d i c a l S e r v i c e s f o r C h i l d re n. ( ). Pe d i a t r i c s e i z u re s i n t h e e m e r g e n c y d e p a r t m e n t : s u m m a r y r e p o r t. Re t r i e ve d S e p t e m b e r 1 7, f ro m : \ \ c h i l d re n s m e m o r i a l. o rg \ D e p a r t \ I l l i n o i s E M S C P ro g ra m \ [ R ESTO R E ] \ E M S C F i l e s \ G ra n t _ T I _ \ S e i z u re _ Q I To o l \ S e i z u re D a t a Re p o r t s \ S e i z u re s _ s u m m a r y _ report.pdf 6. P i l l o w s, M.T., K i m m e l, K., D o c t o r, S. U., & H o w e s, D. S. ( ) S e i z u re A s s e s s m e n t i n t h e E m e r g e n c y D e p a r t m e n t. e M e d i c i n e. M e d s c a p e. c o m. U p d ated J a n u a r y 2 3, F i s h e r, P. G. ( ). F i rst a n d s e c o n d s e i z u re : w h a t t o d o a n d k n o w. C o n t e m p o r a r y Pe d i a t r i c s, 24( 4 ),
102 REFERENCES (CONT.) 8. Steering Committee o n Quality Improvement and Management, Subcommittee on Febrile S eizures. (2008). Febrile seizures: clinical practice guidelines for the long-term management o f the child w ith simple febrile seizures. Pediatrics, 121(6), doi: /peds Millichap, J. J. (2018). Clinical features and evaluation o f febrile seizures. UpToDate. Retrieved July 18, 2018 f ro m: galter.northwestern.edu 10. Freedman, S.B. & Powell, E.C. (2003). Pediatric seizures and their management in the emergency department. Clinical Pediatric Em ergency Medicine, 4 (3), doi: /S (03) American Association o f N euroscience N urses. (2009). Care of the patient with seizures. 2 nd ed: Glenview, IL. 12. Steering Committee o n Quality Improvement and Management, Subcommittee on Febrile S eizures: (2011). Febrile seizures: guidelines fo r the neurodiagnostic evaluation o f the child w ith a simple febrile seizure. Pediatric s, 127 (2), doi: /peds Millichap, J. J. (2018). Treatment and pro gnosis o f febrile seizures. UpToDate. Retrieved July 18, 2018 from galter.northwestern.edu 102
103 REFERENCES (CONT.) 14. Hirtz, D., B erg, A., B ettis, D., Camf ield, C., Camf ield, P., Crumrine, P., et al. (2003). Practice parameter: treatment o f the child w ith a f irst unpro voked seizure: report of the quality standards subco mmittee o f the American Academy of N eurology and the practice co mmittee o f the Child N euro logy S o ciety. Neurology, 60, doi: /01.WNL B6 15. Hirtz, D., Ashwal, S., B erg, A., B ettis, D., Camf ield, C., Camf ield, P., et al. (2000). Practice parameter: evaluating a f irst nonfebrile seizure in children: report of the quality standards subco mmittee o f the American Academy o f N eurology, the Child N eurology S o ciety, and the American Epilepsy S o ciety. Neurology, 55 (5), doi: /WNL Wilfong, A. (2017). S eizures and epilepsy in children: classification, etiology, and clinical features. UpToDate. Retrieved July 18, 2018 f ro m - uptodate.com.ezproxy. galter.northestern.edu 17. Wilfong, A. (2016). Clinical and laboratory diagnosis o f seizures in infants and children. UpToDate. Retrieved July 18, 2018 from - uptodate.com.ezproxy. galter.northestern.edu 18. Wilfong, A. (2017). S eizures and epilepsy in children: initial treatment and monitoring. UpToDate. Retrieved July 18, 2018 f ro m - uptodate.com.ezproxy. galter.northestern.edu 103
104 REFERENCES (CONT.) 19. M i l l i ka n, D., R i c e, B., & S i l b e rg l e i t, R. ( ). E m e r g e n c y t r e at m e n t o f stat u s e p i l e p t i c u s : c u r re n t t h i n k i n g. E m e r g e n c y M e d i c i n e C l i n i c s o f North A m e r i c a, 2 7 ( 1 ), d o i : j. e m c R i v i e l l o, J. J., A s h w a l., S., H i r t z, D., B a l l a b a n - G i l., K., M o r t o n, L. D., P h i l l i p s, S., et a l. ( ). P ra c t i c e p a ra m e t e r : d i a g n o s t i c a s s e s s m e n t o f t h e c h i l d w i t h s t a t u s e p i l e p t i c u s ( a n e v i d e n c e b a s e d r e