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paediatrics > 86. seizures in children: febrile fits and epileptic syndromes > Flashcards

86. seizures in children: febrile fits and epileptic syndromes Flashcards

1
Q

febrile seizures

A

seizures with fever exceeding 38°C in the absence of 1)CNS infection, 2)metabolic abnormalities,
3)history of afebrile seizures.

Peak incidence: 2nd year of life; most commonly occurs between 6 months and 5 years of age

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2
Q

RF

A

unknown PP

Genetic predisposition(fam history)

High fever (> 40°C )

Viral infection ( HHV-6, influenza)

Recent immunization (especially MMR)

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3
Q

clinical sx by International League Against Epilepsy (ILAE) classification of febrile seizures

A

simple (75%)

  • generalized
  • tonic clonic
  • symmetrical
  • no other neuro sx
  • over 15mins
  • 1 seizure/24hrs
  • 6mo-5yo
complex febrile (25%)
-one 1 feature needed to be considered complex
  • focal
  • one side of the body
  • transient speech impairment
  • longer than 15mins
  • more than 1/day
  • younger than 6mo older than 5
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4
Q

what is the post ictal phase

A

phase immediately after the end of a seizure. Notable for typical neurological findings such as confusion, drowsiness, headache, speech impairment, and weakness. Can last for minutes to hours.

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5
Q

post ictal phase in febrile seizures

A
  • quickly return to normal
  • short time of confusion and drowsiness
  • prolonged ictal sx siggests other condtion (meningitis/ status epilepticus)
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6
Q

dg of febrile seizures

A

determine cause

  • physexam
  • urine
  • cbc w/ CRP, gluc

LUMBAR PUNC(exclude meningitis/ herpetic encephalitis

EEG

CT/MRI

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7
Q

rx of febrile seizures

A

simple seizures under 5 mins resolve spontaneously

comples/over 5 mins
-ABORTIVE THERAPY
#IV lorazepam

-after seizure ends
antipyretic rx w/ NSAIDS

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8
Q

PROG of febrile seizures

A

30% risk of reccurent febrile seiizures

risk of epilepsy increases w/ complex febrile seizures

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9
Q

define seizure

A

irregular electrical activity in the brain caused by hyperexcitability of neurons, (especially in cortical areas.) resulting in transient behavioural and EEG changes

Hyperexcitability is the result of altered cellular electrochemical properties

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10
Q

define epilepsy

A

chronic neurologic disorder characterized by

1) One unprovoked seizure with an underlying predisposition to seizures
2) 2+unprovoked seizures separated by more than 24 hours

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11
Q

Define symptomatic epilepsy

A

pilepsy due to an identifiable condition (e.g., brain tumor, structural abnormalities of the brain) that causes an increased predisposition to seizures

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12
Q

define cyrptogenic epilepsy

A

epilepsy due to an unknown cause (genetic association suspected)

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13
Q

define Nonepileptic seizure

A

seizures that are provoked by acute conditions (e.g., intoxication, metabolic disturbances).

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14
Q

define Epilepsy syndromes:

A

epileptic disorders defined by a collection of characteristic clinical manifestations and other features (e.g., age of onset, brain lesions)

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15
Q

Etio classification of seizures

A

1.genetic
(no met/ structural cause)

  1. structural/metabolic
  2. unknown/cryptogenic
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16
Q

classification according to anatomical origin and clinical sx

A

w/ abnormal cognitive features (LOC)

FOCAL
-from neuronal networks confined to one cerebral hemisphere
-can spread to other hemishpere and become 2NDARY GENERALIZED
#w/o abnormal cognitive features( no LOC)

PRIMARY GENERAL
-from neural connections across both hemispheres

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17
Q

types of primary general seizures

A

1) GRAND MAL(clonic-tonic)
2) abscence
3) myoclonic
4) clonic
5) tonic
6) atonic

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18
Q

clinical prorgression of seizures

A

ICTAL PHASE
Sudden onset
-Rapid onset of symptoms
-lasts 1–3 minutes

POSTICTAL PHASE

  • confusion
  • drowsiness
  • todd’s paralysi
  • lasts upt to a few hours
  • -sx of cause(stroke. elec disturbance)
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19
Q

what is todd’s paralysis

A

Focal weakness (e.g., of extremity, speech, gaze) after a seizure,

resolves within 48 hours.
results from exhaustion of the primary motor cortex.

