Presentation
The main outcome measures included cessation of the presenting tonic-clonic convulsion/episode of convulsive status epilepticus; the number of additional drugs required to stop the convulsion; people demonstrating respiratory depression and people requiring [ncbi.nlm.nih.gov]
Approximately 22 other posters about research on perampanel's safety profile and effectiveness were also presented at the meeting. [eisai.mediaroom.com]
This four step guideline is presented in this paper. [adc.bmj.com]
Witnesses present during the episodes often report them as "seizures." The spared consciousness and variability may be evidence against an epileptogenic mechanism. [jamanetwork.com]
They are characterized by non-motor symptoms, although brief twitches may be present. A common symptom of this type of seizure is blank staring that is often mistaken for daydreaming. [dravetsyndromenews.com]
Entire Body System
- Epilepsy
Stakeholder ( Chief Editor Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine Selim R Benbadis, MD is a [medscape.com]
For some people living with epilepsy, the risk of Sudden Unexpected Death in Epilepsy (SUDEP) is an important concern. [cdc.gov]
What is epilepsy How is epilepsy diagnosed? Types of seizures Seizure Triggers Epilepsy is a disorder of brain function that takes the form of recurring convulsive or non-convulsive seizures. [epilepsyaustralia.net]
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic uncontrolled epilepsy (Tomson et al., 2008 ). [onlinelibrary.wiley.com]
- Falling
The muscles will stiffen ( tonic phase), causing him/her to fall to the floor. Increased pressure on the bladder and bowel may cause wetting (urinary incontinence) or soiling (fecal incontinence). [epilepsyontario.org]
Generally, seizures fall into the two categories: focal and generalized seizures. The difference between these types is how they begin. [epilepsyqueensland.com.au]
If they are standing they often fall, usually backwards, and may injure the back of their head. Tonic seizures tend to be very brief and happen without warning. [epilepsysociety.org.uk]
TONIC-CLONIC – ( grand mal) convulsive (Most often recognized, but only 10% of those with epilepsy have this type of seizure) Stiffens, may utter cry, loss of consciousness, falls, body jerking 1 – 3 minutes loss of bladder or bowel control or vomiting [epilepsysandiego.org]
They may however vomit or bite their tongue and can sometimes injure themselves if they hit nearby objects as they fall or convulse. [epilepsyaustralia.net]
- Fever
Most patients had multiple seizures with fever sensitivity, and status epilepticus was common. Their seizures were easily induced by fever or infection. Additionally, the majority of the patients had varying degrees of developmental delay. [unboundmedicine.com]
Depending on the age of the child, the doctor may order blood or urine tests or both, looking for the source of the fever. [emedicinehealth.com]
If your child has a fever, the pediatrician will check to see if there is an infection. [healthychildren.org]
Most cases of SE happen to children under age 15 who have seizures brought on by high fever, and adults over 40 (most often because of strokes). [webmd.com]
They are a convulsion triggered by a fever that often accompanies childhood illnesses. [dravetsyndromenews.com]
- Crying
The person will usually emit a short, loud cry as the muscles in the chest contract and the air rushes between the vocal cods, making a sound. This cry does not indicate pain. [epilepsyontario.org]
TONIC-CLONIC – ( grand mal) convulsive (Most often recognized, but only 10% of those with epilepsy have this type of seizure) Stiffens, may utter cry, loss of consciousness, falls, body jerking 1 – 3 minutes loss of bladder or bowel control or vomiting [epilepsysandiego.org]
At the start of the seizure: the person becomes unconscious their body goes stiff and if they are standing up they usually fall backwards. they may cry out they may bite their tongue or cheek. [epilepsysociety.org.uk]
Tonic Clonic seizures (previously called grand mal seizures) During a tonic clonic seizure a person’s body stiffens, air being forced past the vocal cords causes a cry or groan and they fall to the ground (the tonic phase). [epilepsyqueensland.com.au]
