Fits, Faints and Funny Turns

Febrile seizures

  • Type of seizure that occurs in children with a high fever e.g. due to underlying viral illness or bacterial infection
  • Occur only in children between the ages of 6 months and 5 years
  • In order the make a diagnosis of a febrile convulsion, other neurological pathology must be excluded e.g. epilepsy, meningitis, brain tumour

Management

  • Identify and manage underlying infection
  • Control the fever with simple analgesia such as paracetamol and ibuprofen
  • Reassure parents

Vasovagal episode

  • Most common cause of syncope in children
  • Type of reflex syncope, involves vagal stimulation triggered by emotional distress or orthstatic stress
  • Typical triggers include: prolonged standing, emotional stress, pain, the sight of blood
  • Faint is associated with pallor, sweating and nausea

Management

  • Reassurance
  • Education - avoidance of triggers, how to avert faint through manoevers to increase venous return e.g. horizonal gravity neutralisation position

Breath holding attacks

  • Involuntary episodes during which a child holds their breath, usually triggered by something upsetting or scaring them
  • They typically occur between 6 and 18 months of age and most children outgrow them between by 4 or 5 years

Management

  • After excluding other pathology and making a diagnosis, educating and reassuring parents is the key to management

Reflex anoxic seizures

  • Occur when the child is startled, most commonly a minor bump to the head
  • The vagus nerve sends strong signals to the heart that causes it to stop beating
  • The child will suddenly go pale, lose consciousness and may start to have some seizure-like muscle twitching
  • Within 30 seconds the heart restarts and the child becomes conscious again

Management

  • After excluding other pathology and making a diagnosis, educating and reassuring parents is the key to management

Epilepsy

  • Umbrella term for a condition where there is a tendency to have seizures
  • Seizures are transient episodes of abnormal electrical activity in the brain
  • Investigations include EEG and MRI brain

Management

  • Education about how to manage seizure
  • Anti-epileptic medication