20
Q

sx of FOCAL seizure w/o LOC

SIMPLE PARTIAL SEIZURE

A

origin in one hemisphere

ICTAL PHASE
-prodrome sx (auras)
-conscioiusness preseved
-clonic movements (invol repetitive movment of CONTRALATERAL limbs/ facial muscle) 
-Jacksonian march
-sensory sx
#hallucinations
#parasthesia
#vertigo
#unusual smells
#unusual sounds

POST ICTAL PHASE

  • todd’s paralysis
  • residual neuro deficits
21
Q

what’s Jacksonian march

A

spreading of paresthesia or uncontrolled motor activity from one part of the body to adjacent areas, usually distally to proximally

22
Q

sx of focal seizure w/ LOC

COMPLEX PARTIAL SEIZURE

A

origin is temporal lobe in 70%

ICTAL PHASE

PRODROME: AURA

  • dejavu/ fear/ vertigo. sx hallucination
  • LOC
  • AUTOMATISMS(coorrdinated automatic movement (chewing, swalling, lip smacking)

POST ICTAL

  • confusion
  • anterograde amnesia
  • aphasia
  • muscle flaccidity
  • muscular pain
23
Q

sx of GRAND MAL/TONIC CLONIC

A

ICTAL
-prodromal sx HRS b4 onset
#imparied conc
#anxiety/irritability

  • LOC
  • MOTOR SX
    1) TONIC phase
-general muscl contrxn
#ICTAL CRY(contrxn of laryngeal muscles) 
#rolled eyes
-increased sympathetic tone
#dilated pupils
#tachycardia
#HTN

CLONIC PHASE

  • rythmic muscle twitches
  • bladder/bowel incontinence
  • tongue biting
POST ICTAL PHASE 
-unresponsive pt
-confusion
-amnesia
-hypersalivation 
muscle flaccidity and pain
24
Q

sx of clonic seizure

A

ICTAL

  • LOC
  • rythmic jerky movement

NO POST ICTAL

25
Q

sx of tonic seizure

A

-LOC usually when pt is already sleepy

-muscle contrxn
(flex/extension of head/ trunk)

NO POST ICTAL

26
Q

sx of myoclonic seizure

A

ICTAL

  • brief LOC
  • sudden jerrky movements

NO POST ICTAL

27
Q

atonic seizure sx

A

ICTAL

  • brief LOC
  • sudden loss of muscle tone (head drop/ collapsing)

NO POST ICTAL

28
Q

abscence seizure sx

A 
ICTAL
-breif LOC
-interupted activity(blank stare) 
-several x/day for 5-20 secs
-subtle automatisms that may go unnoticed 
(head nodding)

POST ICTAL

  • none
  • rapid return of consiousness
  • no residual neurp deficits
  • pt unaware
29
Q

dg of seizure

A

history of aura
witnesses

ictal EEG
-Epileptiform discharges (e.g., spikes, sharp waves)

exclude underlying conditn
-ECG: In every patient with loss of consciousness during an ictal event
#arrythmia

-CT: rule out structural lesions in 1st time seizures(e.g., brain tumors)

-LAB
#glucose
#electrolites
#liver & kidney func tests 
-Lumbar puncture
#rule out CNS   infec
30
Q

dx of seizure

A

psychological

  • pseudo seizure
  • panic attack

syncope
-Stokes-Adams attack (sudden loss of consciousness, for a few seconds, due to an abnormal heart rhythm)
-orthohypo
(lack of post ictal state)

stroke

migraine

Breath-holding spell
-kids up to 8y/o
-periods of prolonged expiratory apnea
Followed by loss of consciousness (syncope) dx by EEG

