REFERAT

Kejang Pada Anak

Oleh:
Silvi Apriani
NIM. 1112103000017

Pembimbing:
dr. Pulung M. Silalahi, Sp.A

KEPANITERAAN KLINIK ILMU KESEHATAN ANAK

RS BHAYANGKARA TINGKAT I RADEN SAID SUKANTO
PROGRAM STUDI PENDIDIKAN DOKTER FK UNIVERSITAS ISLAM NEGERI
SYARIF HIDAYATULLAH JAKARTA 2017
 Definition

Seizure a transient occurence of signs and/or symptoms

resulting from abnormal excessive or synchronous neuronal activity
in the brain.
Seizures may be simple , it can stop itself and little need further
treatment , or an early symptom of severe illness, or tends to be status
epilepticus.
 per 100,000 people, there will be:
86 seizures in the first year of life
62 seizures between 1 and 5 years
50 seizures between 5 and 9 years
39 seizures between 10 and 14 years

Epidemiology
Distinguishing Seizures vs Non-Seizure
 SYMPTOMATIC

Etiology CNS Infection:

Meningitis, Encephalitis, Abscess
Toxic:
Drugs, Alcohol, Lead poisoning

CNS Trauma: Tumour

Acute trauma, Previous trauma may
lead to scar tissue formation
Cerebrovascular: Congenital CNS malformations:
Infarction,Hemorrhage, Arteriovenous Cortical dysplasia, Lissencephaly
malformation, Venous thrombosis
Hypoxic: Neurocutaneous syndromes :
Hypoxic ischemic encephalopathy tuberous sclerosis
Metabolic: Fever febrile seizures
Hypoglycemia, Electrolyte
disturbances, Inborn errors of
metabolism, Neurologic effects of
systemic disease

IDIOPATHIC 50% of seizure disorders

 Simple febrile
seizure
True febrile seizure
Complex febrile
seizure

Febrile seizure
Intracranial infection

Non-febrile seizure Electrolit imbalance with fever

epilepsy

Seizure in child
hypoglicemia
Epilepsy with fever

Imbalance elektrolit

Without fever
toxic

trauma
Seizure in child
hypoxia
 Febrile Seizure

Definition Classification of Febrile Seizures

Febrile seizures are seizures that occur with a
temperature of 38C (100.4F) or higher, that are
not the result of central nervous system infection
or any metabolic imbalance, and that occur in the
absence of a history of prior afebrile seizures.

Most causes of febrile seizures are

multifactorial, with two or more genetic and
contributing environmental factors.
Case-control studies suggest that iron and
In Indonesia, the incidence of
zinc deficiencies may also be risk factors for
febrile seizures in children aged 6
febrile seizures.
months to 5 years of almost 2-5 %.
Viral infections are a common cause of fever
that triggers febrile seizures.
Epilepsy

An epilepsy is defined as a neurological condition characterised by recurrent epileptic seizu

res unprovoked by any immediately identifiable cause. An epileptic seizure is the clinical manifest
ation of an abnormal and excessive discharge of a set of neurons in the brain.

In the majority of patiens with epilepsy, diagnosis can be made with a detailed neurologic
history and examination, an EEG, and brain imaging.
Epileptic Syndrome In Children
Epileptic Syndrome In Children
Epileptic Syndrome In Children
Seizure Classifications
Fisiologi
 Patophysiolo
gy

The brain is made up of millions of

nerve cells called neurons. They
generate electrical impulses and
messages to produce thoughts,
feelings and movement. A seizure
occurs when the normal pattern of
these impulses is disrupted, caused
by the neurons rapidly firing all at
once.
 Fever
(increasing 1oC)

Basal metabolism Increasing O2 capacity

+ 20%
(10 15%)

Balance changing
(cell neuron membran)

Difuse into membrane

(ion K+ ------- ion Na+)

Released electric charge

neurotransmitter

Patophysiology
Seizure

Febrile Seizure
 Clinical Manifestation

Abnormality
Abnormality of sensory or
Altered of of motoric otonom
consciousness Abnormality of
behaviour
Clinical Presentation:
Consciousness
Consciousness is the usual alertness or responsiveness the child
demonstrates.

