SEIZURES - Afebrile - Common Patterns Pediatric

1)      Breath Holding Attacks – 6/12-5 yrs, provoked cry, breath holding in the expiration, appearing pale or cyanotic before losing consciousness, the child goes limp, generalized convulsion, opisthotonus and incontinence +/- if breath held for more than 15 secs, sequence of symptoms diagnostic,

2)      Benign childhood epilepsy – fits onset 4-12 yrs, simple partial seizures motor type, generalized tonic-clonic seizures, fits in sleep, EEG – centrotemporal sharp waves, fits remission by 14-16 yrs,

3)      Isolated seizures

4)      Idiopathic epilepsy

5)      Idiopathic epilepsy complex partial seizures

6)      Rolandic Seizures

7)      Infantile spasms – fits onset 4-6/12 age, sudden rapid flexion of trunk lasting less than a second, typical fits stop by 18/12 to be replaced by generalized convulsions, characteristic EEG

8)      Generalized absence seizures or Petit mal – onset 4-8 yrs, usually stops by puberty, normal IQ, brief arrest of consciousness lasting less than 20 secs, child may just have a vacant stare, drop things, upward deviation of eyes, arrest of normal activity, episodes of unresponsiveness, episodes of unawareness, no aura, no fits, no postictal events, EEG – ictal/interictal 3 Hz spike-wave complexes

9)      Grand mal – convulsive twitchings, falls, body stiffness, postictal drowsiness,

10)    Benign neonatal familial convulsions – dominant, may be severe and resistant for a few days, febrile or afebrile seizures may occur later, no dysmorphism,

11)    Infantile familial convulsions – dominant, seizures often in clusters (overlap with benign partial complex epilepsy of infancy), no dysmorphism,

12)    Benign myoclonic epilepsy of infancy – often seizures during sleep, no dysmorphism,

13)    Partial idiopathic epilepsy with rolandic spikes – most frequent, partial seizures (sylvian seizures – face, pharynx, respiratory noises), may appear generalized (secondary generalization), seizures mostly  in relation to sleep (falling asleep, early morning, change in sleep habits), EEG – typical focal sharp waves, in the centrotemporal region, but location may vary, multiple independent foci, sometimes only present in sleep EEG, usually more alarming than clinical state, most cases rare seizures, 100% good prognosis, treatment often not necessary, occasionally long and frequent seizures and atypical forms, temporary cognitive behavioral problems in the active phase of the disease only, no dysmorphism,

14)    Idopathi partial occipital epilepsy – early childhood forms with seizures in sleep and ictal vomiting, may present as status epilepticus,  later forms with migrainous symptoms, no dysmorphism,

15)    Petit mal or absence epilepsy – patients with absences only, some have generalized seizures, 60-80% full remission, absences disappear on therapy, no dysmorphism,

16)    Juvenile myoclonic epilepsy – adolescence onset, early morning myoclonic seizures, generalized seizures during sleep, past absences in childhood, no dysmorphism,

» SYMPTOM, SIGNS, SYNDROMES GLOSSARY