v i e w ) : r e p o r t o f t h e q u a l i t y s t a n d a rd s s u b c o m m i t t e e o f t h e A m e r i c a n A c a d e my o f N e u ro l o g y a n d t h e p ra c t i c e c o m m i t t e e o f t h e C h i l d N e u ro l o g y S o c i e t y. N e u r o l o g y, 6 7 ( 9 ), d o i : / 0 1.w n l d 21. Ku r z, J. E., & G o l d s t e i n, J. ( ). S t a t u s e p i l e p t i c u s i n t h e p e d i at r i c e m e r g e n c y d e p a r t m e n t. C l i n i c a l Pe d i a t r i c E m e r g e n c y M e d i c i n e, 1 6 ( 1 ), d o i : j. c p e m A b e n d, N. S., & D l u g o s, D. J. ( ). Tr e at m e n t o f ref ra c t o r y s t a t u s e p i l e p ti c u s : l i t e rat u re r e v i e w a n d a p ro p o s e d p ro t o c o l. Pe d i a t r i c N e u r o l o g y, 3 8 ( 6 ), d o i : / j. p e d i at r n e u ro l Tay l o r, C., P i a n t i n o, J., H a g e m a n, J., Ly o n s, E., J a n i e s, K., L e o n a rd, D., e t a l. ( ). E m e r g e n c y d e p a r t m e n t m a n a ge m e n t o f p e d i at r i c u n p ro v o ke d s e i z u re s a n d s t a t u s e p i l e p t i c u s i n t h e s t a t e o f I l l i n o i s. J o u r n a l o f C h i l d N e u r o l o g y, 3 0 ( 1 1 ), d o i : / C a ra p e t i a n, S., H a g e m e n t, J., Ly o n s, E., L e o n a rd, D., J a n i e s, K., Ke l l e y, K., et a l. ( ). E m e r g e n c y d e p a r t m e n t e v a l u at i o n a n d m a n a g e m e n t o f c h i l d re n w i t h s i m p l e f e b r i l e s e i z u res. C l i n i c a l Pe d i a t r i c s, 5 4 ( 1 0 ), d o i : /
105 THE END 105
Status Epilepticus in Children
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Status Epilepticus in Children. These podcasts are designed to give medical students an overview of key topics in pediatrics.
More informationDr. Dafalla Ahmed Babiker Jazan University
Dr. Dafalla Ahmed Babiker Jazan University change in motor activity and/or behaviour due to abnormal electrical activity in the brain. seizures in children either - provoked by somatic disorders originating
More informationFEBRILE SEIZURES. IAP UG Teaching slides
FEBRILE SEIZURES 1 DEFINITION Febrile seizures are seizures that occur between the age of 6 and 60 months with a temperature of 38 C or higher, that are not the result of central nervous system infection
More informationDavid Dredge, MD MGH Child Neurology CME Course September 9, 2017
David Dredge, MD MGH Child Neurology CME Course September 9, 2017 } 25-40,000 children experience their first nonfebrile seizure each year } AAN/CNS guidelines developed in early 2000s and subsequently
More informationWHOLE LOTTA SHAKIN GOIN ON
WHOLE LOTTA SHAKIN GOIN ON ADAM M. YATES, MD FACEP ASSOCIATE CHIEF OF EMERGENCY SERVICES UPMC MERCY SEIZURE DEFINITIONS Partial(focal) only involves part of the brain General Involves entire brain Simple
More informationMeasures have been taken, by the Utah Department of Health, Bureau of Health Promotions, to ensure no conflict of interest in this activity
Measures have been taken, by the Utah Department of Health, Bureau of Health Promotions, to ensure no conflict of interest in this activity Seizures in the School Setting Meghan Candee, MD MS Assistant
More informationImages have been removed from the PowerPoint slides in this handout due to copyright restrictions.
Seizures Seizures & Status Epilepticus Seizures are episodes of disturbed brain activity that cause changes in attention or behavior. Donna Lindsay, MN RN, CNS-BC, CCRN, CNRN Neuroscience Clinical Nurse
More informationPediatrics. Convulsive Disorders in Childhood
Pediatrics Convulsive Disorders in Childhood Definition Convulsion o A sudden, violent, irregular movement of a limb or of the body o Caused by involuntary contraction of muscles and associated especially
More informationThere are several types of epilepsy. Each of them have different causes, symptoms and treatment.
