21 - Neurology 1 Flashcards
What are some causes of seizures in neonates?
- HIE
- Infection (meningitis/encephalitis)
- Intracranial haemorrhage/infarction
- Structural CNS lesions (focal cortical dysplasia/tuberous sclerosis)
- Metabolic disturbance (hypoglycaemia, Ca)
- Neonatal withdrawal from maternal drugs or substance abuse
- Kernicterus
- Idiopathic seizures eg benign 5th day fits.
What drugs are needed to treat neonatal seizures if they are recurrent?
Phenobarbital or Phenytoin
What are some causes of non-epileptic seizure like activity in children?
- Non-epileptic attack disorder (pseudo seizure)
- Benign neonatal sleep myoclonus
- Breath holding attacks
- Night terror
- Febrile seizures
- Day dreaming (looks like absence)
- Syncope with myoclonic jerks
- Munchausen’s
What is the definition of epilepsy?
Tendency to have chronic recurrent unprovoked seizures
What are the different types of epileptic seizures that children can have?
- Tonic/clonic
- Absence
- Infantile Spasms/West syndrome
- Myoclonic
- Atonic
What antiepileptics are used in focal seizures?
Reverse of tonic clonic seizures
What antiepileptics are used in generalised seizures?
Tonic Clonic
- First line: sodium valproate
- Second line: lamotrigine or carbamazepine
Absence
Ethosuximide or Sodium Valproate
Myoclonic
- First line: sodium valproate
- Other options: lamotrigine, levetiracetam or topiramate
Atonic (drop attacks)
- First line: sodium valproate
- Second line: lamotrigine
What is West syndrome?
- Brief full body spasms beginning around 6 months (jack-knife)
- Flexion of head, trunk, limbs and extension of arms for 1 to 2 seconds
- Usually due to serious neurologic abnormality (e.g. TS, encephalitis, birth asphyxia)
- Poor prognosis, progressive handicap and ⅓ die by age 25
How is West syndrome (infantile spasms) diagnosed and managed?
EEG: Hypsarrhythmia
Treatment: Prednisolone or Vigabatrin
When do absence seizures occur in children, what do they show on EEG and what is the prognosis?
- Onset 4-8 yrs
- <30 secs with no warning, quick recovery and many per day
- EEG: 3Hz generalized, symmetrical
- 90-95% become seizure free in adolescence
What is Lennox-Gastaut syndrome?
- May be extension of infantile spasms
- Onset 1-5 yrs
- Atypical absences, falls, jerks
- 90% moderate-severe mental handicap
- EEG: slow spike
What are Rolandic seizures?
- Infrequent, brief partial fits with unilateral facial or oropharyngeal paralysis, speech arrest ± hypersalivation
- Common on waking
- Treatment is rarely needed
What investigations are done after a child has a seizure to diagnose or rule out epilepsy?
- If definitely febrile convulsion or vasovagal syncope then no Ix
- EEG: after second seizure
- Videos of seizures
- MRI brain: look for structural abnormalities in certain situations
- ECG to exclude problems in the heart.
- U+Es: including calcium and magnesium
- Blood glucose: hypoglycaemia and diabetes
- Blood/urine cultures,lumbar puncture if sepsis, encephalitis/meningitis suspected
What is the criteria for an MRI brain in children with seizures?
- The first seizure if child under 2 years
- Focal seizures
- No response to first line anti-epileptic medication
What advice do you need to give parents after a child has a seizure?
Recognising, managing and reporting further seizures
Safety Precautions
- Take showers rather than baths
- Be very cautious with swimming
- Be cautious with heights
- Be cautious with traffic
- Be cautious with any heavy, hot or electrical equipment
- Older teenagers with epilepsy will need to avoid driving
What safety advice should you give to parents on how to manage their child when they are having a seizure?
What are the side effects for sodium valproate and carbamazepine?
Sodium Valproate
- Teratogenic
- Liver damage and hepatitis
- Hair loss
- Tremor
Carbamazepine
- Agranulocytosis
- Aplastic anaemia
- Induces the P450 system so there are many drug interactions
What are the side effects for phenytoin, ethosuximide and lamotrigine?
What is a reflex anoxic seizure? (pallid breath holding spell)
Syncopal episode (or presyncope) due to temporary lack of blood flow to the brain, in response to pain or emotional stimuli
Transient asystole in children with very sensitive vagal cardiac reflexesIt
Young children aged 6 months to 3 years
How does a reflex anoxic seizure present?
- Child goes very pale
- Falls to floor
- Secondary anoxic seizures are common
- Rapid recovery and no post-ictal confusion
No specific treatment and prognosis is good. Often misdiagnosed as epilepsy
What are cyanotic breath holding spells?
Young children hold their breath during periods of crying to the point that they faint
The faint can even be accompanied by turning blue and jerking of the limbs
The child recovers quickly with no post-ictal confusion
How are breath holding spells treated?
- After excluding other pathology and making a diagnosis, educate and reassure parents
- Check for iron deficiency anaemia and treat