Recognize different types of seizures
The challenge of managing children with seizures is exacerbated because there are so many different manifestations. "It's important to recognize the different types because the evaluation is completely different," says Ann Dietrich, MD, FACEP. Here are various manifestations of seizures and tips to recognize each:
Partial seizures
These are subgrouped as simple or complex, says Nancy Eckle, RN, MEN, CEN, clinical nurse specialist at Children's Hospital in Columbus, OH.
· Simple partial seizures. These may consist of motor sensory or psychic manifestations without a loss of consciousness, says Eckle. "Motor activities may be focal," she explains. "Other symptoms may include headache, a pins and needles sensation, metallic taste, flushing, sweating, or salivation. They typically last less than one minute without postictal symptoms."
If it does not involve a loss of consciousness, these are usually managed by a neurologist, says Dietrich. "They do not result in a compromise to the airway or ventilation of the patient," she explains.
· Complex partial seizures. These are rare in children less than 10 and usually involve an impairment of consciousness, notes Eckle. "Symptoms include repetitive behavior such as purposeful but inappropriate motor movements such as facial grimacing, fumbling movements, or running," she says. "Seizure typically lasts 30 seconds to several minutes. Lethargy, confusion, fear, or sadness may be apparent in the postictal period."
Generalized seizures
These are subgrouped by the specific pattern of movement that occurs, Eckle explains.
· Absence seizures involve a brief lapse of awareness without loss of consciousness. "Staring, minor motor movements such as blinking or nystagmus, or changes in muscle tone may be evident," says Eckle.
· Tonic clonic seizures involve a loss of consciousness, sustained muscle contraction, and rigidity of extremities that alternates with rhythmic jerking and flexor spasm of the muscles, and deep postictal sleep is common. "Probably tonic-clonic are the most impressive and easily recognized," Dietrich notes.
· Tonic seizures are usually brief and involve tonic contractions of muscles and impaired consciousness. "Periods of apnea may occur with the contraction of abdominal and respiratory muscles," says Eckle.
· Myoclonic seizures are characterized as brief, sudden muscle contraction that may be generalized or limited to individual muscle groups of the face, trunk, or extremities, says Eckle. "The contractions may be subtle and resemble tremors or may occur as a component of an absence seizures or start of a tonic-clonic seizure," she explains.
· Febrile seizure is the most common seizure occurring in childhood, Eckle notes. "Simple febrile seizures usually involve generalized clonic-tonic or tonic motor activity, last less than 10-15 minutes, and have no focal onset," she says. "Complex febrile seizures are also associated with a febrile illness. However, a complex febrile seizure is typically prolonged (more than 15 minutes) and has focal onset."
· Status epilepticus is a medical emergency and the patient is at risk for respiratory depression and hypoxia, stresses Eckle. "Status epilepticus is considered a continuous generalized seizure lasting longer than 30 minutes or recurrent seizure that occurs without full recovery of consciousness between seizures," she says.
Any seizure activity that results in status is usually treated with diazepam or lorazepam, and then followed with a drug such as phenytoin or phenobarbitol, says Dietrich. Early treatment is key, since when status is prolonged, consequences may include brain damage and death, she stresses.
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