Today, I review, link to, excerpt from, and embed The Cribsiders’ “#18 Pediatric Seizures & Epilepsy: Shaking Things Up!”*

*Gaitanis J, Mao C, Chiu C, Berk J. “#18 Shaking Things Up: Pediatric Seizures & Epilepsy with Dr. John Gaitanis”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com. February 3, 2020.

All that follows is from the above resource.

Summary

In this episode, we cover the full spectrum from febrile seizures all the way to status epilepticus with Dr. John Gaitanis, a pediatric neurologist who specializes in care for children with epilepsy. Dr. Gaitanis teaches us what to look out for on neurologic exam, how to counsel families about safety precautions, and the differential diagnosis for seizure-like activity in infants and children. We also discuss the exciting future of epilepsy treatment.

Pediatric Seizures & Epilepsy Pearls

1. Simple febrile seizures in children who have a normal neurologic exam are largely a benign process and do NOT require lumbar puncture, EEG, neuroimaging, or treatment with AEDs (Subcommittee on Febrile Seizures, 2008 and 2011).
   1. See also Febrile Seizures: A Systematic Review of Different Guidelines [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Pediatr Neurol
      . 2024 Jun:155:141-148. doi: 10.1016/j.pediatrneurol.2024.03.024. Epub 2024 Apr 3.
2. Be on the lookout for infantile spasms, as these can be associated with serious developmental delay and increased risk of developing severe epilepsy.
3. Antiepileptic drugs should be started after two unprovoked seizures (febrile seizures don’t count) and continued until at least two years seizure free.
4. If you can’t get IV access during status epilepticus, consider temporary alternatives like rectal diazepam, IM/intranasal midazolam, or an intraosseous line.
5. Don’t overlook alternatives like the ketogenic diet, surgery, and cannabidiol to help manage refractory seizures in certain types of epilepsy.