Child (<16) presents with PAROXSYMAL EVENT – episode of loss of consciousness, blank starring or other brief unusual behaviour

History

• Detailed description of event
• Before (trigger? Concurrent illness? Behaviour change? Cessation of activity?)
• During (collapse? Colour change? Altered consciousness? Body stiff or floppy?, limb movements?)
• After (sleepy?, unusual behaviour? Unsteady?, limb weakness?)
• Copy and paste YAS EPR entry
• Can child be distracted at any point
• Does the event occur during exercise
• Developmental history
• Family History
• Assess for red flags below

Examination

• Documented neurological examination including gait – observe eye movement, look for a new squint
• Cardiac Examination including blood pressure (esp if associated with exercise / colour change)

Investigations

• Ask parents to video events and keep detailed, descriptive diary (day, time, event-before, during and after)
• ECG
• Routine bloods are NOT required unless clinically indicated

RED Flags

• Age < 1year
• Acute confusion
• Pervasive behaviour change / lethargy
• New onset, recurrent convulsive seizures (>1 per week)
• Abnormal cardiac examination or ECG findings
• Abnormal neurological examination findings
• Symptoms of raised intracranial pressure (blurred / double vision, headache at night or on waking, persistent nausea / vomiting)
• Signs of sepsis / meningitis

Referral

• RED Flag– Ref to PAU (Paeds Reg)
• Non Urgent Referral –
  • Document history and examination (esp. neuro)
  • Ask parents to video events
  • Send message to Salim Uka and Matthew Taylor through EPR “Communicate”  to request appointment (usually within a few weeks)
• No Referral Required –
  • The following are examples of benign paroxysmal episodes that do not require a referral to paediatrics if the diagnosis is secure:
    • Breath holding attackes
    • Simple Faint
    • Reflex Anoxic Seizures (document normal ECG)
    • Sleep Myoclonus
    • Night Terrors