1 EPILEPSY Epilepsy is a group of neurological diseases where the nerve cell activity in the brain is disrupted, causing seizures of unusual sensations, behavior and sometimes loss of consciousness. Epileptic
More informationChild-Youth Epilepsy Overview, epidemiology, terminology. Glen Fenton, MD Professor, Child Neurology and Epilepsy University of New Mexico
Child-Youth Epilepsy Overview, epidemiology, terminology Glen Fenton, MD Professor, Child Neurology and Epilepsy University of New Mexico New onset seizure case An 8-year-old girl has a witnessed seizure
More information5/23/14. Febrile seizures: Who need further workup? Afebrile seizures: Who needs imaging? Status epilepticus: Most effective treatments
Febrile seizures: Who need further workup? Afebrile seizures: Who needs imaging? Status epilepticus: Most effective treatments Andi Marmor, MD, MSEd Associate Professor, Pediatrics University of California,
More informationEpilepsy. Epilepsy can be defined as:
Epilepsy Epilepsy can be defined as: A neurological condition causing the tendency for repeated seizures of primary cerebral origin Epilepsy is currently defined as a tendency to have recurrent seizures
More informationOutline. What is a seizure? What is epilepsy? Updates in Seizure Management Terminology, Triage & Treatment
Outline Updates in Seizure Management Terminology, Triage & Treatment Joseph Sullivan, MD! Terminology! Videos of different types of seizures! Diagnostic evaluation! Treatment options! Acute! Maintenance
More informationFebrile Seizures. Preface. Definition, Evaluation, Assessment, and Prognosis. Definition
Febrile Seizures Guideline significantly revised by Rebecca Latch, MD, in collaboration with the ANGELS team. Last reviewed by Rebecca Latch, MD, July 22, 2016. Guideline replaced Evaluation and Treatment
More informationNeuromuscular Disease(2) Epilepsy. Department of Pediatrics Soochow University Affiliated Children s Hospital
Neuromuscular Disease(2) Epilepsy Department of Pediatrics Soochow University Affiliated Children s Hospital Seizures (p130) Main contents: 1) Emphasize the clinical features of epileptic seizure and epilepsy.
More informationEpilepsy CASE 1 Localization Differential Diagnosis
2 Epilepsy CASE 1 A 32-year-old man was observed to suddenly become unresponsive followed by four episodes of generalized tonic-clonic convulsions of the upper and lower extremities while at work. Each
More informationObjectives / Learning Targets: The learner who successfully completes this lesson will be able to demonstrate understanding of the following concepts:
Boone County Fire District EMS Education-Paramedic Program EMS 270 Medical Cases-Seizures Resources Seizures screencast Seizures Flowchart and Seizures Flowchart Video Explanation Objectives / Learning
More informationEpilepsy Pictures Slideshow: Symptoms, Causes and Treatment.
Epilepsy Pictures Slideshow: Symptoms, Causes and Treatment. Reviewed by Louise Chang, MD on Friday, August 12, 2011 What Is Epilepsy? Epilepsy is a disorder of the brain's electrical system. Abnormal
More information1/31/2009. Paroxysmal, uncontrolled electrical discharge of neurons in brain interrupting normal function
Paroxysmal, uncontrolled electrical discharge of neurons in brain interrupting normal function In epilepsy abnormal neurons undergo spontaneous firing Cause of abnormal firing is unclear Firing spreads
More informationEpilepsy and Epileptic Seizures
Epilepsy and Epileptic Seizures Petr Marusič Dpt. of Neurology Charles University, Second Faculty of Medicine Motol University Hospital Diagnosis Steps Differentiation of nonepileptic events Seizure classification
More informationComplex Care Hub Manual: Caring for a Child with Epilepsy/Seizures
Complex Care Hub Manual: Caring for a Child with Epilepsy/Seizures Table of Contents Complex Care Hub Manual: Caring for a Child with Epilepsy/Seizures 1 1. What is epilepsy?... 2 2. Causes of epilepsy...
