August brings more returning travellers, this time with dengue fever. Also adolescent sleep problems, adverse childhood experiences (ACEs), an update on rhinitis and the neurological effects of rotavirus. Do leave comments below.
Cyclical vomiting this month as the message from the front line, BESS as a learning point for those monitoring the size of an infant’s head, milia also for the babies and the perennial problem of whether or not montelukast works to control episodic wheeze. 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: