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Paediatric Epilepsy / First Seizure


First seizure referral guidelines

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
  • 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
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