More informationEpilepsy 101. Recognition and Care of Seizures and Emergencies Patricia Osborne Shafer RN, MN. American Epilepsy Society
Epilepsy 101 Recognition and Care of Seizures and Emergencies Patricia Osborne Shafer RN, MN American Epilepsy Society Objectives Recognize generalized and partial seizures. Demonstrate basic first aid
More informationManagement of Complex Febrile Seizures
Management of Complex Febrile Seizures An 13 month old girl presents to the ED after having a shaking episode at home. Mom describes shaking of both arms and legs, lasting 20 minutes. The child has no
More informationCrackCast Episode 18 Seizures
CrackCast Episode 18 Seizures Episode overview: 1) Define status epilepticus 2) List the doses of common medications used for status epilepticus 3) List 10 differential diagnoses for seizures 4) List 10
More informationObjectives. Amanda Diamond, MD
Amanda Diamond, MD Objectives Recognize symptoms suggestive of seizure and what those clinical symptoms represent Understand classification of epilepsy and why this is important Identify the appropriate
More informationPartners in Teaching: Seizure Awareness Workshop
Partners in Teaching: Seizure Awareness Workshop Learning Objectives 1. Facts About Epilepsy and Seizures 2. Seizure Recognition 3. First Aid and Safety Considerations 4. Learning and Behavioural Impacts
More informationNeonatal Seizure. Dr.Nawar Yahya. Presented by: Sarah Khalil Zeina Shamil Zainab Waleed Zainab Qahtan. Supervised by:
Neonatal Seizure Supervised by: Dr.Nawar Yahya Presented by: Sarah Khalil Zeina Shamil Zainab Waleed Zainab Qahtan Objectives: What is neonatal seizure Etiology Clinical presentation Differential diagnosis
More information*Pathophysiology of. Epilepsy
*Pathophysiology of Epilepsy *Objectives * At the end of this lecture the students should be able to:- 1.Define Epilepsy 2.Etio-pathology of Epilepsy 3.Types of Epilepsy 4.Role of Genetic in Epilepsy 5.Clinical
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Absence seizures, 6 in childhood, 95 Adults, seizures and status epilepticus in, management of, 34 35 with first-time seizures. See Seizure(s),
More informationSeizures. What is a seizure? How does it occur?
Seizures What is a seizure? A seizure is a symptom, not a disease. It happens when nerve cells in the brain function abnormally and there is a sudden abnormal electrical signal in the brain. The seizure
More informationSeizures explained. What is a seizure? Triggers for seizures
Seizures explained What is a seizure? A seizure is a sign of a temporary disruption in the brain s electrical activity. Billions of brain cells pass messages to each other and these affect what we say
More informationEpilepsy: diagnosis and treatment. Sergiusz Jóźwiak Klinika Neurologii Dziecięcej WUM
Epilepsy: diagnosis and treatment Sergiusz Jóźwiak Klinika Neurologii Dziecięcej WUM Definition: the clinical manifestation of an excessive excitation of a population of cortical neurons Neurotransmitters:
More informationActivity 1: Person s story
Epilepsy Session outline Introduction to epilepsy. Assessment of epilepsy. Management of epilepsy. Follow-up of a person with epilepsy. Review or materials and skills. Activity 1: Person s story Present
More informationIs it epilepsy? Does the patient need long-term therapy?
Is it a seizure? Definition Transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain Is it provoked or unprovoked? Is it epilepsy? Does the
More informationDiagnosing Epilepsy in Children and Adolescents
2019 Annual Epilepsy Pediatric Patient Care Conference Diagnosing Epilepsy in Children and Adolescents Korwyn Williams, MD, PhD Staff Epileptologist, BNI at PCH Clinical Assistant Professor, Department
More informationSubspecialty Rotation: Child Neurology at SUNY (KCHC and UHB) Residents: Pediatric residents at the PL1, PL2, PL3 level
Subspecialty Rotation: Child Neurology at SUNY (KCHC and UHB) Residents: Pediatric residents at the PL1, PL2, PL3 level Prerequisites: Any prior pediatric rotations and experience Primary Goals for this
More informationDisclosure. Outline. Pediatric Epilepsy And Conditions That Mimic Seizures 9/20/2016. Bassem El-Nabbout, MD
Pediatric Epilepsy And Conditions That Mimic Seizures Bassem El-Nabbout, MD Assistant Professor, Pediatric Neurology Board Certified in Neurology, and Headache Medicine. Disclosure I have no actual or
More informationIn our patients the cause of seizures can be broadly divided into structural and systemic causes.
