First seizure guidelines

Definition: First afebrile seizure i.e. seizure occurring in absence of fever (<38)

Differential diagnoses

• Unprovoked seizure
• First presentation of epilepsy
• Secondary to traumatic brain injury
• Secondary to intracranial abnormality e.g. tumour, haemorrhage, hydrocephalus, infection
• Vasovagal episode
• Breath holding spell
• Reflex anoxic seizure
• Arrhythmias inc prolonged QTc

Relevant History

• Prodromal event
• Occurring in sleep or wakefulness
• What event looked like and what body parts were involved
• Eyes: open/closed, staring, flickering
• Duration
• Loss of consciousness
• Pallor or cyanosis
• Any incontinence
• Time to recovery
• Family history

Investigations

• Neurological examination
• Blood pressure
• ECG for all children with convulsive seizure
• Finger-prick blood sugar

Urgent  referral (including Red Flags) to Children’s Emergency Department

• Signs of meningism
• Signs of raised intracranial pressure
• GCS not fully recovered
• Complex seizure i.e. focal, recurrent or prolonged (>15mins)
• Young age (<1 year)
• Suspected infantile spasms
• Seizure following head injuryOut Patient Referral criteria

Routine referral

• Children who are well and fully recovered can be referred routinely to paediatric clinic if epileptic seizure is suspected
• Offer seizure first aid advice and general seizure safety advice

First aid advice to be offered

• Note time of start seizure
• Remove harmful objects from around child to prevent head injury
• If seizure lasting more than 5 minutes or concerned about breathing then call for 999 for ambulance
• After seizure, turn child on to left side side into recovery position
• If possible and safe to do so then video record seizure on mobile phone
• Stay with child until fully recovered

Seizure safety advice

Advise extra care with:

• Bathing- supervised
• Swimming- supervised
• Cycling- chose less busy roads & wear helmet
• Climbing – not advised unless has harness