He also noted forced laughter-crying episodes associated with this motor phenomenon when the contralateral thalamus was involved. Dana and other authors believed that the abnormal movements observed in pontine lesions were not convulsive in nature. [jamanetwork.com]
- Fatigue
After a seizure, the person may feel fatigue, confusion and disorientation, which may last from five minutes to several hours or even days. Rarely, this disorientation may last up to two weeks. [epilepsyontario.org]
SOMNOLENCE AND FATIGUE FYCOMPA caused dose-dependent increases in somnolence and fatigue-related events. [eisai.mediaroom.com]
[Journal Article] Clin Neurol Neurosurg 2019; 183:105392 Eguchi K, Tsuzaka K, … Sasaki H CN A 33-year-old man developed a generalized tonic-clonic seizure after a week of fever and fatigue. [unboundmedicine.com]
The child should return to his or her normal self except for fatigue within around 15 minutes. Often the child may have incontinence (lose urine or stool), and it is normal for the child not to remember the seizure. [emedicinehealth.com]
Cardiovascular
- Cyanosis
[…] with epilepsy have this type of seizure) Stiffens, may utter cry, loss of consciousness, falls, body jerking 1 – 3 minutes loss of bladder or bowel control or vomiting possible breathing – during tonic phase, breathing may decrease or cease – causing cyanosis [epilepsysandiego.org]
Because of side effects reported with IV and IM use (eg, cyanosis, cough, hypotension and pulmonary edema), only the rectal route with dilution in oil is recommended. [cps.ca]
Skin
- Sweating
(seeing something not there; occasionally momentary loss of vision) Hearing (music, ringing, person’s voice) Autonomic – change in area controlling automatic bodily functions Strange sensations in abdomen (nausea), chest (pressure), head (dizziness) Sweating [epilepsysandiego.org]
Neurologic
- Seizure
Roll the child on his/her side after the seizure subsides. If a seizure lasts longer than five minutes or repeats without full recovery, seek medical assistance immediately. Talk gently to the person after the seizure. [epilepsyontario.org]
Abrupt seizure termination was defined as a sudden, bilateral, and synchronized electroclinical seizure termination, whereas a gradual seizure termination was defined as seizures that terminated slowly with nonconvulsive ictal discharges or seizures that [onlinelibrary.wiley.com]
An investigator must consider whether to include patients with a narrow spectrum of seizure etiologies (e.g. febrile seizures) as opposed to including ‘all-comers’. Additionally, efficacy and adverse event outcomes are not well standardized. [academiccommons.columbia.edu]
Seizures also may be classified based on their cause such as, for example, febrile seizures, or seizures caused by high temperature, as well as symptoms they cause, myoclonic seizures, clonic seizures, tonic seizures, tonic-clonic seizures, absence seizures [dravetsyndromenews.com]
These seizures are known as focal aware seizures or focal impaired awareness seizures. [epilepsysociety.org.uk]
- Generalized Tonic-Clonic Seizure
(Tonic clonic convulsive status epilepticus) 841 results Monitoring for seizures in the intensive care unit. [unboundmedicine.com]
CONVULSIVE SEIZURE Generalized tonic-clonic seizures are typically bilateral and symmetric although variants with asymmetry including head and eye deviation can be seen. [epilepsydiagnosis.org]
Key points • Syncope is often accompanied by tonic or myoclonic muscle activity. • Myoclonus is usually brief, arrhythmic, and multifocal. • Specific provocation and rapid reorientation helps to distinguish syncope from generalized tonic clonic seizures [medlink.com]
Of the 151 GTCS, 2 (1.3%) were generalized tonic seizures, 28 (18.5%) were generalized clonic seizures, and 121 (80.1%) were generalized tonic clonic seizures (GTCS). [onlinelibrary.wiley.com]
- Headache
S/he may have a headache once s/he regains consciousness. There is no evidence that tonic-clonic seizures cause brain damage. First Aid Expand First Aid Section Keep calm. Protect the child from further injury. Do not restrain the person. [epilepsyontario.org]