Guidelines for the management of Seizures Amalgamation and update of previous policies 7 (Seizure guidelines, ND, 2015) and 9 (Status epilepticus, KJ, 2011) Seizures can occur in up to 15% of the Palliative
More informationAdult Seizure and Epilepsy Management Pathway (16 years of age and above)
Adult Seizure and Epilepsy Management Pathway (16 years of age and above) SUSPECTED SEIZURE Secure and record eyewitness account if available ECG Abnormal ECG Cardiac cause clinically possible Epilepsy
More informationNEONATAL SEIZURES-PGPYREXIA REVIEW
NEONATAL SEIZURES-PGPYREXIA REVIEW This is a very important Postgraduate topics will few Q asked in undergraduation also. Lets see them in detail. References: 1.Volpe s Neurology of newborn 2.Nelson s
More informationTalk outline. Some definitions. Emergency epilepsy now what? Recognising seizure types. Dr Richard Perry. Management of status epilepticus
Emergency epilepsy now what? Dr Richard Perry Imperial College NHS Trust Imperial College Talk outline Recognising seizure types Management of status epilepticus Some definitions Epileptic seizure A clinical
More informationNeurological Emergencies. Aaron J. Katz, AEMT-P, CIC
Neurological Emergencies Aaron J. Katz, AEMT-P, CIC www.es26medic.net 2013 1 Stroke ( CVA ) CerebroVascular Accident Brain Attack Brain damage caused by a blockage of blood to a specific area of the brain
More informationChapter 15 Neurological Emergencies Stroke (1 of 2) Stroke (2 of 2) Seizures Altered Mental Status (AMS) Brain Structure and Function
1 Chapter 15 Neurological Emergencies 2 Stroke (1 of 2) Stroke is the leading cause of death in the United States. After heart disease and cancer It is common in geriatric patients. More than women have
More informationIntroduction to Emergency Medical Care 1
Introduction to Emergency Medical Care 1 OBJECTIVES 21.1 Define key terms introduced in this chapter. Slides 13, 26, 28 29, 32, 39, 52 55, 63 64, 79 21.2 Consider several possible causes of altered mental
More informationThe University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Neurology
The University of Arizona Pediatric Residency Program Primary Goals for Rotation Neurology 1. GOAL: Understand the role of the pediatrician in preventing neurological diseases, and in counseling and screening
More informationEpilepsy Facts. Seizure Training for Child Care and School Personnel. Epilepsy and Children. Epilepsy is. What is a seizure? What is epilepsy?
Seizure Training for Child Care and School Personnel Epilepsy Facts Approximately 3 million Americans have epilepsy Epilepsy is the most common neurological condition in children and the fourth most common
More informationMedical Emergencies. Emergency Medical Response
Medical Emergencies Lesson 23: Medical Emergencies You Are the Emergency Medical Responder You are the emergency medical responder (EMR) responding to a scene on a downtown street involving a male who
More informationCase 2: Epilepsy A 19-year-old college student comes to student health services complaining of sporadic loss of memory. The periods of amnesia occur
Case 2: Epilepsy A 19-year-old college student comes to student health services complaining of sporadic loss of memory. The periods of amnesia occur while the student is awake and occasionally in class.
More informationChapter 21 - Diabetic_Emergencies_and_Altered_Me ntal_status
Introduction to Emergency Medical Care 1 OBJECTIVES 21.1 Define key terms introduced in this chapter. Slides 13, 26, 28 29, 32, 39, 52 55, 63 64, 79 21.2 Consider several possible causes of altered mental
More informationProvide specific counseling to parents and patients with neurological disorders, addressing:
Neurology Description: The Pediatric Neurology elective will give the resident the opportunity to learn how to obtain an appropriate history and perform a complete neurologic exam. Four to five half days
More informationThe fitting child. Dr Chris Bird MRCPCH DTMH, Locum consultant, Paediatric Emergency Medicine
The fitting child Dr Chris Bird MRCPCH DTMH, Locum consultant, Paediatric Emergency Medicine What I am not Detail from The Neurologist, Jose Perez The sacred disease Epilepsy comes from the ancient Greek
More informationEmergent Management of
Emergent Management of When a child with seizures is brought to the ED, the priorities are to terminate the seizures, to determine their cause, if possible, and to admit or refer patients as necessary.
