Presentation

Seizure / Paroxysmal Events

Key Conditions

Key conditions are the core conditions that the Paediatric Undergraduate and Clerkship Directors of Canada (PUPDOC) felt are essential for graduating medical students to know. The Key Conditions are neither a differential diagnosis nor a clinical approach. They highlight conditions that may be unique to paediatrics, that are essential, or that are common. Key Conditions can present in a number of ways – each is listed as under the most common Clinical Presentation.

Clinical Approach

Clinical approaches represent one of many methods to think through a clinical presentation, and narrow down a differential diagnosis. There are many conditions that can present with similar symptomatology. These presentations are not meant to contain an exhaustive list of differential diagnoses, but rather outline how to think through patient signs and symptoms, and understand some of the most common and important Paediatric conditions. There are many different ways to approach any clinical presentation, and these approaches are not meant to replace clinical judgement.

Vignette

A 24 month boy is brought to medical attention following 3 episodes at home where he appeared to stare off into space, and then have a brief period of loss of consciousness

Diagrams

Pre-Clerkship

Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.

Lectures

Small Groups

  • Seizure Small Group Course 5
  • Pediatric Neurology Small Group Course 6
  • Syncope Course 5

Clerkship

Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.

Objectives

By the end of the Paediatric Clerkship, a medical student will be able to:

  1. Distinguish between seizures and paroxysmal events.
  2. Distinguish between simple febrile, complex febrile and non-febrile seizures.
  3. Distinguish between generalized and focal seizures.
  4. Recognize the clinical features and propose a management plan for patients with status epilepticus, arrhythmia, and syncope.
  5. Recognize the clinical features of Brief Resolved Unexplained Events and breath-holding spells.

Half Day Cases

  • A 15 month old child is with the baby sitter. The baby sitter took a toy away from her, at which time she started crying, then stopped and turned blue. She had 15 seconds where she lost consciousness. EMS was called and she is now in the emergency department.
  • A 2 year old has had vomiting, diarrhea and fever for 2 days. Today, the family witnessed a sudden event where his body stiffened up, and then he started having full body shaking. This lasted for 3 minutes. EMS brought the child to the Emergency Department. En route in the ambulance, another episode occurred. The child is now in the Emergency department

Resources

The following resources have been reviewed and collated by canuc-paeds. These resources are aimed to provide information at the level of the medical student. These include overviews of topics, clinical resources, and useful guidelines that contain relevant materials.

Papers 

  • Pediatric Syncope: Cases from the Emergency Department. Fischer WJ et al. .
    Emergency Medicine Clinics of North America 2010; 28(3): 501-516.
  • Pediatric Seizures. Sidhu R et al. .
    Pediatrics in Review 2013; 34(8): 333–342..
  • Febrile Seizures. Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure.
    Pediatrics 2011; 127(2) 389–394.
  • Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. . Tieder JS et al. .
    American Academy of Pediatrics 2016; .
    Clinical Practice Guideline.
  • Emergency management of the paediatric patient with generalized convulsive status epilepticus.
    https://www.cps.ca/en/documents/position/convulsive-status-epilepticus
    Canadian Paediatric Society Position Statement (2011) Very practical.

Videos 

No videos.

Clinical approaches to Seizure / Paroxysmal Events?

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Last updated 09 August 2021.