see: [Seizures Cameron's](x-devonthink-item://E383FFBD-9FD8-4DE9-B350-0F6F60D3E600?page=869&start=2035&length=53&search=Differential%20diagnosis%20and%20specific%20seizure%0Asyndromes) see also: [[Febrile seizure]] > [!Key Points] > - was it a seizure? > - DDx: [[Meningitis]], hypoxic injury, trauma, cardio-resp compromise, [[hypoglycaemia|hypoglycemia]], [[paeds tox|toxin overdose]] especially from [[Toxicology#Tox Seizures]] | cause of seizure | treatment | | ---------------- | --------------------------------------------------------- | | hypoglycemia | 10% dextrose 2mL/kg (2 mL/kg IV for neonate) | | hyponatremia | 3mL/kg 3% saline IV | | hypocalcemia | calcium gluconate 10% 0.5mL/kg (0.11 mmol/kg) over 20 min | | hypo mg | mag sulf 50% 0.2mL/kg slow IV or IM (0.4 mmol/kg) | | isoniazid | pyridoxine | ==antiepileptics generally given if seizure lasts longer than 3 minutes== > **for neonatal seizures:** > - *phenobarbitone* 20 mg/kg IV (additional doses of 5-10 mg/kg can be given up to 40 mg/kg over 20 min > - ==be ready to intubate if given== , but is the most effective in the termination of neonatal seizures > - some updates to therapeutic guidelines forthcoming; in rural context likely would not be first line > - *levetiracetam* 40mg/kg IV over 20 min > - *midaz* IV 0.5-2 mcg/kg per min other drugs used in neonatal seizures: pyridoxine (if deficiency), ketamine # Convulsive status epilepticus > [!treatment] Management > - O2 > - open airway > - IV/IO access > - test BGL > > > [!doses] Drugs > > - IV [[midazolam]] 0.15mg/kg IO, IM, In, or buccal > > - diazepam 0.3-0.5 mg/kg PR also option > > - ==repeat dose if seizure has not stopped in 5 minutes== > > - **second line:** IV *phenytoin* 20mg/kg or *levitiracetam* 40mg/kg IV/IO over 5 min (dilute to 50mg/mL) > > - **neonate:** *phenobarbitone* 20mg/kg IV -- additional doses of 5-10mg/kg can be given up to a total dose of 40mg/kg over 20 min > ![[Pasted image 20230822202424.png]] # Infant seizure types - kernicterus ## familial (and non-familial) infantile epilepsy - frequent and inractable seizures - start btwn 3-20 months - develop normally; seizures usually resolve in a year ## infantile spasms (West syndrome) - age 3-12 months - sudden brief flexion/extension and can occur in clusters - usually developmental delays - a/w genetic/chromosomal disorders ## myoclonic epilepsy of infancy (Dravet syndrome) - abnormalities of sodium channel genes - development delayed beyond 12 months of age # Non-epileptic seizure mimics ## Breath-holding spells - provoked by unpleasant stimulus eg minor trauma 1. pallid breath holding attacks: after short cry, infant loses consciousness and becomes pale, +- tonic stiffening 2. cyanotic breath-holding attacks: after vigerous crying, breath holding in expiration and loss of consciousness As in syncopal episodes, may have brief clonic jerking after an episode. ## Benign neonatal sleep myoclonus - normal during sleep ## jitteriness - common in newborn - path would be [[Hypocalcemia|hypo-Ca]], [[hypoglycaemia]], and neonatal withdrawl syndrome. - Neurocysticercosis