With the child losing consciousness.
Education.
Control the seizure, discover and correct the underlying cause, and live as normal a life as possible.
Yes, they may spread regionally.
Repetitive movements may occur.
Dehydration.
Physio, occupational, and speech therapists.
The frontal lobe.
High levels of ketones can suppress seizures.
Do not attempt to restrain the child, place anything between the child's teeth, give any food or liquid, or move the child unless they are in danger.
Children between ½ - 5 years old.
Angiography, PET, SPECT, CT scan, MRI, and fMRI.
Family history of febrile seizures and lower resistance to high body temperature in children.
It is the phase after the seizure.
Seizures.
They are more difficult to localize and more likely to cause a functional deficit.
Violent jerking movements, limbs undergo rhythmic contraction and relaxation, and possible incontinence of urine and feces.
A surgical procedure to remove a specific area of the brain where seizures originate.
It is the phase prior to the seizure.
Difficulty talking.
Vagus nerve stimulation.
The level of ketone bodies increases.
Grand Mal seizures.
Attend to AED if the child's tonic-clonic seizure lasts longer than 5 minutes or if there is respiratory distress during the seizure.
Headache, nausea, pain, weakness, sleeping, bruising, and exhaustion.
Due to loss of function.
Ketogenic diet.
Age, overall health, and medical history; types of the seizures; frequency of the seizures; response to medications, procedures, or therapies; and expectations for the course of the condition.
By inducing ketosis.
The type and duration of the seizure.
A surgical procedure to remove parts of the brain outside the temporal lobe to control seizures.
A 3-generation family history.
BP, RR, HR, and SpO2.
Between 2 - 5 years of age.
5% to 10%
The selection of an AED should be individualized.
Those not controlled by medication, diet therapy, or other therapies; those with severe side effects from medications that significantly affect quality of life; and those whose seizure focus is in a resectable part of the brain with low risk of causing worse functional impairment.
Yes, most patients continue taking antiepileptic medication.
Modified Atkins diet (MAD) and modified ketogenic diet.
Instructions on medications, advice on contraception for adolescents, regular dental follow-up, follow-up date reminders, and encouraging parents to inform the school about the child's disease.
Diazepam, lorazepam, or midazolam.
No, there is no postictal state.
They can affect developmental abilities.
Dangerous activities such as rock/mountain climbing and tree climbing should be avoided if seizures are not well controlled.
Parents should be encouraged to inform the school about the child's disease.
Patients who have not responded to antiepileptic drugs.
Aware seizure and impaired aware seizure.
CBC, electrolytes, glucose, and medication levels.
A chronic condition characterized by recurrent (more than 2 episodes) and unprovoked seizures.
A surgical procedure that involves disconnecting one hemisphere of the brain to control seizures.
A surgical procedure that involves cutting the corpus callosum to prevent the spread of seizures between the brain's hemispheres.
Just after waking up.
Generalized seizures, especially atonic seizures.
Sudden disturbance of brain function.
Administer medication as prescribed.
Generally, individuals are fully awake, alert, and able to recall events during the seizure.
Less than 15 seconds.
Protect the child from injury.
Delayed development.
Altered family processes.
All necessary equipment should be in place and function properly.
Constipation and diarrhea.
Remove unnecessary objects.
Lift up the side-rails.
To use stored glucose and glycogen, and burn stored body fat.
Fruit and fruit juice, breads and cereals, vegetables (corn, peas, and potatoes), beans, milk, soda, snack foods (chips, snack cakes, crackers), and sweets.
Grand Mal seizures (強直陣攣發作).
Preictal (Prodromal), Ictal, and Postictal.
Voice changes/hoarseness, throat pain/cough, headache/insomnia, tingling or prickling of the skin.
Encourage them to express their fears and anxieties.
Urge to urinate or defecate.
The child's overall physiologic status.
Reassure parents that one occasion of febrile seizures does not mean the child will go on to have epilepsy.
Any age.
Usually between 4 - 8 years of age.
Discharge planning and home care teaching should include guidance on safe activities, supervision requirements, and avoiding dangerous activities if seizures are not well controlled.
Swelling in the brain.
Risk of anxiety.
Butter, heavy cream, oil, mayonnaise, cream cheese, bacon, and cheese.
