You will hear many different phrases over the course of your career: ‘funny do’, ‘funny turn’, ‘fit’, ‘faint’. However, what these should all mean to the discerning clinician is ‘suspected seizure’.
A seizure is a period of abnormal discharge of neurons in the brain, and can take many forms depending on the site and type of the paroxysmal activity. The major types of seizure are shown below.
This is vital in real life (and therefore vital to mention in exams!), especially if the ‘suspected seizure’ is occurring right there and then. Management will differ whether the child is in the community, but an algorithm for hospital management is shown below. The algorithm can be stopped at any point at which is becomes obvious the child has not or is no longer experiencing a seizure (e.g. patient is lucid, Hx or examination points to different cause).
*You will note the algorithm below is the same as that for status epilepticus, a condition characterised by:
Practically, however, the algorithm is started after a seizure has lasted more than 5 minutes.
The history is the most useful diagnostic tool when dealing with a suspected seizure; as such it is imperative to take a comprehensive and detailed history from the child and/or carer as appropriate. A general paediatric history should be taken, but below is a list of seizure-specific questions to ask.
1) Age of the child
This is the first discriminating factor that will aid in cutting down your differential diagnosis, e.g. febrile seizures typically occur in children aged 6 months - 6 years.
2) History of presenting complaint - from both child and witness if possible
3) Past medical/surgical history
4) Obstetric history
5) Developmental history
This is typically important. However, always be ready to justify relevance, particularly to examiners - e.g. 'Epilepsy is more common in autistic spectrum disorders, therefore history of social development is pertinent.'
6) Family history
7) Social history
8) Systems review
A full review of a paediatric neurological examination is outside the scope of this article, but four general areas are important to examine:
History will often indicate which (if any) investigations need performing, but here is a list of investigations that may prove useful in establishing a diagnosis:
It is important that, until a diagnosis is confirmed, carers are advised on how to manage a genuine seizure and avoid specific dangers (e.g. injury from falling, swimming, unprotected heat, moving objects and machinery). This is necessary even if non-epileptic disorders are strongly suspected.
Potential OSCE Stations
Counseling a concerned parent about a febrile convulsion is very difficult. They will typically ask:
Suggested OSCE Revision Tasks
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