More informationEvaluating an Apparent Unprovoked First Seizure in Adults
Evaluating an Apparent Unprovoked First Seizure in Adults Case Presentation A 52 year old woman is brought to the emergency room after a witnessed seizure. She was shopping at the local mall when she was
More informationEpilepsy 7/28/09! Definitions. Classification of epilepsy. Epidemiology of Seizures and Epilepsy. International classification of epilepsies
Definitions Epilepsy Dr.Yotin Chinvarun M.D., Ph.D. Seizure: the clinical manifestation of an abnormal and excessive excitation of a population of cortical neurons Epilepsy: a tendency toward recurrent
More informationChapter 15 Neurological Emergencies Stroke (1 of 2) Stroke (2 of 2) Seizures Altered Mental Status (AMS)
1 2 3 4 5 Chapter 15 Neurological Emergencies Stroke (1 of 2) Stroke is the leading cause of death in the United States. After heart disease and cancer It is common in geriatric patients. More than women
More informationOn completion of this chapter you should be able to: list the most common types of childhood epilepsies and their symptoms
9 Epilepsy The incidence of epilepsy is highest in the first two decades of life. It falls after that only to rise again in late life. Epilepsy is one of the most common chronic neurological condition
More informationEpilepsy / Seizures EPI
Epilepsy / Seizures EPI Epilepsy is a chronic condition, characterized by recurrent unprovoked seizures. It has several causes; it may be genetic or may occur in people who have a past history of birth
More informationHello! Seizures. Definition: Disclosures: None. Connecting school and the emergency department 8/20/2018
Ashley Creedy ARNP Managing Emergencies for School Nurses Pediatric Emergency Department Frank Hello! Jake Connecting school and the emergency department Disclosures: None Objectives: Discuss immediate
More informationManagement of a child after a first afebrile seizure(s)
Management of a child after a first afebrile seizure(s) Colin Dunkley, Hemant Kulkarni, William Whitehouse, Children s Epilepsy Workstream in Trent (CEWT) Steering Group. (Based on an adaptation of Childhood
More informationObjectives. their possible impact on students. l Recognize common seizure types and. l Know appropriate first aid
Objectives l Recognize common seizure types and their possible impact on students l Know appropriate first aid l Recognize when a seizure is a medical emergency l Provide social and academic support 2
More informationJanuary 26, Montgomery County Regional Outpatient Center Dietary Therapies Program (Main Hospital) Comprehensive Pediatric Epilepsy Program
First time Seizure and New onset Epilepsy Stirred not shaken January 26, 2017 First time Seizure and New onset Epilepsy Amy Kao, MD Children s National Health System Center for Neuroscience and Behavioral
More informationESETT ELIGIBILITY OVERVIEW. James Chamberlain, MD
ESETT ELIGIBILITY OVERVIEW James Chamberlain, MD Eligibility Age Convulsive Status Benzos Not excluded Eligibility Age 2 years to < 18 years (Pediatric) 18 years to 65 years (Adult) > 65 years (Geriatric)
More informationEpilepsy DOJ Lecture Masud Seyal, M.D., Ph.D. Department of Neurology University of California, Davis
Epilepsy DOJ Lecture - 2005 Masud Seyal, M.D., Ph.D. Department of Neurology University of California, Davis Epilepsy SEIZURE: A temporary dysfunction of the brain resulting from a self-limited abnormal
More informationSEIZURE DISORDERS. Recognition and First Aid
SEIZURE DISORDERS Recognition and First Aid Generalized Tonic-Clonic Also called Grand Mal Sudden cry, fall, rigidity, followed by muscle jerks, shallow breathing, or temporarily suspended breathing, bluish
More informationThe Fitting Child. A/Prof Alex Tang
The Fitting Child A/Prof Alex Tang Objective Define relevant history taking and physical examination Classify the types of epilepsy in children Demonstrate the usefulness of investigations Define treatment
More informationSeizures and strokes: Teaching plan
Seizures and strokes: Teaching plan To use this lesson for self-study, the learner should read the material, do the activity, and take the test. For group study, the leader may give each learner a copy
More informationNeurological Problems
Neurological Problems Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme Neurological Problems The child s nervous system may be damaged through:
More informationEpilepsy 101. Aileen Rodriguez ARNP-BC. Comprehensive Epilepsy Program
Epilepsy 101 Aileen Rodriguez ARNP-BC Comprehensive Epilepsy Program Aileen.Rodriguez@mch.com About Me: 2006 BSN from UM School of Nursing Started working @ MCH (3 south nights)july 2006 Worked Days shift