Parents/caregivers may report or you may observe the child to

have:
Baseline alertness
Diminished level of consciousness
Unresponsive and unconscious
Clinical Presentation:
Motor Changes
Parents/caregivers may report seeing:

Repetitive non-purposeful movements

Staring
Lip-smacking
Falling down without cause
Stiffening of any or all extremities
Rhythmic shaking of any or all extremities
Seizure activity cannot be interrupted with verbal
or physical stimulation
Clinical Presentation:
Sensory and Autonomic

Parents/caregivers may report the child is:

Feeling nauseous
Feeling odd or peculiar
Losing control of bowel or bladder
Feeling numbness, tingling
Experiencing odd smells or sounds

20
Elements that are highly suggestive of true seizure activity include:

1. Lateralized tongue-biting (high specificity)

2. Flickering eye-lids
3. Dilated pupils with blank stare
4. Lip smacking
5. Increased heart rate and blood pressure during event
6. Post-ictal phase
Diagnosis

Physical Supporting
History
Examination Investigation
Description the Vital sign Blood test
seizure Head to toe Lumbal punction
Pre-ictal and examination EEG
post-ictal Neurologic Imaging
Etiology examination
History family
 Diagnosis
Pemeriksaan
Anamnesis Pemeriksaan fisik
penunjang
Deskripsi kejang Tanda vital (terutama Pemeriksaan lab
Kejadian preiktal suhu tubuh) Pungsi lumbal
post iktal Pemeriksaan head to EEG
Etiologi kejang toe (kelainan bentuk Pencitraan
Riwayat kepala, trauma
kejang/epilepsi di kepala, TIK, cari
keluarga fokus infeksi)
Pemeriksaan
neurologis

Setyabudhy, Irawan Mangunatmaja. Kejang. Dalam: Pudjiadi, Antonius H. Latief, Abdul. Budiwardhana, Novik. Buku Ajar Pediatri Gawat Darurat. Jakarta: Unit Kerja Pediatri Gawat
Darurat IDAI. 2011
Pusponegoro, Hardiono D, Widodo, Dwi Putro, Ismael Sofyan. Konsensus penatalaksanaan kejang. IDAI. Jakarta. 2006
Supporting
Blood Test
Investigation
Blood studies (serum electrolytes, calcium, phosphorus, magnesium, and complete
blood count) are not routinely recommended in the work-up of a child with a irst
simple febrile seizure.
If clinically indicated (e.g., in a history or physical examination suggesting
dehydration), these tests should be performed.
Lumbar Puncture
Lumbar puncture should be performed for all infants younger than 6 mo of age who
present with fever and seizure, or if the child is illappearing or at any age if there are
clinical signs or symptoms of neurological abnormality
EEG
If the child is presenting with the irst simple febrile seizure and is otherwise
neurologically healthy, an EEG need not normally be performed as part of the
evaluation. An EEG would not predict the future recurrence of febrile seizures or
epilepsy even if the result is abnormal.

Imaging
Imaging of the brain should be performed on any child with a signicant motor or
cognitive impairment of unknown etiology, abnormalities on neurological
examination, a seizure of partial (focal) onset.
Treatment

1. Acute Treatment

2. Treat the causes of seizure

3. Chronic antiepilepsy therapy

Parents Education
Make sure that febrile seizure has a good prognosis

Tell them how to take care of child with seizure

Give them information about relapsing possibilities

Tell them to give medication for prevention but also they must
take a good care about its side effect
If its relapsing......
Calm and dont panic

Untied every clothes and accessories especially in necks area

Unconscious: supine and clean up the mess if it is there

Do not put anything on mouth

Observation the temperature

Stay with the child during seizure Memo the type of seizure and how long does
it takes

Give diazepam rectal

Hospital Indication
> 1 period of seizure in 24 hours

Hiperpireksia

Complex seizure

There is neurological deficit

 Risk of Recurrence After an Initial Febrile Seizure

Prognosis
Risk Factors for Future Epilepsy After a Febrile Seizure

Prognosis
Referensi
Setyabudhy, Irawan Mangunatmaja. Kejang. Dalam: Pudjiadi, Antonius H. Latief, Abdul.
Budiwardhana, Novik. Buku Ajar Pediatri Gawat Darurat. Jakarta: Unit Kerja Pediatri Gawat
Darurat IDAI. 2011
Johnston, Michael V. Nelson Textbook of Pediatrics : Seizure in Childhooh, Febrile Seizure. 18th
edition. Saunders Elsevier Inc, Philadelphia. 2007.
Rudzinski, Leslie A. Jerry J. The Classification of Seizures and Epilepsy Syndromes. Emory
University School of Medicine, Mayo Clinic Florida. U.S.A. 2011.
Pusponegoro, Hardiono D, Widodo, Dwi Putro, Ismael Sofyan. Konsensus penatalaksanaan
kejang. IDAI. Jakarta. 2006.
Gram L, Dam M. Epilepsy explained. 1st edition. Munksgaard, Copenhagen, 1995.
Panduan Pelayanan Medis Departemen Ilmu Kesehatan Anak RSCM. 2015.
Shorvon S. Status epilepticus. Program and abstracts of the 17th World Congress of Neurology;
June 17-22, 2001; London, UK. J Neurol Sci. 2001;187(suppl 1):S213
International League Against Epilepsy (ILAE). Seizure Classification. http://www.ilae.org. 2015
Waite, Shelley R. Pediatric First Seizure. emedicine.medscape.com. 2015
THANK YOU