Seizures – Neurology

Seizures: abnormal excessive discharges in the cerebral cortex (usually, rarely from other structures i.e. basal ganglia or other grey matter)
Epilepsy: 2 unprovoked seizures occurring 24 hours apart. Can be subclinical and not apparent symptomatically.
Further investigations on initial presentation: if etiology isn’t apparent on history/examination/MRI then the child should be evaluated for underlying metabolic, genetic, immune-mediated, or neurodegenerative disorders (especially if there is developmental delay or abnormal neurology):
– Serum (and CSF) amino acid analysis

  • Urine for quantitative organic acids
  • Serum calcium, glucose, liver function tests
  • Serum acylcarnitine profile, ammonia, lactate and pyruvate
  • Chromosomal karyotype
  • Serum and CSF autoantibodies

EEG: a lot of seizures show up during sleep so sleep EEG’s are important. A sleep deprived EEG is done to maximise the likelihood of natural sleep during EEG.
Starting medication: Antiepileptics do not need to be started after a single seizure or before a diagnosis is made. Once started close monitoring needs to be kept for side-effects.


Medication side-effects

  • All antiepileptics can cause lethargy, solemness, hyperactivity, behaviour change, GI upset.