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>
Haematuria this month with links to an algorithmic Australian guideline on how to manage it in children, assessing paediatric hypertension, postural orthostatic tachycardia syndrome and the last for the time being in the “decoding the FBC” series – MCHC.
Please do leave comments below:
With thanks to Geoff Ferguson, Director of the Parent Infant Centre (www.infantmentalhealth.com) for the following explanation of the Acquarone scales:
The Acquarone Detection Scales for Early Relationships are observational scales that provide a powerful tool for assessing an infant’s capacity to form relationships and a mother’s ability to respond to her infant. The scales have been developed during several decades of clinical practice by Dr Stella Acquarone, who is also the author of several books on infant development and parent infant psychotherapy and Principal of the Parent Infant Clinic. The Parent Infant Clinic is a private service but does have some subsidised places for families with limited financial resources.
There are two scales, a 25 item scale for observations of the infant and a 13 item scale for observations of the mother. In each case observations are divided into four domains: interpersonal, sensorial, motor and affect. Within each domain observers are asked to note the frequency of certain behaviours. For example, when observing ‘calling’ the observer is looking for ‘facial expressions, noises or gestures that seek to produce an affectionate response from the partner’.
A concern about the infant or the mother might be raised if a particular behaviour was never observed, perhaps showing a difficulty in relating, or was constantly observed, perhaps showing a defensive repetitiveness. The scales can be used to establish a thorough observational benchmark against which later changes can be compared.
Click here to see an example.