Paediatric Acute care Guidelines PMH Emergency Department
  • A seizure is the physical and behavioural changes that occur after an episode of abnormal activity in the brain or part of the brain
  • It is a symptom not a diagnosis

Background

  • By the age of 16 years approximately 1% of the population will have suffered a seizure without a fever
  • Recurrence risk :
    • 50% will have a second afebrile seizure
    • 75% of those will have a third afebrile seizure
    • 88% of these are within two years

Assessment

History

General history, plus consideration of:

  • Neurological state and behaviour prior to seizure
  • Duration of seizure, focal features
  • Recent trauma
  • Poisons / drug ingestion
  • Co-morbidities e.g. ventriculoperitoneal (VP) shunt
  • Developmental history
  • Determine if the child has had a vacination in the past 14 days. If so, a WAVSS WA Vaccine Safety Surveillance: Adverse Reaction Reporting Form needs to be completed.

Examination

  • Full systems examination including neurological
  • Assess for meningism

Investigations

  • Glucose
  • U&E, Calcium, Magnesium, Phosphate
  • CT if clinically indicated (seek Emergency Department Senior Doctor advice)
  • ECG
  • EEG (as outpatient)
  • Metabolic screen if clinically indicated

Differential diagnoses

  • Breath holding
  • Syncope
  • Gastro-oesophageal reflux (GOR)
  • Arryhthmias
  • Stroke
  • Panic attack
  • Migraine
  • Psychosis
  • Pseudoseizures

Management

  • Most seizures will terminate within 5 minutes. Those that last longer are likely to continue.
  • If a seizure is still in progress on arrival to the Emergency Department, treatment should commence as per ED Guideline: Status Epilepticus.

Admission criteria

  • Prolonged seizure > 15 minutes
  • GCS < 15 (1 hour post seizure)
  • Age < 1 year
  • > 1 seizure
  • Focal seizures
  • Signs of raised intracranial pressure (ICP)
  • Meningism
  • Signs of aspiration
  • NAI
  • High parental/carer anxiety

Discharge criteria

  • Parents should be warned that all children or adolescents who have had seizures should be supervised when bathing, swimming, riding a bicycle on the road, and should avoid tree climbing.
  • Parents should be advised of first aid measures and given parent information sheet – First Aid for Seizures.
  • Arrange referral to General Paediatric Clinic and EEG request (PMH – complete green form).

Nursing

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