Paediatric Seizures; Roadside to Resus

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Jan 14, 2026

This discussion dives into the complexities of paediatric seizures, emphasizing timely recognition and management. It highlights the critical role of pharmacology, detailing the effectiveness of benzodiazepines and comparing levetiracetam with phenytoin. The conversation also covers how to distinguish seizures from other conditions, the importance of videos for diagnosis, and essential clinical cues like tongue bites. Key insights into pre-hospital care and acute management strategies ensure that listeners grasp the urgent nature of treating these time-sensitive events.

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INSIGHT

Status Epilepticus Is Time-Critical

Status epilepticus is defined as a seizure lasting five minutes or longer and requires treatment. 30 minutes or more despite second-line drugs is refractory status epilepticus and needs escalation.

INSIGHT

Why Children Seize More Easily

Seizures result from a shift toward excitatory glutamate (NMDA) over inhibitory GABA signalling. Children have a lower seizure threshold due to immature inhibitory systems and a leakier blood-brain barrier.

INSIGHT

Receptor Changes Explain Treatment Failure

Prolonged seizures cause GABA-A receptor internalisation and NMDA upregulation, reducing benzodiazepine efficacy over time. This receptor shift explains why early treatment works but delayed therapy often fails and causes neuronal injury.

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Paediatric seizures are common, time-critical events and they're something most of us will deal with, whether that's pre-hospital, in the emergency department, or on the ward. They make up around 1–2% of ED attendances, and about 1 in 20 children will have a seizure at some point. Most seizures self-terminate, but the longer they go on the harder they are to stop, and the higher the risk of harm. In paediatric seizures, time really matters.

In this episode we take a step-by-step look at how to assess and manage a child who's seizing. We start with the fundamentals; how seizures are defined and classified, what status epilepticus actually means in practice, and why recognising it early makes such a difference.

We then dig into the physiology behind seizures, exploring why early benzodiazepines work well and why delayed treatment often doesn't. Understanding what's happening at a receptor level helps make sense of when to escalate treatment and why different drugs work at different stages of a prolonged seizure.

Pharmacology is a big part of this episode. We talk through first- and second-line anti-seizure medications, routes of administration, and how effective they really are. We cover the EcLiPSE and ConSEPT trials comparing levetiracetam and phenytoin, and look at newer evidence from the Ket-Mid study and what that might mean for managing refractory status and thinking about RSI.

We also work through the approach to cases, pre-hospital management and in-hospital care aligned with UK and European recommendations. There's a clear focus on febrile seizures too, separating simple from complex presentations and helping you decide who needs investigating, admitting, or reassuring and discharging.

As ever, the aim is to turn guidelines and evidence into something usable on the shop floor. Paediatric seizures are stressful, but with a structured approach, early treatment, and good airway management, they're absolutely manageable and we can make a real difference on outcomes.

Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James