More informationPathophysiology. Central Nervous System (CNS) Peripheral Nervous System (PNS) Consists of. Consists of brain/spinal
Neurological Emergencies Pathophysiology Central Nervous System (CNS) Consists of brain/spinal cord Peripheral Nervous System (PNS) Consists of everything else Afferent (sensory) Efferent (motor) Autonomic
More informationRefractory Seizures. Dr James Edwards EMCORE May 30th 2014
Refractory Seizures Dr James Edwards EMCORE May 30th 2014 Refractory Seizures Seizures are a common presentation to the ED and some patients will have multiple seizures or have a reduced level of consciousness
More informationSummary Report for Individual Task Manage a Seizing Patient Status: Approved
Report Date: 26 Jul 2011 Summary Report for Individual Task 081-833-0002 Manage a Seizing Patient Status: Approved DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited. DESTRUCTION
More informationManagement of the Fitting Child. Dr Mergan Naidoo
Management of the Fitting Child Dr Mergan Naidoo Seizures A seizure is a change in movement, attention or level of awareness that is sustained or repetitive and occurs as a result of abnormal neuronal
More informationEpilepsy after stroke
Call the Stroke Helpline: 0303 3033 100 or email: info@stroke.org.uk Epilepsy after stroke In the first few days and weeks after a stroke some people have a seizure, and a small number go on to develop
More informationTurning Point Services Seizure Training. Developed By Eric Franklin, RN Approved by Lisa Storie, RN Updated July 2017
Turning Point Services Seizure Training Developed By Eric Franklin, RN Approved by Lisa Storie, RN Updated July 2017 Purpose The purpose of this training is to provide general knowledge about seizures/epilepsy
More informationDiagnosis, Assessment and Evaluation for Seizures
Lehigh Valley Health Network LVHN Scholarly Works Neurology Update for the Non-Neurologist 2013 Neurology Update for the Non-Neurologist Feb 20th, 7:40 PM - 8:10 PM Diagnosis, Assessment and Evaluation
More informationA learning module for Rose Tree Media School District Staff
A learning module for Rose Tree Media School District Staff What is a seizure? A seizure results from a person experiencing abnormal electrical impulses in some area of the brain. This abnormal activity
More informationNeurology. Access Center 24/7 access for referring physicians (866) 353-KIDS (5437)
Neurology The Neurology practice at Valley Children s provides diagnostic services, medical treatment, and followup care to infants, children, and adolescents who have suspected or confirmed neurological
More informationReview. 1. How does a child s anatomy differ from an adult s anatomy?
Chapter 32 Review Review 1. How does a child s anatomy differ from an adult s anatomy? A. The child s trachea is more rigid B. The tongue is proportionately smaller C. The epiglottis is less floppy in
More informationFirst aid for seizures
First aid for seizures What is epilepsy? Epilepsy is a tendency to have repeated seizures that begin in the brain. For most people with epilepsy their seizures will be controlled by medication. Around
More informationNonConvulsive Seizure
Sample Protocol #5: Management of status epilepticus and seizures in hospitalized patients nconvulsive Seizure Patient presents with alteration of consciousness unexplained by other etiologies AND suspicious
More informationDisclosures. What is Status Epilepticus? Purpose of Today s Discussion. Nothing to Disclose. How do I recognize Status Epilepticus?
Disclosures Nothing to Disclose Neurologic Emergencies SID W. ATKINSON MD Chief, Division of Child Neurology, and Developmental Pediatrics Purpose of Today s Discussion Understand 2 Neurologic Emergencies
More informationSeizure classification In 2010 the ILAE proposed that febrile seizures could be organised by typical age at onset (that is, infancy and
Link to this article online for CPD/CME credits Febrile s Nikhil Patel, 1 Dipak Ram, 2 Nina Swiderska, 2 Leena D Mewasingh, 3 Richard W Newton, 1 Martin Offringa 4 1 Imperial College School of Medicine,
More informationChapter 19. Objectives. Objectives 01/09/2013. Seizures and Syncope
Chapter 19 Seizures and Syncope Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key terms
More informationSEIZURE PODCAST Transcript
SEIZURE PODCAST Transcript CCP = Child Care Provider RN = Nurse Consultant CCP: I have been asked to watch Kiara, a 4-year-old with epilepsy and I have several questions. I have heard of it, but what exactly
More informationEpilepsy is Seizure Recognition & Response. Epilepsy Facts. Possible Causes of Epilepsy. What happens to the brain during a seizure?