The regions of the cortex affected.
A popular, ambiguous, and unofficial term describing uncontrollable muscle contractions.
Vagus Nerve Stimulation is used as a treatment for seizures.
It is used for treating partial seizures in adults and adolescents over 12 years of age.
Patients with refractory seizures despite multiple antiepileptic medications and those not suitable for brain surgery.
Answer their questions honestly.
Maintain airway patency and ensure adequate ventilation.
The antiepileptic effect is mediated via an inhibitory effect at the brainstem level.
Language disorders, neuropsychological impairment, and motor dysfunction.
Involuntary muscle activity, change in level of consciousness, altered behavior, and altered sensory manifestations.
Drug knowledge.
Jerking movement may involve one or both extremities, and eyes and head may turn to the opposite direction.
Usually genetic cause.
The seizure focus must be in a part of the brain that can be resected with a low probability of causing worse functional impairment than the intractable seizures.
Loss of peripheral (side) vision.
Yes, the cause of seizures in children and adolescents can sometimes be unknown.
They are able to continue the activity.
Damage to the functional hemisphere.
Bone fractures.
An alternative treatment option for epilepsy.
Myoclonic astatic epilepsy and infantile spasms.
To record the brain's continuous electrical activity and help find out the cause of seizures.
Emotional support.
Carbamazepine, Benzodiazepine, Clonazepam, Levetiracetam, Clobazam, Sodium valproate, Gabapentin (Neurontin), Vigabatrin, Lorazepam, Phenobarbital, and Phenytoin.
Start with a single AED (monotherapy).
Ineffective breathing pattern.
4 to 6 weeks.
Sudden dropping forward, head flexed, arms extended, legs drawn up, eyes may roll upward or inward.
Position the child on his/her side.
Loss of movement or sensation on the opposite side of the body.
Risk of injury.
Muscles suddenly become limp.
Kidney stones.
No, they do not have a warning sign.
Ketogenic diet.
Nothing should be placed in the child's mouth.
Documenting the seizure attack.
Anterior temporal lobectomy and extratemporal cortical resection.
Abnormal electrical activity in one hemisphere or in a specific area of the cerebral cortex.
Violent jerking movements, limbs undergo rhythmic contraction and relaxation, may be incontinent of urine and feces.
The person appears to relax, may remain semiconscious or awaken in a few minutes, has poor coordination, mild impairment of fine motor movements, may have visual and speech difficulties, may vomit, and has no recollection of the entire event.
The person appears to relax, may remain semiconscious or awaken in a few minutes, has poor coordination, mild impairment of fine motor movements, possible visual and speech difficulties, and may vomit. There is no recollection of the entire event.
Memory loss and confusion.
Fear, embarrassment, frustration, depression, and sadness.
To help diagnose conditions that might be causing seizures.
A rapid increase in body temperature >39°C.
The vagus nerve stimulator is implanted and connected to the vagus nerve in the neck.
It is the phase during the seizure.
The device can be set to emit electronic pulses every 5 minutes.
A high fat, adequate protein, very little carbohydrate diet.
Throat pain or cough.
A magnet wand can be used over the stimulator to deliver extra stimulation.
Approximately 90 percent.
Headache and insomnia.
Infection, bleeding, and allergic reaction to anesthesia.
Most people will grow back their hair over the incision site.
Yes, they may associate with other seizure forms.
Tingling or prickling of the skin.
The infant may cry during and after the seizure.
1 - 2 seconds
Kidney stones, high cholesterol levels in the blood, dehydration, constipation, slow growth or weight gain, bone fractures, and diarrhea.
Girls are more commonly affected than boys.
1 - 2 seconds.
Play is important as it encourages normal development and social interaction, but it should be supervised to ensure safety.
Parents should be educated on not restraining the child, not placing anything between the child's teeth, not giving food or liquid, and not moving the child unless in danger.
A brief, temporary disturbance in the brain’s electrical activity, usually self-limited.
Support groups and counseling services.
Voice changes or hoarseness.
By monitoring serum drug levels.
About 50% of patients.
Sudden loss of tone.
In infants 4 - 8 months old.
Particularly in the morning hours and shortly after awakening.
Most people will be able to reduce or eliminate medications.
There may be a loss of consciousness (LOC).
