NICE on faltering growth this month, paediatric stroke, a reminder of the new epilepsy classification and a contribution from the safeguarding team on what constitutes a “legal high”? Do leave comments below:
Actually the classification of seizures changed in July 2017 but I’ve only just been brought up to date by Emily O’Connor, a medical student who writes blog posts for Paediatric Pearls. Here is her article:
In 2017 the International League Against Epilepsy revised their classification of seizure types, with the aim of creating greater flexibility, accuracy and transparency in the naming of seizures. Below, is a brief guide to applying this new approach to classification and a summary of the changes in terminology.
The new approach can be applied by asking two or three questions about the seizure:
- Where was the onset of the seizure?
- It could be: focal/generalised/focal to bilateral/unknown
- What was the patient’s level of awareness during the seizure? – FOR FOCAL SEIZURES ONLY
- It could be: focal aware/focal impaired awareness
- What was the first prominent sign or symptom of the seizure?
- It could be: motor/non-motor
- This can then be further classified according to the specific symptom
This new classification system for seizures has led to a change in some of the traditional terminology used to describe seizure types, the below table shows a summary of these changes:
|Traditional/‘Obsolete’ Term||New/‘Replacement’ Term|
|Partial seizure||Focal seizure|
|Simple partial seizure||Focal aware seizure|
|Complex partial/Dyscognitive seizure||Focal impaired awareness seizure|
|Psychic seizure||Cognitive seizure|
|Primary generalised seizure||Generalised seizure|
|Secondary generalised seizure||Focal to bilateral tonic-clonic seizure|
For more information on the ILEA 2017 classification system, please see the below references:
1. Fisher et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017. 58. 4. 522-530.
2. Epilepsy Foundation of America. 2017 Revised Classification of Seizures. [online] Epilepsy Foundation of America. 2017. 18/02/2018. <https://www.epilepsy.com/article/2016/12/2017-revised-classification-seizures>
Retinoblastoma mnemonic this month. Plus information on lower sugar content recipes for the reintroduction of cows milk into a child’s diet, labial adhesions, 6 in 1 vaccine and don’t miss infantile spasms as early treatment improves overall prognosis. Do leave comments below.
Delayed sleep phase this month and chronotherapy which sounds like quite an undertaking. Also a link to a new parent’s guide to picking up and talking about sexual abuse, links to handy recent uploads to the site, the BSACI guideline on allergic rhinitis and more banging on about vitamin D supplementation – please.
Do you know your valgus from your varus? Or your myclonic epilepsy from your sleep myoclonus? A link this month to new asthma patient information leaflets and some reminders of NICE’s “Do not do recommendations” in feverish children. Also the BSACI egg allergy guideline. Do leave comments on any of these topics below.
This month’s emergency department version of Paediatric Pearls has information on dehydration from the NICE guideline on gastroenteritis in the under 5s, a bit on seizures and the evidence behind our reluctance to let you request chest x-rays for children. I’ve featured the NICE guideline on antibiotics for respiratory illness in primary care too as they are also relevant for the children we see in EUCC and the Emergency Department. I hope you find it helpful; I think the average length of time for each infection is useful information to be able to hand on to parents. Download December’s Paediatric Pearls here.