Afebrile Seizures in Children

A seizure is a sudden event characterized by behavior change of the patient and afebrile one simply means, there is no associated fever. It is caused by abnormal and excessive activity of a group of neurons (specialized cells that transmit nerve impulses in the brain).Occurrence and appearance of a seizure is dependent on thelocation and extent of brain damage. 

How do seizures occur?
Like mentioned above, it occurs when a large number of neurons in the brain are discharged in anabnormalway. Depending on affected area, it can be a generalized or partial seizure.

Epilepsy is defined as occurrence of two or more unprovoked seizures. It occurs frequently in children due to their immature nervous system and if not treated adequately can put the child at a risk for cognitive andbehavioral abnormalities.

Classification of seizure types

Whenever a child comes at the emergency, it is important to evaluate the type;

Partial seizures– involve a portion of the brain at onset, associated with lack of complete loss of consciousness. However, they are also divided into two; Simple partial seizure and complex partial seizures. The former, does not impair consciousness while the latter does. Simple partial seizures, present with focal signs like focal clonic movement, arrest of movement and speech.

Complex partial seizures on the other hand present with staring spells, blinking, fumbling or cloth pricking. At this state, the patient is unconscious.

Generalized seizures

Characterized by sudden loss of consciousness.

They are divided into convulsive and no convulsive seizures.

Convulsive generalized seizures

This entails tonic-clonic which begins with sudden loss of consciousness, followed by jerky movements and after that the patient falls asleep, urinates on them or cry. Clonic one occurs by jerky movement and tonic, the patient is unconscious.

Non-convulsive generalized seizures

Involves absence, myoclonic, tonic and atonic seizures. Absence is brief and last few seconds arresting movement and consciousness. The mother may report a fixed stare of the baby or patient holding a glass and it falls unknowingly. Myoclonic involves twitching of a particular group of muscles. Atonic involves loss of muscle tone and this can lead to the patient falling sustaining other injuries.

Diagnosis

A detailed history from the parents or anyone who witnessed the seizure is paramount.

Carefully neurological exam can be done to detect any probable cause like increased intracranial pressure.

Blood works may show elevated white blood count especially in prolonged seizures.

Electroencephalogram (EEG) is the most important radiological exam for seizure.

Treatment

A wide number of seizures are self-limiting, first contact with patient at home the parents are advised to ensure the surrounding is safe for the child to avoid injuries.

At the emergency department, the child may be put on anti convulsants like benzodiazepines especially I.V diazepam 0.2-0.5mg/kg (max 10mg) and per rectal diazepam 0.5mg/kg (max 20mg) or I.V lorazepum 0.1mg/kg (max 8mg)

Long-term anticonvulsant treatment

Phenytoin, carbamazepine, phenobarbital and valproic acid are excellent choices for generalized and partial seizures. However, any choice has its limitations. Commonly used is the carbamazepine class.

As a parent, it is important to look out for such symptoms and bring your child for evaluation to avoid complications later on.

Image courtesy of abclawcentre.com