If their seizures are not controlled by other treatments, if they experience severe medication side effects, or if the seizure focus can be safely resected.
They may have many episodes per day.
Protein.
No, they occur without a postictal phase.
Up to more than 20 attacks per day.
Myoclonic astatic epilepsy and infantile spasms.
Yes, they can have an aura before a stronger seizure appears.
A medical emergency where tonic and clonic seizures last more than 30 minutes without regaining a premorbid level of consciousness.
More than 30 minutes.
History & physical examination, EEG, Imaging, Presurgical testing (e.g., Visual fields and visuospatial function test, Wada test & brain mapping), Neuropsychology evaluation.
Visual fields and visuospatial function test, Wada test, and brain mapping.
Extratemporal cortical resection.
A type of seizure that affects both sides of the brain from the beginning.
To visualize the brain structure and identify any abnormalities.
Pre-operation care.
It helps identify any physical signs that may indicate the cause or type of seizure.
A complex febrile seizure has a focal onset, lasts 15 minutes or longer, and can occur more than once within a 24-hour period. It often has no family history of febrile seizures and may be associated with developmental delay and focal features or postictal deficit.
15 minutes or longer.
An aura is a possible pre-seizure sensation or experience.
Tonic-clonic and epileptic spasms.
A surgical procedure that removes portions of one hemisphere which is not functioning normally.
Start with an alternative first-line or second-line drug.
Ineffective airway clearance.
Onset, focal or generalized seizure, level of consciousness, signs of hypoxia, duration, vital signs, and any injury.
Administer oxygen.
Perform suction if necessary.
If the child has no episodes for at least 2 years and has a normal EEG.
Usually awake, sudden brief contractures of a muscle or group of muscles in the whole body or just in an arm or leg, occur singly or repetitively.
Near the nursing station.
Brain tumor, alcohol or drugs, head trauma, infection, and certain nutritional deficiencies.
The phase after the seizure where the person may or may not be confused and may be able to return to usual activity.
Document the seizure condition.
One-to-one supervision is required for a child with seizures to safely participate in swimming and water sports.
1. Onset or beginning of a seizure, 2. A person’s level of awareness during a seizure, 3. Movements happen during a seizure.
To prevent the child from getting injured.
Administer medication if it has been prescribed by a doctor.
Maintain a patent airway.
Perform a jaw thrust maneuver.
To assess cognitive function and identify any potential risks associated with surgery.
Functional hemispherectomy.
Anesthetics.
It helps classify the type of seizure.
Idiopathic means the cause of the seizures is unknown.
Hallucinations, buzzing, ringing, or drumming sounds.
Birth trauma can lead to hypoxia, which can cause seizures in newborns and infants.
Fever can lower the seizure threshold, making seizures more likely to occur, especially in children.
Age 3 to adolescents.
Focal features or postictal deficit.
Tonic-clonic, clonic, myoclonic, myoclonic-tonic-clonic, myoclonic-atonic, atonic, and epileptic spasms.
A type of generalized onset seizure characterized by repetitive, rhythmic jerking movements.
For a period of time as determined by the doctor.
Less than 10% of patients.
Risk of aspiration.
Structural change in the brain, genetic causes, and metabolic causes such as phenylketonuria.
The child's vital signs, neurological level, color, seizure duration, and pattern.
Grand Mal (強直陣攣發作)
Flushing, pallor, or cyanosis.
A child with seizures can participate in sports when adequate supervision is provided.
Be calm and stay with the child, position the child on their side, loosen restrictive clothing, prevent the child from any harm, clear the area of hazards, administer prescribed medication, allow the seizure to end without interference, and seek medical advice immediately.
The person stares blankly and is not responsive.
Unconsciousness, fall to ground, up-rolling eyeballs, continuous tonic muscular contraction, arms flexed, legs, head & neck extended, apnoeic leading to cyanosis, and loss of swallowing reflex.
Loosen restrictive clothing to ensure the child can breathe easily.
Febrile seizure.
Fever management.
Certain nutritional deficiencies can be an acquired cause of seizures in children and adolescents.
Swallowing reflex.
It helps determine the type and potential causes of seizures.
Any factors that may have triggered the seizure.
Using age-appropriate pain scales and administering medication as prescribed.
