|Seizure Disorders In Children|
Children with epilepsy often suffer from impaired social interaction. Their peers know something is wrong, but they do not understand the problem. Children who have epilepsy may have difficulty making friends and participating in school activities. Some just choose to isolate themselves.
Some children with epilepsy cannot control their seizures in school or at home and may need special accommodations. Children with epilepsy who participate in sports or clubs may need special safety equipment.
Some children with epilepsy have unusual behaviours, such as staring or blinking. Some children become dependent on a parent or caretaker. Parents of children with epilepsy may be overly protective. Children with epilepsy may be teased or made to feel different. Some children with epilepsy have problems learning. Children with seizure disorders may miss school because of seizures. Some children with epilepsy do not attend school.
When a child is diagnosed with epilepsy, the whole family changes. Parents may worry that the child is not maturing or will develop other problems. Parents of children with epilepsy must adjust to the child’s limitations and learn to communicate with each other.
Treatment for children often involves a combination of medication and surgery. Medications can bring about more than 90 per cent of seizure suppression. Surgical treatment can cure epilepsy in some cases.
A child with epilepsy is different, but so is everyone. Some children with epilepsy have normal lives. Others may have problems. A child with epilepsy needs the same love and support as any other child.
There are three forms of seizure in children:
- Neonatal seizure
- Febrile convention
Neonatal seizure is seizure in the first twenty-eight days of life. Febrile convulsion occurs between six months and five years. Epilepsy occur after five years. Seizure is an abnormal electrical discharge of cerebral neurone accompanied by a motor, sensory or affective phenomenon with or without loss of consciousness. Of all the three types of seizure disorders, only febrile convulsion will be treated here.
This occurs due to excessive fever as the child’s thermoregulatory machanism is not well developed to prevent it. It is an abnormal, response of the developing brain to high fever.
1. Excessive high fever up to 39 C and 40 C
2. Occur in fifteen per one thousand case of high fever within the age group.
3. Age is between six months and five years.
4. Occur more in male than female.
5. There us usually a family history of febrile convulsion.
6. It is a generalised type of seizure, that is, the tonic and clonic type.
7. It is short-lasting. Not more than fifteen minutes.
8. Post ictal sleep.
9. Incontinence of urine and faeces.
10. It is not always recurrent, only one attack per each febrile illness.
- Otitis media
MANAGEMENT OF FEBRILE CONVULTION
1. Keep calm and calm down every body around.
2. Take off all the child’s clothing.
3. Control fit with either of:
(a) Im paraldehyde Icc per year of life. Do not exceed 5cc even if patient is over five years.
(b) IV Valium 2-5 mg slowly depending on age.
4. Clear airway: Suck and extend neck of baby.
5. Tepid sponge and expose to fan if febrile.
6. Gastric wash out by ryle’s tube if any native drug has been used.
7. Take short history and examine the child properly.
8. Dextrostix = to exclude hypoglycaemia. Blood film = for malaria parasite. Lumbar puncture = to exclude meningitis.
9. Treat based on finding.
10. Give intravenous fluid if child is not taking orally.
Should the above treatment fail to control the fit, it is pertinent to refer the child to a centre where there is a paediatrician. The child will need intubation with intermittent positive pressure ventilation (IPPV) and a muscle relaxant like d – tubocurarine. If a child is less than three years of age and has febrile convulsion for up to three or four times, it is advised that such a child be put on anti-convulsant therapy like phenobarbitone syrup.