Seizures in Children — Viva

Q1: Febrile Seizures (3 min)

"How do you manage febrile seizures?"

• Simple FS: generalised, under 15 min, once/illness, no Todd's — reassure, NO investigations, NO AEDs
• Complex FS: focal, over 15 min, multiple, Todd's — EEG, neuroimaging, consider AED prophylaxis
• Antipyretics for comfort (NOT seizure prevention)
• Risk of epilepsy: simple 2%, complex 5-10%

Q2: Status Epilepticus (3 min)

"What is the protocol for paediatric status epilepticus?"

• 0-5 min: ABC, check glucose, oxygen
• 5-10 min: IV lorazepam 0.1 mg/kg (or buccal midazolam if no IV)
• 10-30 min: IV levetiracetam 40 mg/kg OR phenytoin 20 mg/kg
• Over 30 min: intubation, propofol/thiopentone in PICU
• Target: control within 60 minutes [1]

Q3: AED Choice (2 min)

"How do you choose an antiepileptic drug?"

• CAE → ethosuximide
• JME → valproate (males); levetiracetam (females)
• Focal → levetiracetam or lamotrigine
• Infantile spasms → ACTH or vigabatrin
• Avoid carbamazepine in generalised epilepsies

Q4: Valproate in Females (2 min)

"What are the risks of valproate in females?"

• Teratogenic: neural tube defects, cardiac malformations
• Risk of PCOS and weight gain
• MHRA Pregnancy Prevention Programme (PPP)
• Only use if no alternative and fully informed
• Switch to levetiracetam or lamotrigine before pregnancy

References

1. [1]Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, Lagae L, Moshé SL, Peltola J, Roulet Perez E, Scheffer IE, Zuberi SM. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017.PMID 28276060