الفهرس 
Seizures in children (EpilepsyOnly 14 pages are availabe for public view
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Abstract
An epileptic seizure is defined as “an excessive burst of abnormally synchronized neuronal activity affecting small or large neuronal networks that results in clinical manifestations that are sudden, transient, and usually brief.”
Seizures are classified into: Generalized seizures which are subdivided into tonic-clonic type [in any combination], myoclonic, clonic, tonic and atonic. In addition to this, there are types as focal seizures and epileptic spasms.
Patients who are erroneously diagnosed with epilepsy will be unnecessarily subjected to many medications that may produce serious side effects. Specific differential diagnostic entities that must be differentiated from seizures include the conditions that mimic epilepsy. Confirming or ruling out epilepsy not only prevents unnecessary treatment and exposure to interventions, but also reduces patient and family anxiety and possibly unnecessary stigma. Monotherapy in appropriate dose controls seizures in 70- 80% cases. If seizures are uncontrolled with the first drug, choose alternate monotherapy and gradually withdraw the first drug. If seizures are still not controlled, refer to a child neurologist. The patient may require polytherapy, ketogenic diet or surgery. Before labeling drug failure, always check compliance; rule out conditions that mimic epilepsy.
Recently, the American Academy of Pediatrics (AAP) has announced a standard definition of febrile seizures as a seizure occurring in febrile children between the ages of 6 and 60 months who do not have an intracranial infection, metabolic disturbance, or history of afebrile seizures. Febrile seizures are the most common seizures of childhood, occurring in 2 to 5 percent of children six months to five years of age.
There are suggested risk factors, however, such as developmental delay, discharge from neonatal unit after 28 days, daycare attendance, viral infections, some vaccinations, genetic predisposition, and iron and zinc deficiencies several risk factors for developing the first FS have been suggested. The degree of fever height is probably more relevant than the degree of rise of temperature itself, contrary to previous thought. A history of FS in a first-degree or higher relative seems to be the factor with the strongest prediction power.
Simple type is characterized by tonic-clonic activity which is generalized without features of focal convulsion, each convulsion lasts for less than ten minutes, and resolves spontaneously, and there are no further convulsions within the next 24 hours. While Complex type is characterized by each convulsion lasts more than ten minutes, a second convulsion may occur within 24 hours, there is a focal seizure in which, for example, convulsions occur on only one side of the body, full consciousness is not regained within one hour, there are post-ictal neurological abnormalities, there is a brief period of paralysis after the convulsion and febrile status epilepticus may occurs.
Major risk factors for recurrent FS include factors as age less than 1 year, duration of fever less than 24 hours and fever 38-39°C. While minor risk factors for recurrent FS include family history of febrile seizures, family history of epilepsy, complex febrile seizures, daycare, male gender and lower serum sodium at the time of presentation.
Summaary
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Management includes; control of seizure, control of fever and decision for hospital admission or discharge. Prevention includes; prophylaxis with continuous anticonvulsants, prophylaxis with intermittent anticonvulsants, prophylaxis with antipyretics, vaccinations, counseling and education.
Selenium is a trace mineral found in minute quantities within the body. It is a major structural component of many enzymes such as glutathione peroxidase, thioredoxin reductase and deiodinases. It is present in Nature and in organisms as organic and/or inorganic forms. The main organic forms are selenomethionine (Semet) and selenocysteine (Secys).
The majority of recently published studies considers beneficial effects of Se on the CNS; however, Se neurotoxicity, causing pro-oxidant and pro-apoptotic consequences, should be not disregarded either. Both neuroprotective and neurotoxic properties of Se manifest themselves in neurodegeneration pathology.
Neuroprotection may be defined as maintaining the highest possible integrity of cellular interactions in the brain resulting in undisturbed neural function. Since at least half of the selenoproteins are involved in reducing oxidative stress, main presumed mechanism of neuroprotection includes ROS and reactive nitrogen species (RNS) scavenging.
The most transparent mechanism of Se role in the neurotransmission is selenoprotein participation in the redox regulation. Nevertheless, other routes should be also considered such as influencing calcium homeostasis, anti-inflammatory action, alteration of protein phosphorylation and brain cholesterol metabolism. It is showed that serum selenium levels were significantly lower in the simple febrile seizure patients.
Oxidative stress and low function of antioxidative mechanisms induce seizures by production of free radicals and selenium that prevent oxidative injury through specific enzymes and therefore might prevent seizures.
The aim of the study was to assess change of serum level of selenium in children with febrile seizures compared to epileptic and febrile children in relation to their clinical findings.
This case control study was conducted on 80 children divided into 4 equal groups (group A for twenty children with febrile seizures, group B for twenty children with afebrile seizures, group C for twenty children with fever without seizures and group D for twenty healthy children), enrolled from emergency room, outpatient clinics and Pediatric departments of Menoufia University hospital - Egypt, during the period from February 2017 to February 2018, and children aged between 6-months to 5-years old.
The following findings were obtained:
There were no significant differences between the 4 groups regarding age and sex of children.
No one of children with FS had past neurological insult or developmental delay in contrast to children with afebrile seizures who were found to have these abnormal neurological histories in their neonatal period.
There were no statistical significant differences between children with FS& children with afebrile seizures; regarding seizure type, family