儿童原发性癫痫治疗指南(2)

儿童癫痫指南

clonic, and focal tonic seizures are usuallyaccompanied by ictal EEG activity while subtle,generalized tonic and myoclonic episodes may benon-epileptic as they are not associated withelectrographic ictal activity(3). True seizures areoften accompanied by open eyes(4). Non-epilepticphenomena like jitteriness and benign sleepmyoclonus should be differentiated. Serum glucose,electrolytes, calcium and magesium must be done inall(5,6). CSF studies and culture must be done in allexcept when the diagnosis is definite e.g. hypoxicischemic encephalopathy. A portable 60 minute EEGby a trained technician and interpreter is useful inrecognizing subclinical seizures, epilepticencephalopathies and prognosis(6). A cranialultrasound is the minimum imaging required, but anin-house MRI with diffusion tensor imaging is themodality of choice, done immediately for aetiologyand at 3-6 months for prognosis(6). Managementshould be done as per Fig.1(5-7).

Oral phenobarbitone should be continued tilldischarge or up to 3 months (especially in those withan abnormal neurologic examination).2. Acute Symptomatic Seizures

A seizure occurring within a week of an acute braininsult (trauma, infection, toxic, metabolic or vascularinsult) is called an acute symptomatic seizure(8).Future risk of unprovoked seizures is only 3-10%.Serum calcium, magnesium, electrolytes andglucose should be estimated for all children. Lumbarpuncture should be done in febrile infants and inthose with suspected meningoencephalitis. A plainCT scan is indicated in traumatic brain injury and acontrast enhanced CT scan is indicated in childrenabove 2 years, especially those presenting withconvulsive seizures, focal seizures, cluster of seizure(9), or focal neurological deficits to rule outgranuloma.

In a hypocalcemic breastfed infant, an underlyingvitamin D deficiency state in the child and thefeeding mothers should be corrected(10). Anti-epileptic drugs (AED) are required in the acute phaseand can be withdrawn in a week in acute traumaticbrain injury(11) or in 3 months in illnesses withparenchymal involvement (e.g. CNS tuberculosis orMaintain ABC and temperature.

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Withdraw blood for biochemistry

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Immediate glucose by dextrostix

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Correct glucose and calcium

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Administer IV- phenobarbitone 20 mg/kg.

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Repeat in 5mg/kg boluses till a maximum of 40 mg / kg

every 15 minutes if seizure continues.

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IV Phenytoin 15-20 mg /kg diluted in equal volume

of normal saline at a maximum rate of1mg/kg/min over 35-40 minutes

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IV Lorazepam (0.05 to 0.1 mg/kg) or Diazepam

(0.25mg/kg bolus or 0.5 mg/kg rectal)

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Or IV Midazolam as a continuous infusion(an initial IV bolus of 0.15 mg/kg, followed bycontinuous infusion (1 µg/kg/min) increasing by0.5 to 1 µg /kg/min every 2 minutes until a favorable

response or a maximum of 18 µg/kg/min

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100 mg pyridoxine IV or oral (if IV not available)

should be givenFIG 1. Algorithm for management of neonatal seizure.

pyogenic meningitis with parenchymalinvolvement).3. Febrile Seizures

A simple febrile seizure occurs between the age of 6months to 5 years. Complex febrile seizures arecharacterized by partial onset, duration ≥15 minutes,or multiple episodes in the same illness(12). Lateonset febrile seizures, persistent febrile seizures,generalized epilepsy and febrile seizure plus(GEFS+) and febrile status epilepticus (FSE) are partof the spectrum of febrile seizures(13).

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