Epilepsy

Causes of seizures

Investigations

Indications for CT scan

Take a good history to ensure that this is seizures as other conditions may mimic seizures. 

These include for example: 

Breath-holding attacks

• 6/12 – 4 years old 
• Responds to pain 
• Preceded by crying/anger 
• May result in loss of consciousness 
• Fleeting twitching of the body 

Vasovagal episode

• Older children 
• Responds to pain 
• Falls down 
• No post ictal symptoms 

Hypnogogic jerk 

• Limb jerks when falling asleep. 

Night Terrors

• Child < 10 years of age 
• Wakes showing panic 
• Agitation 
• Inconsolable 
• Goes back to sleep 
• Has no memory of event in morning. 

Causes of seizures 

Infancy/early childhood: 

• Common causes:
  • Febrile convulsion 
• More serious causes:
  • Meningitis/Encephalitis 
  • Brain damage or defects 
  • Metabolic abnormalities 
  • Infantile spasms 

Children > 5 years: 

• Common causes:
  • Idiopathic Epilepsy 
  • Neurocysticercosis 
  • Tuberculoma 
• More serious causes:
  • Meningitis/Encephalitis 
  • Brain damage 
  • Metabolic causes 

Investigations 

• Single episode GTC non febrile seizure. Short-lived, with no neurological fallout, signs of meningitis or toxin ingestion.
  • Blood glucose 
  • Blood pressure 
  • U&E + Calcium + Magnesium (especially in infants) 
  • No further investigations necessary if > 2 years old 
• Recurrent episodes of uncomplicated generalised seizures in children perfectly well between episodes and no neurological abnormalities:
  • Outpatient EEG warranted. (If possible within 24 hours of seizure as this may be most helpful but often practically not feasible). Phone TBH (021) 938-5500 for bookings. 
• Recurrent generalised seizures with any neurological abnormalities or regression:
  • Neurology consult needed 
• Focal seizure of any nature – whether focal feature witnessed or on history:
  • Requires EEG and neuro-imaging. Imaging not urgent (i.e. can be done the following day) if no residual abnormal neurological signs nor persistent abnormal level of consciousness. 
• Infantile spasms- these may present without the full salaam spasm having developed, such as with only brief flexion followed by a cry. Discuss early with a neurologist as this is a neurological emergency. 

Indications for CT scan 

• Focal element to seizure 
• Prolonged seizure > 30 minutes 
• URGENT = persistent depressed level of consciousness or focal signs 
• Otorrhoea (controversial) 
• Evidence of raised ICP