Differential diagnosis and metabolic causes
When evaluating seizure syndrome in children, pediatricians must rule out metabolic abnormalities. These include hypocalcemia, hypoglycemia, and hypomagnesemia. Such verification of electrolyte balance fundamentally changes emergency management compared to pure epilepsy.
- Spasmophilia: accompanied by metabolic shifts, differs from true epilepsy.
- Epileptic seizures: characterized by recurrent unprovoked episodes and specific EEG changes.
- Breath-holding spells: provoked by crying and stress, presenting with transient apnea and cyanosis.
Febrile seizures in children
These are non-epileptic manifestations occurring against the background of elevated body temperature, most commonly at the moment of its decrease. The stages of the seizure include a prodrome, ocular symptoms (glassy stare or version), as well as tonic and clonic phases.
The therapeutic approach combines:
- Etiotropic therapy: fever reduction and infection treatment.
- Pathogenetic therapy: administration of anticonvulsants (unlike epilepsy, where only anticonvulsants are used).
International practice shows that antipyretics do not directly prevent the development of seizures, so the emphasis is placed on specific anticonvulsant drugs.
Antipyretic management and specific care
Basic antipyretics are used to reduce fever in children. At the same time, lowered thermometry thresholds are established for at-risk patients:
| Temperature threshold | Patient category |
|---|---|
| > 38,0 °C | Children with a history of febrile seizures, infants under 3 months, severe pathology |
| > 37,5 °C | Development of "pale fever" |
| Any values | Severe pain syndrome, worsening well-being |
The drug of choice for emergency seizure termination is diazepam. Additionally, measures are taken to ensure airway patency, monitor vital functions, and provide physical cooling.
Status epilepticus
Status epilepticus is defined as a series of recurrent generalized tonic-clonic seizures between which the patient does not regain clear consciousness. Intervals between episodes are usually 5 to 15 minutes.
Main causes:
- Abrupt cessation of anticonvulsant medication.
- Intracranial tumors and severe traumatic brain injuries.
- Eclampsia.
Continuous seizures lead to secondary hyperthermia, impaired cerebrospinal fluid dynamics, and progressive cerebral edema. Intravenous diazepam, alternative routes of administration (rectally or via a gastric tube), as well as supportive dehydration and anti-shock therapy, are used for termination.
Class and exam questions
What metabolic causes trigger seizure syndrome?
The main metabolic causes include hypocalcemia, hypoglycemia, and hypomagnesemia, which require laboratory verification.
Are antipyretics effective for the prevention of febrile seizures?
According to international practice, antipyretics do not prevent the development of seizures; therefore, specific anticonvulsant therapy must be used to terminate the seizure.
What is status epilepticus?
This is a series of recurrent generalized tonic-clonic seizures occurring at intervals of 5–15 minutes, during which the patient's clear consciousness is not restored.
What else to study on this topic
- Spasmophilic syndrome and its laboratory diagnostics
- Features of the lytic cocktail and its use in refractory fever
- Criteria for systemic inflammatory response syndrome (SIRS)
- Alternative routes of administration for benzodiazepines in status epilepticus
- Prevention and prediction of the transformation of febrile seizures into epilepsy
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