See also

Cerebral Palsy - Common Emergency Presentations:

Chest infection
Pain/Irritability 

Afebrile Seizures

Background

• Children with cerebral palsy and known epilepsy may present with increased seizures or break-through seizures
• Consider possible precipitants:
  • Intercurrent illness (viral illness, chest infection, UTI)
  • Changes in medications
  • Vomiting or diarrhoea causing reduced absorption 
  • Non-adherence with medication
  • CNS infection 
  • Shunt malfunction (many children with cerebral palsy have VP shunts)

Assessment

• Check blood glucose if presents with a seizure
• Anticonvulsant levels may be useful in some situations
  • Phenytoin, phenobarbitone (see  Therapeutic Drug Monitoring - available on RCH Intranet only)
  • Carbamazepine or sodium valproate levels are not usually helpful
• Consider LP, see Lumbar puncture, imaging, antibiotics flowchart
• Assessment of conscious state and responsiveness may be difficult. Failure of improvement of conscious state post seizure or worsening conscious state requires re-evaluation and consideration of neuro-imaging.
• Consider the possibility of non-convulsive status particularly in those with seizure disorders with multiple seizure types. This may require EEG confirmation
• Check for regression (consider possible neurodegenerative disorder)

Management

• See Afebrile Seizures for management of acute fitting
• Treat intercurrent illness as appropriate

Adjustments to maintenance anti-convulsants should be discussed with the consultant responsible