Pediatric Seizures: Model Clinical Case, Presentations, and Viva Questions

Clinical Case of Seizures in Children

Clinical Case: Febrile Seizure in a 2-year-old

A 2-year-old boy, previously healthy, is brought to the emergency department by his parents. They report that 30 minutes ago, the child suddenly became unresponsive, his eyes rolled back, and his entire body began to shake. The episode lasted approximately 2 minutes, after which the child appeared confused and sleepy.

History:

• No previous history of seizures
• Developed a fever (39.5°C / 103.1°F) earlier in the day
• No recent head trauma or ingestion of toxins
• Up-to-date on vaccinations
• No family history of epilepsy

Physical Examination:

• Temperature: 39.2°C (102.6°F)
• Heart Rate: 130 bpm
• Respiratory Rate: 28/min
• Blood Pressure: 90/60 mmHg
• Oxygen Saturation: 98% on room air
• Appears lethargic but arousable
• No focal neurological deficits
• Tympanic membranes slightly erythematous bilaterally

Assessment and Plan:

1. Diagnosis: Simple Febrile Seizure
2. Immediate management:
   • Ensure airway patency and adequate oxygenation
   • Antipyretic medication (acetaminophen or ibuprofen)
   • Close monitoring of vital signs and neurological status
3. Investigations:
   • Complete blood count
   • Basic metabolic panel
   • Urinalysis
4. Patient education:
   • Explain febrile seizures to parents
   • Discuss home management of fever and seizure recurrence
5. Follow-up:
   • Schedule follow-up with pediatrician in 1 week
   • Provide guidelines for when to seek immediate medical attention

Varieties of Clinical Presentations of Seizures in Children

Clinical Presentations of Seizures in Children

1. Generalized Tonic-Clonic Seizures

   • Sudden loss of consciousness
   • Rigid muscle contractions (tonic phase)
   • Followed by rhythmic jerking movements (clonic phase)
   • May be accompanied by tongue biting, urinary incontinence
   • Post-ictal confusion and sleepiness

2. Absence Seizures

   • Brief episodes of staring and unresponsiveness
   • May have subtle eye blinking or mouth movements
   • Typically last 5-10 seconds
   • Abrupt onset and cessation
   • No post-ictal confusion

3. Focal Seizures (Simple Partial)

   • Preserved consciousness
   • Localized motor, sensory, or autonomic symptoms
   • May involve jerking of one limb or face
   • Can progress to secondary generalization

4. Complex Partial Seizures

   • Altered consciousness or awareness
   • May involve automatisms (lip smacking, picking at clothes)
   • Often preceded by an aura
   • Post-ictal confusion common

5. Febrile Seizures

   • Occur in children 6 months to 5 years old
   • Associated with fever (typically >38°C or 100.4°F)
   • Can be simple (generalized, <15 minutes) or complex
   • Usually self-limiting and benign

6. Infantile Spasms

   • Typically occur in infants 4-8 months old
   • Brief, sudden flexion or extension of trunk and limbs
   • Often occur in clusters
   • Associated with developmental regression

7. Atonic Seizures (Drop Attacks)

   • Sudden loss of muscle tone
   • May cause falls and injuries
   • Brief duration, typically <15 seconds
   • Common in Lennox-Gastaut syndrome

Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30

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