They may have a headache and want to sleep. This drowsiness can last for a numbers of hours. Although this type of seizure can be frightening to watch, the seizure itself is unlikely to seriously harm the person having the seizure. [epilepsyqueensland.com.au]
They may feel tired or confused after the event and have a headache. Tonic seizures are very rare in Dravet syndrome. Tonic-clonic seizures Tonic-clonic seizures usually are generalized onset, but also can be focal onset. [dravetsyndromenews.com]
In all perampanel-treated subgroups, the most common TEAE was dizziness, and there were no notable differences in the types of TEAEs across subgroups, including somnolence and headache. [eisai.mediaroom.com]
[…] affected and become difficult or sound noisy their skin may change colour and become very pale or bluish they may wet themselves After the seizure (once the jerking stops): their breathing and colour return to normal they may feel tired, confused, have a headache [epilepsysociety.org.uk]
- Febrile Seizures
A febrile seizure occurs when a child contracts an illness such as an ear infection, cold, or chickenpox accompanied by fever. Febrile seizures are the most common type of seizure seen in children. [emedicinehealth.com]
Febrile seizures Febrile seizures usually are of generalized seizure. They are a convulsion triggered by a fever that often accompanies childhood illnesses. [dravetsyndromenews.com]
An investigator must consider whether to include patients with a narrow spectrum of seizure etiologies (e.g. febrile seizures) as opposed to including ‘all-comers’. Additionally, efficacy and adverse event outcomes are not well standardized. [academiccommons.columbia.edu]
Febrile Seizures Treatment of the Child with a First Unprovoked Seizure (AAP Practice Guideline Endorsement) Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure (AAP Clinical Practice Guideline) The [healthychildren.org]
The most common cause of CSE is a prolonged febrile seizure. Children experiencing this type of seizure may not require an extensive workup. The same may apply to children with a known seizure disorder who are already on anticonvulsant therapy. [cps.ca]
- Atonic Seizures
Like tonic seizures, atonic seizures tend to be brief and happen without warning. With both tonic and atonic seizures people usually recover quickly, apart from possible injuries. Myoclonic seizures Myoclonic means ‘muscle jerk’. [epilepsysociety.org.uk]
atonic seizures, focal impaired-awareness seizures. [dravetsyndromenews.com]
Atonic seizures Atonic seizures cause a sudden loss or decrease of normal muscle tone and the person often falls to the ground. Seizures usually last less than 15 seconds. Often called drop attacks, theses seizures can cause head or facial injury. [epilepsyqueensland.com.au]
Atonic seizure Atonic seizures are generalised seizures that affect muscle tone causing the person to collapse to the ground. The person usually remains conscious. [epilepsyaustralia.net]
Urogenital
- Incontinence
Increased pressure on the bladder and bowel may cause wetting (urinary incontinence) or soiling (fecal incontinence). The child may bite the tongue, which may cause bleeding. The extremities will then jerk and twitch rhythmically ( clonic phase). [epilepsyontario.org]
Her family observed 3 "severe shaking episodes" with urinary incontinence. Angiography showed proximal basilar artery stenosis. Silverstein 21 analyzed 83 autopsies of patients with pontine infarcts. Eleven (13%) had basilar artery occlusions. [jamanetwork.com]
Often the child may have incontinence (lose urine or stool), and it is normal for the child not to remember the seizure. Sometimes the jerking can cause injury, which may range from a small bite on the tongue to a broken bone. [emedicinehealth.com]
Workup
Children experiencing this type of seizure may not require an extensive workup. The same may apply to children with a known seizure disorder who are already on anticonvulsant therapy. [cps.ca]
Treatment
2009 Articles Commentary by David McGillivray, Peter Dayan and Martin Pusic The treatment of an acute convulsion can be a lifesaving intervention, especially in cases where the convulsion is likely to be prolonged or leaves the patient susceptible to [academiccommons.columbia.edu]
