11- Paediatric Neurology Flashcards
seizures background
A sudden and temporary change in the electrical and chemical activity in the brain which leads to a change in a persons movement, behaviour, level of awareness and or feelings
causes of seizures
- Epileptic seizure
- Infection on the brain
- Strokes
- Tumours
- Hypoglycaemia
- Febrile convulsions
epileptic seizures vs other seizures
- Epileptic when there is no apparent reason that the electrical and chemical activity has changed
- More than 2 unprovoked seizures more than 24 hours apart
epilepsy background
Umbrella term for a condition where there is a tendency to have seizures.
- Seizures are transient episodes of abnormal electrical activity in the brain
types of epileptic seizures
Many types of seizures, with different treatments
o Generalised tonic-clonic seizures
o Absence seizure
o Atonic sieurs
o Myoclonic seizure
o Infantile spasm
epilepsy investigations
Good history – exclude vasovagal and identify type of seizure
EEG – can show typical patterns in different forms of epilepsy and support diagnosis
- Perform EEG after the second simple tonic-clonic seizure
- Children can have 1 simple seizure before being diagnosed with epilepsy
MRI brain can be used to visualise structure of the brain e.g. Exclude tumours.
- When the first seizure is in a child under 2
- Focal seizure
- No response to first line anti-epileptic medications
Additional
- ECG to exclude cardiac problem
- Blood electrolytes
- Blood glucose e.g. exclude hypoglycaemia
- Blood cultures, urine cultures and LP
general precautions for people with epilepsy
- Take showers rather than baths
- Be very cautious with swimming unless seizures are well controlled and they are closely supervised
- Be cautious with heights
- Be cautious with traffic
- Be cautious with any heavy, hot or electrical equipment
generalised tonic-clonic seizures backgroun
- Classic epileptic seizure.
- There is loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) movements.
- Typically the tonic phase comes before the clonic phase.
- There may be associated tongue biting, incontinence, groaning and irregular breathing.
- After the seizure there is a prolonged post-ictal period where the person is confused, drowsy and feels irritable or low
management of tonic clonic seizures
- First line: sodium valproate
- Second line: lamotrigine or carbamazepine
absence seizures background
Absence seizures typically happen in children.
Presentation
- The patient becomes blank, stares into space and then abruptly returns to normal.
- During the episode they are unaware of their surroundings and won’t respond.
- These typically only lasts 10 to 20 seconds. Most patients (more than 90%) stop having absence seizures as they get older.
management of absence seizure
sodium valproate or ethosuximide
focal seizure background
- Focal seizures start in the temporal lobes.
- They affect hearing, speech, memory and emotions.
- There are various ways that focal seizures can present:
o Hallucinations
o Memory flashbacks
o Déjà vu
o Doing strange things on autopilot
management of focal seizure
One way to remember the treatment is that the choice of medication is the reverse of tonic-clonic seizures:
- First line: carbamazepine or lamotrigine
- Second line: sodium valproate or levetiracetam
atonic seizures background
- Atonic seizures are also known as drop attacks.
- They are characterised by brief lapses in muscle tone.
- These don’t usually last more than 3 minutes.
- They typically begin in childhood. They may be indicative of Lennox-Gastaut syndrome.
Lennox-Gastaut syndrome
a severe condition characterized by recurrent seizures (epilepsy) that begin early in life.
management of atonic seizures
- First line: sodium valproate
- Second line: lamotrigine
Febrile convulsions
- Seizures which occur in children during fever
- Not caused by epilepsy or any neurological pathology
- Between ages of 6 months and 5 yo
- Prognosis: excellent
- 1/3 will have another febrile convulsion
- Slightly increases risk of epilepsy in future
breath holding spell
- Involuntary episodes where child holds their breath, usually triggered by something upsetting or scaring them
- 6-18 months
- Child has no control over breath holding
- Not harmful in long term and does not lead to epilepsy
Types
- Cyanotic breath holding spells
- Pallid breath holding spells (reflex anoxic seizures)
Cyanotic breath holding spells
occur when the child is really upset, worked up and crying. After letting out a long cry they stop breathing, become cyanotic and lose consciousness. Within a minute they regain consciousness and start breathing. They can be a bit tired and lethargic after an episode.
Reflex Anoxic Seizures
Reflex anoxic seizures occur when the child is startled. The vagus nerve sends strong signals to the heart that causes it to stop beating. The child will suddenly go pale, lose consciousness and may start to have some seizure-like muscle twitching. Within 30 seconds the heart restarts and the child becomes conscious again.
management of breath holding spells
- Exclude other pathology
- Reassure and educate parents
- Links to iron def anaemia -> treat if required
general mangeemnt of epilepsy
Aim is to be on the minimum anti-epileptic medication to be seizure free. Ideally monotherapy.
MOA of anti-epileptics: raise the seizure threshold therefore reducing the likelihood of patients having a seizure-> requires titration
1) First line: Sodium valproate
2) Second line: Carbamazepine
3) Phenytoin
4) ethosuximide
5) lamotrigine
Sodium valproate
Most forms of epilepsy except focal
- MOA: Increases activity of GABA
Side effects
- Teratogenic (should be avoided in girls unless unsuitable for alternatives)
- Liver damage and hepatitis
- Hair loss
- Tremor
carbamazepine
- Indication: Focal seizures
Side effects - Agranulocytosis
- Aplastic anaemia
- Induced P450- drug inter
phenytoin
Side effects
- Folate and vit D def
- Megaloblastic anaemia
- Osteomalacia
Ethosuximide
Side effects
- Night terrors
- Rashes