31
Q

rx of first seizures (epilepsy)

A

remove provoking factor

no longterm therapy req

32
Q

how are reccurent seizures rx

A

antiepileptic drugs raise the pathologically lowered threshold

indications
1)2seizures/6months unknown cause/ un rxable cause

2) if first seizure shows path EEG/ structural pathology

33
Q

rx if focal seizures

A

first line LAMOTRIGINE

children
PHENOBARBITOL

34
Q

rx of grand mal

A

lamotrigine

phenobarb for kids

35
Q

rx of abscence

A

ETHOSUXIMIDE first line

36
Q

rx of myoclonic

A

rist line VALPROATE/ TOPIRAMATE

37
Q

surgery for rx of epilepsy

A

only if medical rx fails

) resection of structural anaomalies

2) vagus nerve stim
3) deep brain stim (implantation of an electrode into the patient’s brain to deliver electrical stimuli.)

38
Q

complications

A

ACUTE
-status epilepticus

-excitatory toxicity

-physical trauma
#post dislocation of glenohumeral joint
#positional asphyxia

CHRONIC
-psychiatric disorders

39
Q

what is STATUS EPILEPTICUS

A

≥ 5 min of continuous seizures
OR
≥ 2 seizures with consciousness not being fully regained

caused by

  • w/drawal from antieptileptic med
  • drug toxicity
  • CNS infec

RX
-IV LORAZEPAM

40
Q

etiology of focal seizures in children

A

perinatal injury to the brain

teenagers: cerebral trauma/ encephalitis

other
-metabolic imbalance
-drugs
-sttructural anomalies( hippocampal sclerosis) 
-
41
Q

which focal seizure has a genetic cause

A

Benign epilepsy with centrotemporal spikes(benign rolandic epilepsy)

-most common GENETIC cause of paediatric epilepsy

clinical

  • occurs during sleep
  • facial twitching and aphasia
  • can become 2ndary generalized

EEG:
centrotemporal spikes
BILATERAL

spontaneously resolve by ppuberty

rx: VALPROATE in severe cases

42
Q

what is the rare form of inherited focal seizures

A

Benign childhood epilepsy with occipital spikes

early onset(before 10)

  • freq vomiting
  • night seizures for 5 mins

late onset (gastaut)

  • visial sx common
  • daytime seizure
  • less than 5 mins
43
Q

what is the most common form of focal epilepsy

A

Temporal lobe epilepsy

def: complex partial seizure originating in temporal lobe
d/2 Hippocampal sclerosis

sx
ICTAL
-aura
-motorsx
#lip smacking
-absent minded but no LOC
-autonomic sx
#mydriasis
#salivation
#sweating

POSTICTAL
-confusio & fatigue

dg: tempral lobe spikes on EEG

rx
lamotrigine

poor prog, 60% still have sx

44
Q

what is Frontal lobe epilepsy

A

Frontal lobe epilepsy is a simple partial seizure w/ motor sx

  • head directed to affected side
  • muscle tension
  • autonomic sx
  • JACKSONIAN MARCH
  • TODD’s paralysis

NO AURA
NO POST ICTAL SX

45
Q

what is parietal lobe epilepsy

A

parietal lobe epilepsy is a simplepartial seizure w/ SENSORY SX

  • paresthesia
  • pain
  • sensory aphasia

tends to transition into temporal or frontal lobe epilepsy

46
Q

what is occipital lobe epilepsy

A

occipital lobe epilepsy is a rare simple partial seizure w/ VISUAL HALLUCINATIONS

  • gazze deviation
  • cortical blindness

transition into temporal/ frontal lobe epilepsy

47
Q

what is Epilepsia partialis continua

A

epilepsia partialis continua is a rare unspecific damage to the cortex causing focal epilepsy

sx
-partial clonicity
(clinic contrxns in a part of the body e/g/ mouth/ finger) 
-sx are CONTINOUS for several days
-a focal type of status epilepticus

paediatrics (34 decks)

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