Fever can increase the likelihood of seizures by raising the body's temperature, which can affect brain function.
Due to inadequate information or inability to place it in other categories.
Sleep deprivation can disrupt normal brain function and increase the likelihood of seizures.
Congenital problems such as brain malformations or genetic disorders can lead to seizures.
There is a loss of consciousness (LOC) and mental confusion.
No, there is often no family history of febrile seizures.
Aware and Impaired Awareness.
Tonic, Clonic, Tonic-clonic, Absence, Myoclonic, Akinetic or atonic, Febrile, Infantile spasm, and Catamenial epilepsy.
Generalized full body tonic-clonic movement.
3-4 to 1 on a caloric basis.
The doctor will gradually decrease the dose based on the child's condition.
Seizures not controlled by medication, diet therapy, or other therapies; severe medication side effects affecting quality of life; and a defined seizure focus in a resectable brain area with low risk of worse functional impairment.
Many patients have improvements in mood, alertness, and overall quality of life.
A high proportion of fats and strict control of carbohydrates.
Paresthesia and decreased auditory or visual sensations.
Allow the patient to sleep, then reorient upon awakening.
1 - 3 minutes
The side-rails of the bed should be padded.
Body weight and height.
Abrupt onset.
Infections can be an acquired cause of seizures in children and adolescents.
Usually 10-15%.
History of Present Illness.
Headache, incontinence, injury, and residual deficits.
The diet is individualized.
A sensory or perceptual disturbance that precedes a seizure.
Bruises, burns, fractures, lacerations, and mouth trauma.
Behavior change, confusion, language disturbance, poor coordination, weakness/paralysis of body part(s), and sleep pattern disturbance.
Genetic factors can predispose individuals to seizures through inherited conditions or mutations.
Fluid and electrolyte status.
Numbness, weakness, or a feeling of separation from the body.
Photic stimuli, such as flickering lights and visual patterns, can trigger seizures in susceptible individuals by overstimulating the brain's visual cortex.
The child may have bicycling movements of the legs.
Focal onset, Generalized onset, and Unknown onset.
A type of generalized onset seizure that occurs in infants, characterized by sudden bending of the body and stiffening of the arms and legs.
Because there are similar medications like Sodium valproate and Sodium valproate SR.
No, do not restrain the child's movements.
Duration: 5 - 20 seconds.
An alternative treatment option.
Yes, they may incur injury.
Yes, they are able to maintain postural control.
Head trauma is an acquired cause of seizures in children and adolescents.
Approximately 50% reduction.
Prenatal, perinatal, and neonatal history.
Vital signs monitoring, ICP (Q1H till stable) & neurological status, fluid & electrolyte status, CSF leaking & wound drainage, wound care, bleeding observation, and pain management.
Every hour (Q1H).
Character, duration, location, and severity.
A seizure that starts as a focal seizure and progresses to a bilateral tonic-clonic seizure.
The person has a reduced level of awareness during the seizure.
Symptoms and behaviors observed after the seizure ends.
Certain medications and recreational drugs can alter brain chemistry and electrical activity, increasing the risk of seizures.
Less than 15 minutes.
Developmental delay.
Typical, atypical, myoclonic, and eyelid myoclonic.
A type of generalized onset seizure characterized by brief lapses in awareness, often described as 'staring spells'.
The person may fall to the ground, the head may drop, eyelids may droop, and the upper body may slump over.
Petit Mal (失神發作).
Changes in blood pressure, heart rhythm, and bowel or bladder function.
Cholesterol and ketone levels.
Alcohol or drugs can act as acquired causes of seizures in children and adolescents.
Parents and children should be instructed about the information of the medications, including usage, side effects, and importance of adherence.
1. Focal onset seizures, 2. Generalized onset seizures, 3. Unknown onset seizures.
Pre-surgical evaluation.
Antiepileptic drugs.
Focal cortical resection.
A type of seizure that begins in one area of the brain.
Motor Onset (including Tonic-clonic and Other motor) and Non-motor (absence).
To sever the corpus callosum to prevent seizure spread between hemispheres.
To assess language and memory functions of each hemisphere of the brain.
The person remains aware during the seizure.
The phase during which the seizure occurs, with symptoms dependent on the type of seizure.
