Seizure - first

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Refer to the Emergency Department via ambulance if:

  • seizure is prolonged >5 minutes - give buccal midazolam (0.3mg/kg)
  • there is cyanosis or poor recovery or signs of meningitis, raised intercranial pressure or severe infection
  • there is concern for infantile spasms.

Introduction

A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in child’s behaviour, movements or feelings, and in levels of consciousness.

Seizures can be associated with epilepsy or other medical conditions.

Many non epileptic paroxysmal disorders can mimic seizures. These include but are not limited to syncope, hypoglycaemia and severe anxiety.

Pre-referral investigations

  • Full history of event including prodomal event and associated symptoms (eg. headache, vomiting, fever, incontinence), witnesses, any associated pallor or cyanosis, loss of consciousness, time to recovery, frequency of event and if occurs during sleep or wakefulness.
  • Physical exam including birth marks and features of dysmorphism.
  • Growth charts including head circumference - micro or macrocephaly will be seen more urgently.
  • Neurological exam
  • Cardiac exam including blood pressure (lying and standing blood pressure if child over 10 years)
  • Developmental history
  • Blood glucose at time of presentation
  • Bloods – FBC, U&E’s, Calcium, Phosphate, Magnesium, LFT
  • ECG if indicated i.e. query syncope
  • Family history of seizure disorders.

Pre-referral management

Offer seizure first aid advice (PDF) and general seizure safety advice.

When to refer

Refer to General Paediatrics (local hospital) if child well, fully recovered and an epileptic seizure is suspected. 

How to refer

  • Routine non-urgent referrals from a GP or a Consultant are made via the Central Referral Service
  • Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals are made via the PCH Referral Office (Fax: 6456 0097 or email PCH.Referrals@health.wa.gov.au)
  • Urgent referrals (less than seven days) are made via the PCH Referral Office. Please call Perth Children’s Hospital Switch on 6456 2222 to discuss referral with the relevant speciality registrar.

Essential information to include in your referral

  • A detailed description of the event including duration, witnesses, associated pallor or cyanosis, loss of consciousness, time to recovery, frequency, and if occurring in sleep or wakefulness.
  • All blood results or details of pathology lab if results not yet available.
  • Examination findings.
  • Growth charts including head circumference
  • Family history of seizure disorders
  • Relevant medical history.

Useful resources


Reviewer/Team: Dr Andrew Martin, Dr Simon Williams, Charlotte Allen (CNS) Dr Twinkle Ghia, Dr Collin Derrick
Last reviewed: Dec 2021


Review date: Dec 2022
Endorsed by:

Dr Andrew Martin, General Paediatrics Head of Dept (fast track) Date:  Dec 2021


This document can be made available in alternative formats on request for a person with a disability.


Referring department

General Paediatrics