ppt referat kejang
DESCRIPTION
asthma in childreenTRANSCRIPT
JULIANTI MULYA UTAMIFaculty of Medicine
YarsiPediatric Department
Rumah Sakit Bhayangkara tk.I R.S.
Sukanto-JakartaPeriode: 15 March –
24 May 2015
Seizure Disorder In Children
DEFINITION Seizures refer to excessive neuronal
discharge with change in motor activity or behavior.
Epilepsy is a chronic neurological condition characterized by recurrent, unprovoked seizures, occurrence of at least 2 unprovoked seizures 24 hours apart.
ETIOLOGY
Idiopathic (70 – 80%) – cause unknown but presumed genetic
Secondary Cerebral dysgenesis /malformation Cerebral vascular occlusion Cerebral damage
- Antenatal: Congenital infections, drugs, alcohol- Natal: birth trauma- Postnatal: CNS infections, trauma, tumour
Cerebral tumours Neurodegenerative disorders Neurocutaneous syndrome
NON GENETIKMalformasi
vascular
Trauma mekanik
Brain Tumour Struktur abnormal
Parasit chronic
MeningitisInfection
Ensefalitis
Neonatal Asfiksia
CVA
Hipoksemi-iskemi
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P
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L
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P
S
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Patofisiologi EPILEPSI
CLASSIFICATION
ILAE 2010 CLASSIFICATION
Tonic clonic seizuresTonic phase• The tonic phase begins with flexion of the trunk and
elevation and abduction of the elbows. Subsequent extension of the back and neck is followed by extension of arms and legs.
• Piercing cry may be present due to passage of air through closed vocal cords.
• Autonomic signs are common during this phase and include increase in pulse rate and blood pressure, profuse sweating
• This stage lasts for 10-20 seconds.
Tonic clonic seizuresClonic phase tremor occurs at a rate of 8 tremors per
second, which may slow down to about 4 tremors per second. This is because phases of atonia alternate with repeated violent flexor spasms. Each spasm is accompanied by pupillary contraction and dilation. Some patients may have tongue or cheek bites.
The atonic period lasts about 30 sec.
The clonic phase lasts for 30 sec. to 1minute.
Absence seizures
Patient stares briefly and stop talking or ceases to respond.
Most of the patient are completely motionless while some feel some myoclonic movements in eye lids,facial muscles,fingers at a rate of 3 per sec..and this rate corresponds to the abnormality in EEG as generalized 3 per sec.spike & wave pattern.
Occurs at the age of 4-12 years Prognosis is good.95% remission in adolescense
MYOCLONIC SEIZURES These are brisque,brief muscular contractions some of them involve only single muscle or a part of
the muscle & some of them are so large that they include whole body or both the limbs.
Myoclonic jerks are common in the morning involving entire body both the limbs and sometimes absence seizures are common.
This is the most common form of idiopathic gen.epilepsy in childhood.it begins at adolescence (15 yr).
4 to 6 Hz irregular spikes have been noted in EEG.
SPECIAL EPILEPSY SYNDROME
INFANTILE SPASM:-
-Most cases appears in 1st yr of life. - Single brief recurrent gross flexion
movements of the limb …rarely extension movements
-EEG shows multifocal,multiple small spikes.
-On maturity it disappears(4 to 5yr) -CT & MRI mostly normal.
TREATMENT
STATUS EPILEPTIKUS
DIAGNOSIS EEG is most sensitive tool for
diagnosis which shows electrical activity changes in the brain but it also require clinical correlation
Many children with epilepsy may have normal EEG and many children who will never have epilepsy have EEG abnormalities
DIAGNOSIS MRI and CT -not required routinely for childhood generalized
epilepsy. To identify a tumour,vascular lesion or area of sclerosis.
PET and SPECT. To detect areas of hypometabolism in epileptogenic
lesions OTHER INVESTIGATIONS Blood test and metabolic investigations(seizures related
to feed and fasting). Genetic studies Lumbar puncture
ADVISE FOR PATIENT Educate and counsel on epilepsy. Emphasize compliance if on anticonvulsant. Don’t stop the medication by themselves.this
may precipitate breakthrough seizures. In photosensitive seizures-watch tv in brightly lit
room.avoid sleep deprivation. Use a shower with bathroom door unlocked No cycling in traffic,climbing sports or swimming
alone. Know emergency treatment for seizure Inform teachers and school about the condition.
Febrile Seizure Febrile seizures are the most
common seizure disorder in childhood, affecting 2 - 5% of children between the ages of 6 months and 5 years
Febrile Seizure Caused by the increase in the core
body temperature greater than 100.4F or 38C
Threshold of temperature which may trigger seizures is unique to each individual
Can occur within the first 24 hours of an illness Can be the first sign of illness in 25 - 50% of
patients
MANAGEMENT FEBRILE SEIZURE
Simple Febrile Seizure:Diagnostic Testing
Ongoing Management Reassess temperature
Consider giving antipyretic if not previously administered
As source of fever is identified, treat appropriately
Instruct parent/caregivers to prevent injury during a seizure :
Position child while seizing in a side-lying position
Protect head from injury Loosen tight clothing about the neck Prevent injury from falls Reassure child during event Do not place anything in the child’s mouth
ADVISE FOR PATIENT
ADVISE FOR PARENTS (CONT..)
Educate regarding use of: Thermometer Antipyretics for fever management When to contact 9-1-1 or ambulance
Identify Primary Care Provider for follow-up appointment and stress importance of follow-up
Provide developmentally appropriate explanation of event for child and family members
THANK YOU
Questions 1. Nataly (UPH): komplikasi dari kejang? 2.Hadi ( YARSI): algoritma penanganan kejang
demam? 3. Devina (UPH): faktor risiko seorang anak
dapat mengalami kejang demam? 4.Dika (YARSI): mengapa kejang demam
sering terjadi pada anak-anak? 5. Ayu (YARSI): apakah kejang demam dapat
menyebabkan epilepsi? 6.Hilya (YARSI): kapan seorang anak dapat
dikatakan mengalami kejang demam?