Approach to a child with seizures (Refer Algorithm)
A. History:
- A complete description of seizure type tonic, clonic, tonic-clonic, atonic, absence, myoclonic, sensory-motor generalized seizures and partial seizures – simple complex, partial with secondary generalization and mixed seizures.
- Details of aura, start of seizure, its spread, duration, automatism, loss of consciousness, post ictal weakness, timing of seizures, minor motor manifestations.
- Severity of the episode, injury, resultant congnitive impairment after seizures, multiple seizure types, precipitating or triggering factors, average frequency of attacks, response to previous medications
- Developmental history ¾ Family history, history of neonatal or febrile seizures, previous brain injury, and history of other neurologic or systemic disease.
B. Physical examination: Epilepsy should be examined as a symptom of progressive brain damage and specific etiological groups like the following identified
- A neonate with neuro metabolic disorder, failure to
thrive, vomiting, rash, odor etc
- Dysmorphic facies, micro/macrocephaly
- Neuro ectodermatosis – depigmented spots, facial hemangiomas
- Focal neurological deficit, raised intra cranial pressure
- Neuro developmental
delay, cerebral palsy, other neurogenetic disorders.
- Mental retardation, hyperactivity.