Epilepsy is Seizure Recognition & Response NOT contagious NOT a mental illness NOT a mental impairment NOT a single disease Epilepsy is A neurological disorder of the brain characterized by the tendency
More informationJennifer A. Vickers MD Associate Professor of Neurology
Jennifer A. Vickers MD Associate Professor of Neurology Conflict of Interest Disclosure Speaker: _Jennifer A. Vickers, MD X 1. I do not have any potential conflicts of interest to disclose, OR 2. I wish
More informationCONVULSIONS - AFEBRILE
Incidence All Children require Management Recurrence Risk Indications for starting therapy Starting Anticonvulsant medication Criteria for Referral to Paediatric Neurology Useful links References Appendix
More informationAdvanced Concept of Nursing- II
In The Name of God (A PROJECT OF NEW LIFE HEALTH CARE SOCIETY, KARACHI) Advanced Concept of Nursing- II UNIT- VIII Advance Nursing Management Of neurovascular Diseases. Shahzad Bashir RN, BScN, DCHN,MScN
More informationUnderstanding. Epilepsy. Berit, diagnosed in 2005, with her mother, Jenine.
Understanding Epilepsy Berit, diagnosed in 2005, with her mother, Jenine. What Are Seizures and Epilepsy? Epilepsy is a medical condition where a person has recurring unprovoked seizures. Having a single
More informationAuthor(s): C. James Holliman, M.D. (Penn State University), 2008
Project: Ghana Emergency Medicine Collaborative Document Title: Status Epilepticus (SE) Author(s): C. James Holliman, M.D. (Penn State University), 2008 License: Unless otherwise noted, this material is
More informationPrescribing and Monitoring Anti-Epileptic Drugs
Prescribing and Monitoring Anti-Epileptic Drugs Mark Granner, MD Clinical Professor and Vice Chair for Clinical Programs Director, Iowa Comprehensive Epilepsy Program Department of Neurology University
More informationSchool of Hard Knocks! Richard Beebe MS RN NRP MedicThink LLC
School of Hard Knocks! Richard Beebe MS RN NRP MedicThink LLC Fall of a Teton How Bad is He Hurt? What REALLY happened inside Johnny s head? How common are these types of injuries? PONDER THIS What part
More informationNon-Epileptic Attack Disorder in the Emergency Unit
Non-Epileptic Attack Disorder in the Emergency Unit Khalid Hamandi, Consultant Neurologist Malisa Pierri, Epilepsy Specialist Nurse University Hospital of Wales COI declaration none relevant to this talk
More informationESETT OUTCOMES. Investigator Kick-off Meeting Robert Silbergleit, MD
ESETT OUTCOMES Investigator Kick-off Meeting Robert Silbergleit, MD Primary objective The primary objective is to determine the most effective and/or the least effective treatment of benzodiazepinerefractory
More informationSUBJECT: Seizure Management
DBHDD SUBJECT: Seizure Management Policy: 03-514 Page 2 of 5 II. DEFINITIONS Epileptic Seizure: A transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity
More informationNeonatal Seizure Cases. Courtney Wusthoff, MD MS Assistant Professor, Neurology Neurology Director, LPCH Neuro NICU
Neonatal Seizure Cases Courtney Wusthoff, MD MS Assistant Professor, Neurology Neurology Director, LPCH Neuro NICU Disclosures I have no conflicts of interest I will discuss off-label use of anti-epileptic
More informationModule 2: Different epilepsy syndromes
Module 2: Different epilepsy syndromes By the end of this module the learner will: Understand the use of epilepsy as an umbrella term Explain different types of epilepsy and the associated symptoms Be
More informationEpilepsy: 10 Things Patients & Family Members Should Know
Epilepsy: 10 Things Patients & Family Members Should Know 1. Seizure Disorder = Epilepsy (but not all seizures are epilepsy) Epilepsy is a brain condition that causes seizures. Some doctors might use the
More informationInitial Treatment of Seizures in Childhood
Initial Treatment of Seizures in Childhood Roderic L. Smith, MD, Ph.D. Pediatric Neurology Clinic of Alaska,PC Incidence of Seizures Overall 5% by age 20 yrs. Lifetime risk= 5-10% CNS Infections= 5% TBI=10%
More informationNEONATAL SEIZURE. IAP UG Teaching slides
NEONATAL SEIZURE 1 INTRODUCTION One of the important neonatal neurological emergencies requiring immediate medical care. Contribute to significant morbidity and mortality Incidence is around 0.5 to 0.8%
More information