Normal neurodevelopment.
Performing repeated purposeless activities such as head nodding, smacking lips, chewing or sucking lips, and staring into space.
A type of generalized onset seizure that occurs in young children and is associated with a high fever.
Adolescents should be advised on contraception until a pregnancy is desired.
It can cause high cholesterol levels in the blood.
Because anticonvulsive drugs may cause gingivitis.
Failure to control seizures.
Slow growth or weight gain.
Ketosis improves seizure control.
To ensure continuous monitoring and management of the patient's condition.
Onset or beginning of a seizure.
Focal onset, Generalized onset, and Unknown onset.
Movements happen during a seizure.
Motor Onset (including Tonic-clonic and Other motor) and Non-motor (absence).
Observing for any bleeding and ensuring proper wound drainage.
Continuous EEG monitoring.
Emotional stress can alter brain chemistry and electrical activity, potentially triggering seizures.
Metabolic or chemical imbalances such as hypoglycemia and hypocalcemia can cause seizures.
More than one episode.
Both hemispheres of the brain, including the cortex and brainstem.
A type of generalized onset seizure that is related to the menstrual cycle.
To prevent choking and ensure the airway remains clear.
Usually cease at puberty.
Arms are flexed.
Legs, head, and neck are extended.
In N/PICU (Neonatal/Pediatric Intensive Care Unit).
A person’s level of awareness during a seizure.
Impaired Awareness, Motor Onset, and Non-motor Onset.
Any CSF leaking, wound drainage, and bleeding.
Urinary and bowel incontinence.
A type of seizure where the beginning is not known.
To reduce the frequency and intensity of seizures.
Bright lights, zig zag lines, spots, tunnel vision.
A simple febrile seizure is a generalized onset seizure that lasts less than 15 minutes and occurs as a single episode within a 24-hour period. It is often associated with a family history of febrile seizures and normal neurodevelopment.
One episode.
Central apnoea.
Automatism, atonic, clonic, epileptic spasms, hyperkinetic, myoclonic, and tonic.
A type of generalized onset seizure characterized by muscle stiffness.
Prepare emergency equipment at bedside.
Assist the child with investigation.
Seek medical advice immediately.
Interfering can cause harm to the child and may prolong the seizure.
Provide suction if needed and administer oxygen.
To monitor and record electrical activity in the brain.
The ketogenic diet.
Acquired causes of seizures include birth trauma, congenital problems, fever, and metabolic or chemical imbalances.
Alcohol can affect brain function and withdrawal from alcohol can also trigger seizures.
A seizure that cannot be placed in other categories due to inadequate information or inability to classify.
A type of generalized onset seizure characterized by a sudden loss of muscle tone, leading to collapse.
The person may resume normal activity or may need to reorient themselves to the previous activity.
Regularly for febrile conditions only.
No.
Overdressing the child.
Diazepam or phenobarbital.
Prescribed diazepam suppository (DDA).
Fever, emotional stress, hyperventilation, sleep deprivation, medications (e.g., recreational drugs), metabolic disturbance, alcohol, photic stimuli (flickering lights, visual patterns).
How long the seizure lasted and how it developed over time.
Hyperventilation can lead to changes in blood gas levels, which may provoke seizures.
Tests that can help identify underlying conditions or abnormalities.
Psychological symptoms can vary and are part of the aura experience.
Yes, there is often a family history of febrile seizures.
A seizure that starts in one part of the brain (focal) and then spreads to both sides (bilateral) resulting in tonic-clonic activity.
A type of generalized onset seizure that involves both muscle stiffness (tonic) and rhythmic jerking (clonic).
Apnoea leading to cyanosis.
For 2 years.
It is beneficial for patients who have not responded to antiepileptic drugs.
Encourage fluid intake.
The phase before the seizure begins, often characterized by an aura.
To accurately assess and manage the patient's pain according to their developmental level.
Smelling burning rubber or an electrical smell.
Metabolic disturbances such as electrolyte imbalances, hypoglycemia, or acidosis can trigger seizures.
They are tired and confused for 5-15 minutes.
Autonomic, behavior arrest, cognitive, emotional, and sensory.
They may affect the conscious status.
A type of generalized onset seizure characterized by sudden, brief jerks or twitches of the muscles.
