Paediatrics: Paroxysmal episodes - general management

2021-03-02 12:00 AM

The majority of paroxysmal episodes can be classified with a careful history. No episode can be safely classified, even after EEG and MRI, if an adequate history has not been taken.

Paroxysmal episodes: general management

Assessment

History

The majority of paroxysmal episodes can be classified with a careful history. No episode can be safely classified, even after EEG and MRI, if an adequate history has not been taken. Take details of the following:

  • First episode: when, where, what happened, and the child responsiveness; how long, recovery, and talk to the witness.
  • Subsequent episodes: situation, precipitants, duration, frequency.
  • Full medical history, family history, developmental and psychosocial history.

Video

If you are unsure about the diagnosis, then request the carers to take a video recording of the event. Do not investigate or treat until the diagnosis is confirmed. Children are safer off treatment when the clinician is unsure if the caution below is followed. Even when you are sure of the diagnosis, it is a good clinical practice to request a video recording of all different paroxysmal events, since the episodes or events may evolve.

Management

Infantile non-epileptic disorders, syncopal episodes and jerks 

Allay the carers’ concerns over the diagnosis.

Psychologically determined paroxysmal events

PDPE can be difficult to treat, but these patients do respond to well-organized management. The principal areas include the following:

  • The unambivalent diagnosis explained to both the parent and the child/ young person.
  •  Acknowledgement/acceptance by the young person, carers and all health professionals that these are non-epileptic.
  • Stabilization phase where the family is developing understanding.
  • Strengthen coping abilities and remove gain from the behaviour.
  • Psychological support is essential. Some families will feel very threatened when the possibility is raised of looking at psychological issues that may have triggered these events in the child.