First-line treatment First-line treatment usually begins outside the hospital. It has been shown that prehospital treatment of children reduces seizure length but often is not utilized [11]. [cps.ca]
Treatment for non-convulsive status epilepticus is less urgent than for convulsive status epilepticus. [nice.org.uk]
BACKGROUND: Tonic-clonic (grand mal) convulsions and convulsive status epilepticus (currently defined as a grand mal convulsion lasting at least 30 minutes) are medical emergencies and demand urgent and appropriate anticonvulsant treatment. [ncbi.nlm.nih.gov]
"Experiencing freedom from seizures, especially convulsive seizures, is a key objective in the treatment of epilepsy, and there is growing interest among doctors in the safety and efficacy of monotherapy AED treatment options like perampanel," said Lynn [eisai.mediaroom.com]
Prognosis
What Is the Prognosis for Seizures in Children? The prognosis for children with seizures depends on the type of seizures. Most children do well, are able to attend regular school, and have no limitations. [emedicinehealth.com]
Etiology
An investigator must consider whether to include patients with a narrow spectrum of seizure etiologies (e.g. febrile seizures) as opposed to including ‘all-comers’. Additionally, efficacy and adverse event outcomes are not well standardized. [academiccommons.columbia.edu]
Common etiologies are listed in Table 1 [3]. Mortality has been reported to be between 2.7% and 8%, with an overall morbidity (mainly newly diagnosed neurological disorders) of between 10% and 20% [2]. [cps.ca]
With PGES Without PGES Number of patients 109 64 45 Age (year) 35 (12.3) 35 (14.7) 35 (10.9) Gender F (56%), M (44%) F (57%), M (43%) F (54%), M (46%) Seizure onset (year) 11 ± 8.3 12 ± 8.1 10 ± 9.4 Duration of epilepsy 21 ± 10.7 20 ± 12.1 22 ± 10.3 Etiologies [onlinelibrary.wiley.com]
If signs or symptoms are present, immediately evaluate the patient and discontinue FYCOMPA if an alternative etiology for signs or symptoms cannot be established. [eisai.mediaroom.com]
Epidemiology
Descriptive epidemiology of epilepsy: Contributions of population-based studies from Rochester, Minnesota. Mayo Clinic Proceedings, 71(6). 576-586. [epilepsyaustralia.net]
Data from epidemiological studies suggest that four to eight children per 1000 may be expected to experience an episode of CSE before the age of 15 years, 8 and in children with first seizures, 12% present with CSE as their first unprovoked seizure. 9 [adc.bmj.com]
Key Words: Convulsions; Emergency management; Paediatrics; Seizures; Status epilepticus Background and epidemiology The conventional definition of convulsive status epilepticus (CSE) is continuous generalized tonic-clonic seizure activity with loss of [cps.ca]
Pathophysiology
The pathophysiological mechanisms remain uncertain. Further functional studies are necessary to clarify the nature of this phenomenon. Accepted for publication July 5, 2000. We thank Jose A. Bueri, MD, for his kind collaboration. [jamanetwork.com]
Prevention
How to Prevent Seizures in Children Most seizures cannot be prevented. There are some exceptions, but these are very difficult to control, such as head trauma and infections during pregnancy. [emedicinehealth.com]
Termination of the seizure and prevention of recurrence Principles of treatment and monitoring The major goal of treatment is to stop the seizure and, in doing so, prevent brain injury. [cps.ca]
Simple preventative measures can be taken to decrease seizures triggered this way such as wearing wrap-around sunglasses to reduce glare and covering one eye to reduce the effects of flickering or flashing light. [epilepsyaustralia.net]
However, these approaches do not prevent future febrile seizures, but only make the child more comfortable. If a bacterial infection is present, your doctor will probably prescribe an antibiotic. [healthychildren.org]
However, the guideline stated that 'for practical purposes, the approach to the child who presents with a tonic–clonic convulsion lasting more than 5 minutes should be the same as the child who is in "established" status – to stop the seizure and to prevent [nice.org.uk]