Paediatric Convulsions

Paediatric seizures are classified depending on the presence or absence of fever:

• Febrile seizures happen when a child’s body temperature rises quickly, often due to a viral or bacterial infection. These seizures are most common in children between the ages of 6 months and 6 years.
• Afebrile seizures occur without fever. They may be linked to underlying conditions such as:
  • Neurological disorders, such as recurrent seizures (epilepsy) or motor disorders (cerebral palsy)
  • Metabolic imbalances, such as low blood sugar (hypoglycaemia), low calcium (hypocalcaemia), or electrolyte imbalances.
  • Family history of epilepsy
  • Brain injuries due to trauma or hypoxia during birth
  • Infections affecting the brain, such as meningitis or encephalitis
  • Structural brain abnormalities seen on imaging scans.

The clinical features of seizures vary by type and severity. Symptoms may include:

• Brief episodes of disorientation
• Periods of unresponsiveness or vacant staring
• Uncontrollable jerking of the arms and legs
• Loss of consciousness or awareness
• Cognitive or emotional changes, including sensations of fear, anxiety, or a sense of déjà vu (where one feels they have experienced the current moment before).

Seizures in children may occur due to specific causes or may be more likely in children with certain risk factors. 

The causes include:

• Fever (febrile seizure).
• Metabolic imbalances (low blood sugar, low calcium, electrolyte imbalances).
• Brain infections (meningitis, encephalitis).
• Brain injuries from trauma or birth complications.
• Structural abnormalities in the brain.

Factors that make seizures more likely include:

• Family history of epilepsy or seizures.
• Previous febrile seizures.
• Premature birth or low birth weight.
• Developmental delays or neurological impairments.
• Brain infections or trauma.
• Exposure to toxins or drugs.

The diagnosis of epilepsy requires a comprehensive evaluation, which may include:

• Medical history review with emphasis on family history and potential hereditary factors.
• Electroencephalogram (EEG), a key diagnostic test that measures electrical activity in the brain and helps detect abnormal brain wave patterns linked to epilepsy.
• Diagnostic imaging such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, to identify structural abnormalities or lesions in the brain.
• Blood tests are performed to detect infections, metabolic imbalances, or genetic conditions that may be the underlying cause of the seizures.
• Electromyography (EMG) tests to assess muscle responses, particularly in differential diagnosis.

Management of paediatric seizures requires a multidisciplinary approach:

• Antiepileptic drugs (AEDs) are the first-line therapy, tailored to seizure type and child's overall health.
• Epilepsy surgery may be considered in drug-resistant cases to remove or isolate the seizure-causing brain region.
• Neonatal seizure management focuses on identifying the underlying cause and providing targeted treatment.
• Comprehensive care may include lifestyle changes, ketogenic diet, or neuromodulation (such as vagus nerve stimulation).
• Long-term epilepsy management involves regular follow-up, monitoring seizure frequency and response to treatment, adjusting medications, and assessing cognitive and developmental progress.

Seek urgent medical care if a child:

• Experiences a seizure lasting more than 5 minutes.
• Has repeated seizures without regaining consciousness in between.
• Develops breathing difficulties, bluish lips, or unresponsiveness during or after a seizure.
• Experiences a first-time seizure, regardless of duration or severity.

Not all seizures can be prevented, but some steps can lower risks:

• Regular follow-up is critical for managing paediatric convulsions.
• Prompt treatment of infections can reduce fever-related seizures.
• Avoiding head injuries through protective measures.
• Ensuring adherence to prescribed antiepileptic medications.
• Tertiary care hospitals use routine EEG monitoring, medication adjustments, and ongoing assessment of the child’s developmental and cognitive progress to reduce seizure risk. 

Children with suspected or confirmed seizures should consult a paediatric neurologist. In acute cases, immediate care in a hospital emergency department is essential.